Post-Covid strategija ortopedske stroke

Sklepi sestanka Stalnega strokovnega sveta za ortopedijo – 4/1/2021

Sestanek izpeljan preko videokonferenčnega portala Webex, 4/1/2021 19-20h

Udeleženi člani SSOR: Prof. dr. Matej Drobnič, Prof. dr. Vane Antolič, Prof. dr. Samo K Fokter, Doc. dr. Riharba Trebše, Doc. dr. Simon Kovač

Vabljen Doc. dr. Gregor Rečnik, predsednik ZOS

Nesprejemljivo dolge čakalne dobe v ortopedski kirurgiji se zaradi staranja populacije zadnja leta kljub prizadevanjem različnih deležnikov ne skrajšujejo. Ukrepi za zajezitev in zdravljenje bolnikov Covid-19 pandemije so pomembno zaustavili delovanje dejavnosti ortopedske kirurgije v letu 2020.

V večini bolnišnic je bila ortopedska dejavnost v času zapore ob prvem in drugem valu reducirana zgolj na nujne posege, medtem ko je dejavnost med obema valoma epidemije bila povprečno zmanjšana na 70%. To je privedlo do izrazitega podaljšanja čakalnih dob, tako za redne kakor tudi za prednostne posege. Bolniki iz vzhodnega in osrednjega dela RS so se tako znašli v izrazito neenakopravnem položaju glede na bolnike iz zahodnega dela države, kjer je največji ortopedski bolnišnici uspelo ohraniti del dejavnosti, saj se v nasprotju s splošnimi bolnišnicami in obema kliničnima centroma ni spremenila v Covid-bolnišnico.

Čakalne dobe za ortopedske posege so se podaljšale med 70 do 100%, odvisno od geografske lokacije, stopnje nujnosti in operativne indikacije. Tudi v svetu so na globalni ravni še pred drugim valom pandemije ocenili, da bo obseg dela potrebno povečati vsaj za 20 %, da bi v enem letu čakalne dobe skrajšali na nivo ob koncu leta 2019.

V imenu SSOR predlagamo sledeče kratko- in srednje-ročne  ukrepe za sanacijo aktualnega stanja in preprečevanje nadaljnjega poslabšanja zdravstvenega stanja pri ortopedskih bolnikih:

  1. Kratkoročni ukrepi

1) Financiranje ortopedskih operacij s strani MZ in ZZZS naj bo odprto, brez omejitev. Vse ortopedske bolnišnice in oddelki opravijo polni operativni program v rednem delovnem času, kot največ zmorejo.

2) Poleg rednega programa se v obliki dodatnega financiranja omogoči izvedbo dodatnih (popoldanskih, sobotnih) programov v maksimalnih prostorskih in časovnih možnostih. Izbor dodatnih operativnih posegov določi vsaka bolnišnica oz. oddelek sama skladno s podatki čakalne vrste. Ocenjujemo, da lahko z obstoječimi kapacitetami v popoldanskem/sobotnem času izvedemo do 30 %  rednega programa.

3) Vodstva bolnišnic pozivamo, da čimprej sprostijo prostorske in človeške kapacitete, ki so bile namenjene ortopedski dejavnosti in so trenutno preusmerjeni v infektološko dejavnost.

  1. Srednjeročni ukrepi

4) Največji izziv, tudi že sicer in še dodatno ob zaostankih zaradi pandemije, predstavlja zdravljenje zapletov ter revizijski in kompleksni/multidisciplinarni operativni posegi. Zaradi neustreznega načina financiranja (plačevanje po pavšalu) ustanove niso zainteresirane za obravnavno tovrstnih bolnikov, ki pa zdravljenje nujno potrebujejo. ZZZS zato pozivamo, da čimprej revidira način financiranja, da bodo ortopedske ustanove za zdravljenje takšnih bolnikov ustrezno finančno pokrite.

5) Srednje-ročna vizija ortopedije v RS je tudi konsolidacija dejavnosti, saj razdrobljenost za majhne oddelke s posameznimi specialisti ortopedske kirurgije ni smotrna niti iz organizacijskega niti iz strokovnega vidika. Razdrobljena ortopedska dejavnost je tudi v stalni kompeticiji z drugimi »bolj nujnimi« kirurškimi dejavnostmi in je praviloma odrinjena vstran.

V vzhodnem delu Slovenije bi se tako dejavnost iz ortopedskih oddelkov 5 bolnišnic lahko združila v eni večji specialni ortopedski bolnišnici, ki bi jo zaradi dostopnosti zgradili po možnosti med celjsko in mariborsko bolnišnico v bližini avtoceste in tretje razvojne osi. Alternativno bi prišla v poštev (cenejša) izgradnja dodatnega namensko-ortopedskega objekta ob eni manjših obstoječih bolnišnic z obstoječo infrastrukturo (npr. SB Ptuj).6) Povečanje kapacitete je kritično tudi v osrednje-slovenski regiji, bodisi z novimi OP dvoranami Ortopedske klinike UKC ali širitev dejavnosti na drugo lokacijo.

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