Emergency medicine may be empowered to send patients back

Photo: Sander Ilvest / Postimees

Until now, emergency medicine departments have helped all who show up, even if they have to wait for hours. Now, ideas are being pondered about how to scare some off right from the door. 

North Estonia Regional Hospital chief emergency doctor Kristiina Põld says nobody is held waiting out of spite – they go by categories and severest cases get in front of the line.

Valdo Toome of said hospital added that according to studies it is the 20 to 40 olds who tend to jam the system in working hours while they could easily go see family doctor.

Convenient

«Emergency medicine has turned into a convenience service where one basically can come as they get the idea to have their health checked, as here one is always received,» he observed.

Increasingly, PERH is having to deal with people working abroad without Estonian health insurance and thus without granted access to family doctor.  

As lion’s share of those having recourse to emergency medicine could actually be helped elsewhere, Tallinn is pondering how to thin the waiting lines.

Ms Põld said there is no regulation currently how emergency units could refuse to receive a patient.

«Ideally, we would only see people showing up during work hours as sent by family doctor and fresh trauma, or as brought by ambulance with severe complaints,» she said, adding that in places like Finland it would be out of the question for people with back pain to head straight to Meilahti Hospital emergency department, in Helsinki.

«We have masses of patients complaining of back ache who come to emergency hoping to be sent speedily to neurosurgeon for consultation,» she said.

Just in case

Till today, there is this understanding prevalent in Estonia that once one shows up at emergency medicine unit, he is granted access to see a neurologist, cardiologist or some other medical specialist.

While both doctors think it would ease the emergency units if in Tallinn family doctors would see patients 12 hours a day.

Meanwhile, they see no easement in lifting visit fee at emergency from €5 to €10.

«That’s small money nowadays. Besides, perhaps someone will not be able to come though in real need.»

Some doctors say Estonians are practicing a so-called defensive medicine i.e. having as many medical inspections as possible just in case.

A strong decision is needed to send some patients back once emergency is found to be missing. If they could cut the load by third, things would be a lot better.

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When to go

Turn to emergency unit with:

• Fresh trauma (within 48 hours);
• Wounds needing a stitch;
• Sudden severe headache;
• Sudden severe pain in chest;
• Out of breath;
• Sudden severe stomach pain;
• Rhythmic heart trouble;
• Convulsions, lack or loss of consciousness;
• Sudden paralysis of a side of body;
• Haemorrhage;
• Over three days of high fever accompanied by general organism functionality failures.

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Mandatory procedures

Once at emergency unit, they always measure your blood pressure, heart rate, frequency of breathing, body temperature, blood oxygen level, and assess pain on scale of 10.

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International triage categories

Red tags - (immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival.

Yellow tags - (observation) for those who require observation (and possible later re-triage). Their condition is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital care and would be treated immediately under normal circumstances.

Green tags - (wait) are reserved for the «walking wounded» who will need medical care at some point, after more critical injuries have been treated.

White tags - (dismiss) are given to those with minor injuries for whom a doctor's care is not required.

Black tags - (expectant) are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.

Source: hospitals