Not all specialists nightwatching at major hospitals

Photo: Küllike Rooväli

At various major Estonian hospitals, all medical specialists are not on the spot for night watches, some of them «standby» in their homes. The hospitals assure there is no need for panic, as, in critical situations, emergency department doctors deal with patients till the specialists arrive.

«In daytime, the hospital has all its on-call doctors in the building. During the nights and weekends, some of these specialties are guaranteed by the so-called house watch – an on-call doctor being on the spot – and some by doctors on standby to be summoned [as needed],» explained the North-Estonian Regional Hospital (PERH) press secretary Inga Lill.

In PERH, a leading Estonian hospital by size, 27 doctors are on-call in the house, 17 specialists spending their night watches at home. In their homes, nurses and technicians for two surgery teams also stand by.

According to Ms Lill, an exception is made with ear, nose and throat doctors, who are on house watch from Monday to Thursday from 8am to 8 pm, also standby in their homes on those days. «From Friday to Monday morning, ear-nose-throat doctors are in the house both night and day,» she added.

According to Piret Valdek, Head of emergency medicine at East-Tallinn Central Hospital (ITK), home watches cover most of the specialties.

«At night, the hospital has the emergency medicine staff on spot, competent to deal with patients in all specialties needed, in essence,» she explained. Minimum 15 doctors spend their nights in the building, some 10 specialties backed up from homes.

The Pärnu Hospital head of treatments Veiko Vahula said that, as a central hospital, they are obligated to ensure readiness in such specialties as emergency medicine, surgery, internal diseases, delivery assistance and gynaecology, paediatrics, anaesthesiology/intensive care, traumatology-orthopaedics and psychiatry.

In these specialties, Health Insurance Fund finances the 24 hours readiness of hospitals. In addition, a surgeon, ear-nose-throat doctor, gynaecologist, anaesthetist, neurologist, radiologist, as well as endoscopy specialist and a blood specialist are standby in their homes.

Should emergency care be required in specialties not provided by Pärnu Hospital, the patients will be given initial treatment within the hospital’s competency and forwarded, as quickly as possible, to other medical institutions. Mainly, patients will be sent to PERH, ITK or Tartu University Hospital (TÜK).

Ida-Viru Central Hospital (IVKH) affirmed that night watches on location are filled in all specialties required by rules. These being: emergency care, anaesthesiologist, surgeon, orthopaedist, gynaecologist, paediatrician and internal diseases specialist.

In addition to that, the hospital also has a neurologist on the spot, starting this year. As the need arises, three specialists can be summoned from their homes.

TÜK has 28 doctors on location , in the night. According to press representative Kristi Tael, this covers all specialties. «In narrow specialties like hand surgery, organ transplant team etc, doctors may be summoned,» she explained.

Even though, depending on the hospital, doctors should be able to arrive within 15-40 minutes, all hospitals assure people need not panic by doctors having to come all the way from homes.

«We have so arranged the work, that, for patients in need of emergency care, help is guaranteed 24/7 in all specialties offered by our hospital,» stated the PERH press secretary, Ms Lill. According to her, it is being considered that people severely injured need immediate help.

«Should a neurosurgeon be needed, then, during the time he reaches the hospital, the patient is stabilised in emergency care department, all necessary tests are performed, an anaesthesiologist with the surgery team preparing the patient to be operated on,» Ms Lill said, bringing an example.

The ITK emergency head Ms Valdek also assured no one will be left without help, every patient treated according to his/her condition.

«However, people need to be more aware that in emergency department, only urgent problems are treated,» she stressed.

According to press secretaries, home standby option is used for years, already. «The system has been developed over the years and it is based on need, optimal administration and resources. Such systems are also used in other countries, Estonia not being an exception,» said the PERH spokesperson.

According to Ms Lill, it is impossible to say how often doctors are summoned from their homes – some specialties averaging two, others perhaps four calls a week. «In reality, there are the weeks with now calls at all. And then there are the weeks with calls in every night, in all specialities,» she added.

As revealed by the IVKH experience, an eye doctor and endoscopy specialist had to spend five per cent of standby time at work. Radiologists were in much greater demand – having to spend up to a third of home-watch-hours in the hospital.