Life-Saving Networks: Where Every Minute Counts
The Italian National Agency for Regional Healthcare Services (AGENAS) recently published results from the 4th National survey on the Implementation of Time-Dependent Care Networks. The report examines clinical-care networks responsible for conditions in which the time to treatment is a critical determinant of clinical outcomes, including myocardial infarction, stroke, major trauma, and emergency and urgent care.
Regulatory framework:
The regulatory foundation developed from Ministerial Decree No. 70 of 2 April 2015 mandates the establishment of pathology-specific networks within the national hospital framework to ensure integration between acute and post-acute hospital care and community-based services. This approach was further articulated in the State–Regions Agreement of 24 January 2018, which introduced the Guidelines for the Revision of Clinical Networks: Time-Dependent Networks (TDN).
Within this regulatory and organisational context, the multicentre MDR in AIS project—co-funded by the European Commission and the Tuscany Region—has been launched to engage stakeholder groups, integrate telemedicine and favour implementation of evidence based protocols across European stroke networks. The Stroke Network of AUSL South-East Tuscany and the Siena University Hospital Trust coordinate the initiative as project leads.
Main findings: advances and persistent heterogeneity
The report confirms that almost all Italian regions have formally established time-dependent networks, yet marked inter-regional disparities endure. Governance capacity—encompassing coordination mechanisms, strategic planning and resource allocation—varies appreciably across regions.
In the Emergency Cardiology Network, the proportion of patients with acute myocardial infarction receiving primary percutaneous coronary intervention (PCI) within 90 minutes remains a pivotal quality indicator. Performance in several inland areas continues to fall short of recommended thresholds. With respect to the Stroke Network, 30-day mortality rates for ischaemic stroke are broadly consistent with European benchmarks (<10%). However, utilisation rates of thrombolysis and thrombectomy remain suboptimal in several regions, and integration with post-acute neuro-rehabilitation services is uneven.
The Emergency–Urgency Network continues to encounter structural pressures, including emergency department overcrowding, extended waiting times and pronounced territorial inequities. The MDR in AIS project tackles this challenge by facilitating direct access to stroke treatment pathways, bypassing the traditional emergency department route. This approach has been shown to reduce both healthcare costs and in-hospital delays, while upholding or improving established safety standards.
Geographical trends: a structurally asymmetrical system
One of the report’s most salient findings is the persistence of structural asymmetries within the healthcare system. Northern and select central regions demonstrate higher levels of maturity, integration, and performance in their time-dependent care networks. The report emphasizes the need for sustained national initiatives to reduce this heterogeneity and promote equitable care provision throughout the country. Initial results from the retrospective arm of the MDRinAIS study confirm these discrepancies, revealing significant differences both within regional stroke networks and across European countries.
Strategic directions:
The document outlines several priority areas for future action:
- Strengthening continuity of care between community-based and hospital settings, with particular emphasis on post-acute management and rehabilitation pathways.
- Enhancing monitoring, accountability and transparency: a newly launched public platform now provides real-time information on TDN accessibility, including travel times and regional mapping.
- Promoting hub-and-spoke configurations, reinforced by multidisciplinary teams and broader implementation of digital health technologies.
- Advancing substantive equity, with the aim of reducing structural disparities between well-resourced and underserved areas and achieving consistent standards of care and timely intervention nationally.
Within this broader strategic framework, the MDR in AIS project is advancing both research and implementation activities. International collaboration has highlighted that territorial discrepancies in clinical outcomes and in-hospital process times reflect underlying variations in care pathways. Such disparities are evident not only within Italy but also—frequently more markedly—across European health systems. The project seeks to build on high-performing models, refine the elements most involved in high yield sustainable results and facilitate their transferability to other European stroke networks.
Conclusion:
The AGENAS report provides a cautiously positive assessment: time-dependent networks have strengthened, organisational structures have evolved and data accessibility has improved. Nevertheless, substantial challenges remain. In a domain in which the temporal dimension is intrinsically linked to clinical prognosis, the objective is unambiguous: to ensure that effective, coordinated and timely care is available throughout the national delays and guaranteeing that, from myocardial infarction to stroke and from trauma care to emergency and urgent services, responses are prompt, integrated and effective everywhere.
Author(s): Lorenzo De Stefano, The South East Tuscany Local Health Authority
References: AGENAS: Quarta Indagine Nazionale sullo stato di attuazione delle Reti tempo – dipendenti. 2025
Links: www.agenas.gov.it