One of Luleå Hospital’s three surgical wards, Cava (Ward 53), has been closed since the beginning of September. The reason, Lakartedningen previously said, is the shortage of nurses. The department has become completely dependent on temporary employees.
– The department’s closure was another blow and a bigger step than before, after a long period of cuts in care places, says Matthias Bergmann, one of twelve doctors specializing in surgery in Norrbotten.
Was closing the department a mistake?
– It’s not really possible to answer. No other decision can be made. It wasn’t even almost a decision, it was more like, ‘There’s no one working in the department, so there’s no department.’
What are the consequences of this on your work environment?
– Of course it gets worse. If you’re on the emergency team, you have patients in many different places. It gets messier. There are not more patients overall, but it becomes more difficult for each patient, says Matthias Bergmann.
Due to the scarcity of surgical care, surgical patients remain in the emergency room and are cared for in short-term temporary settings connected to the emergency room or another department. This makes it difficult for doctors because they do not have the same support from nurses who specialize in the patient group, according to Matthias Bergmann.
Mistakes happen all the time, of course, and we doctors have to be more vigilant.
In the emergency department, there is no formal round like in a hospice, but doctors go down to the emergency department and review the samples, medications given, vital signs, and the patient’s condition and talk to the charge nurse. Matthias Bergmann points out that this leads to a much greater risk of doctors and nurses missing something than on a care ward.
– Emergency nurses are not equipped, either in terms of competence or in terms of work methods, to be a care department. There are problems with things like administering medications, taking samples, and checking vital signs. Every patient who stays in the emergency department makes it more difficult for doctors, nurses, and ancillary nurses to care for the new patients who come in.
How does it affect patient safety?
– He is placed out of work. There are no normal security checks, says Matthias Bergmann, citing two examples from the past few days. A patient with pancreatitis who was in the emergency room did not urinate because she was not receiving fluids. For another postoperative patient, routine tests were missed, extending the hospital stay by half a day.
– In the surgical suite, nurses do things automatically, such as taking certain samples. For satellite patients, doctors have to prescribe specific things, otherwise they won’t get done, he explains.
In order to reduce the burden of the emergency department and provide space for surgical patients, seven temporary places were created, where patients can stay for a maximum of 72 hours. The places are staffed with rented staff and will remain until October, when the Norrbotten region expects the situation with regard to inpatient care places to improve. There are also short-term placements, where patients must stay a maximum of 24 hours. Matthias Bergmann describes it as a “band-aid on the wound” and an emergency solution to avoid a complete disaster in the emergency department. According to him, the atmosphere in the medical group is collegial and helpful. At the same time, there is a growing sense of resignation.
– It is not always safe for patients. We doctors can’t do a good job. Some people feel bad before their work shifts. We want to be surgeons and take good care of patients but we find it difficult to do so now.
Do you think that the closed surgery department will be able to reopen by the end of the year?
– I hope so. If this problem has to be solved, something has to change for the employees. You can’t expect to continue in the same way and just recruit new people. They will not stay unless there is a clear change. Regional management must change conditions and working methods so that employees want to work.
Matthias Bergmann feels that line managers are working hard for change, but he believes that solutions and proposals at higher levels in the hospital and regional management are also needed to achieve lasting improvement.
Do you see any danger of doctors resigning?
– I haven’t heard anyone talking about that, but there is clearly a risk. It’s mentally difficult. There’s a difference between being nervous because I have a bad patient. I can do something about it. But if there are patients in the emergency room that I know are receiving poor care, I can’t do anything about it.
How is your ST education affected?
– It is difficult to find time to work directly with the patient and have time to see fewer emergency patients because too much time is spent doing too many other things.
Before the lockdown, Mats Lundin, director of the health care department of District 2 within the Norrbottens district, told Norrbottens-Kuriren that this would be a challenge. He pointed out that the closure was not done to save money, but rather because it is not sustainable to have a department run entirely by certain employees.
-I completely understand how the emergency room staff feels, but we truly believe this will be good for both patients and staff in the long run. We always have to solve the problem of emergency care and we do that every day,” he said It is also to the newspaper.
The plan is still to reopen Cava at the beginning of the year with permanent staff, according to Mats Lundin. “It is too early to answer today whether it will go well,” he wrote in an email response to Läkartidningen. » Work to open more care places in the surgery department is underway, and the results of that work will determine the date of closing the seven additional care places. “The goal remains to close these care settings in October.”
Mats Lundin describes the concern for patient safety among surgeons as relevant and believes it should be taken seriously.
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