Five health units dedicated to emergency care will start in February


The Government published today (30 January), in the Diário da República, the ordinance that establishes the new rules and incentives that will be attributed to responsibility centres integrated with teams dedicated to the emergency service (CRI-SU).

In the first phase, five pilot projects will advance in the Local Health Units (ULS) of Santa Maria, São José, in Lisbon, Coimbra, and São João and Santo António, in Porto, which are “five of the most differentiated emergencies” in the National Health Service (SNS), said the Secretary of State for Health.

“We have been working with these teams so that they are organized into integrated responsibility centres”, said Ricardo Mestre, adding that the ordinance, which comes into force on Wednesday, allows regulating the way in which performance is remunerated and how incentives are attributed to teams.

What is intended, according to the government official, is that these are projects with great local flexibility: “We want these five local health units to be able to adapt to their concrete reality and, from February onwards, they will have the opportunity to do, until the end of the year (when the pilot project ends)”.

For the governor, this is “a very important organisational innovation for the SNS emergency services”.

“We want these projects to bring stability to the operation of emergency services and also to improve the response conditions of these emergency services”, he argued.

To this end, a commission is created to permanently evaluate these pilot projects, which introduces any necessary regulatory technical adjustments, so that at the end of this process there are “integrated responsibility centre models that are robust, that have the greatest stability for teams, which promote teamwork, which value the definition of objectives, taking into account the local reality and the provision conditions of each location”, he stressed.

Projects must also value the work of these teams and strengthen the partnership relationship with primary health care, within the scope of local health units, to allow, “in a systemic and structural way, to guarantee a high-performance response from emergency services of the SNS”.

“This Commission has this technical mission and at the end of the pilot project it will allow us to have a model that can then be extended to other SNS hospitals because this is the response that we consider structural for emergency services and for the internal organization of our NHS hospitals to respond to emergencies”, he defended.

According to the ordinance, this new generation of integrated responsibility centres takes advantage of the experience gained with the more than 40 CRIs that already exist and renews the model, which will make it possible to enhance health gains and retain professionals in the public health service.

The CRI-SU will have doctors, nurses, technical assistants and auxiliary health technicians who work exclusively in the emergency service, but each institution may decide to include other professions, according to the needs identified at local level.

The matrix of indicators foreseen for the new CRI-SU encompasses dimensions of access, quality, efficiency and integration of care, such as the percentage of patients treated within the time provided for in screening until the first observation by the doctor, the rate of readmissions, resolution of the team, the ability to guide patients towards outpatient care, frequent users or avoidable hospitalisations.

Professionals can double their salary if they meet the objectives that allow them to receive the respective supplements and performance incentives.

“At the start of the projects, as there is not yet a history of recording and evaluating indicators, professionals will receive 75% of the maximum predicted value”, but if the evaluation turns out to be higher, a payment will be made with a retroactive value to the CRI start date.

The monitoring program is jointly ensured by each ULS and by the Executive Directorate of the SNS, the Central Administration of the Health System and the Shared Services of the Ministry of Health.