Do you really need to be seen in the Emergency Room?

BY DR JACQUILINE BISASOR-MCKENZIE

Wednesday, March 16, 2011

EMERGENCY departments in public hospitals across the island are straining against large patient loads and inadequate staffing. Of the hundreds of patients seen daily, however, only a fraction of them really need to be seen in an emergency setting.

Many of these patients have illnesses that can be seen in primary care facilities. Nonetheless, the island’s primary care facilities are even more inundated by the large number of patients who flock to them each day. Inadequate space, inadequate staff of all categories, inadequate facilities such as a pharmacy, dressing rooms, treatment areas, etc, cause patients to spill over into the hospital emergency rooms. In addition, there is a seemingly lack of confidence in the health centres as patients believe they will receive better care in the emergency rooms.

Most of our working population adhere to an 8:00 am to 4:00 pm workday. The convenient time to visit the doctor is after work hours. Many general practices have extended opening hours to facilitate this. The public health centres, however, close at 4:00 pm. In order to complete their workload they must stop registering some time before this. Sometimes by noon, in some centres, patients have to be sent away as no one else can be registered for that day. These patients turn to the hospital which is open 24 hours.

As a result, a vast number of patients are registered in public hospitals daily. The triage or screening system used by the hospitals’ emergency room dictates the registration of three types of patients, those that are life threatening and must be seen right away (for example, a heart attack), those that are urgent with problems that have the potential to deteriorate (example appendicitis), and those that can wait but have definite problems that would need emergency room care (for example, a broken wrist or an infected diabetic ulcer).

Doctors, despite trying to adhere to these criteria, are forced because of a variety of reasons to register other patients who could be seen in the health centres (for example, those with colds and flus, chronic aches and pains, and skin rashes).

The reasons for registering include the health centre being full, the patient has been waiting for a long time and therefore should not be turned away, the health centre is closed, the patient is elderly or very young, the patient is behaving badly, and the fact that some persons believe that no one should be deferred to another facility. The huge number of patients requiring only primary care and who are being registered takes up a large amount of time. This leads to long waiting times, inadequate care and frustration among patients and staff.

The patient who needs to be seen in an emergency department of a hospital is a patient who requires more care. This patient is either more ill or requires treatment that cannot be obtained in a primary care facility. Some of them are referred from primary care or general practitioners for a next step in treatment. More time is spent in arriving at diagnoses, investigating, treating, reviewing and disposing of these patients. This allows for appropriate care and timely interventions that will result in good outcomes. It may sometimes require more than one doctor to resuscitate and stabilise such a patient (eg, severe trauma cases, diabetic emergencies, unresponsive patients).

Because of the volume registered, less time is spent with each patient. Hasty decisions may be made and inadequate investigations done because the doctor has to move on to the next patient quickly. The waiting times for patients who really need to be seen increases with increasing morbidity and dissatisfaction.

Doctors have to be taken from the emergency bay of the department to staff nonurgent areas of the department to facilitate these “nonemergency room” patients being seen. This results in inadequate staff to deal with true emergencies.

If this island is to improve its emergency care, the primary care facilities have to be strengthened with adequate space, adequate staff, adequate facilities and increased opening hours. Adequate supervision needs to be provided within these primary care centres by specialists to improve the standard of clinical care and to restore the confidence in these centres.

This will allow the emergency rooms to function as true emergency care units and improve waiting times, morbidity and mortality, and patient and staff satisfaction.

Dr Jacquiline Bisasor-McKenzie is a consultant emergency physician and President of the Jamaica Emergency Medicine Association (JEMA).

Do you feel buying into Facebook now is a good investment for the long-run?
	Yes
	No

View Results
Results published weekly in Sunday Finance

Username:
Password:

GCT to go down, white rum prices going up

Do you really need to be seen in the Emergency Room?