Closing emergency rooms and re-providing general emergency services

to reply. Our colleagues Ida Stuart-Beck and Erik Fachsen argue in Lakartedningen on 16 November against the Social Democrats’ proposal to close Narkaut in Hotorget [1]. We, who work as district doctors in Stockholm, believe that the people of Stockholm would receive better care without local hospitals – provided their resources are diverted to health centers and public emergency services are reintroduced.

The idea behind these close quarters was to provide emergency medical care to patients who did not need hospital resources. In almost all parts of the country, this care is carried out within primary care, but the Stockholm region has chosen to create an additional level for this particular care.

We think this is unfortunate for several reasons.

1. Emergency departments divide care. It is known that continuity of care is important for quality. This leads not only to lower costs, but also to lower health care consumption and even lower mortality [2]. Organizing care so that as much continuity as possible is achieved should be a top priority, not only in the individual care setting, but also when we organize care overall.

2. It will be more expensive with close sales. The book writes that a visit to the emergency room is cheaper than a visit to the emergency hospital. According to the aforementioned report, visiting the health center is cheaper [3]With this argument it is clear that this is where the money should be put. Additional costs are the result of duplication of work that often occurs when patients are first cared for in an outpatient clinic and then followed up with a visit to a health center. Stuart Beck and Faksen do not take this into account at all in their economic calculations. Patients who seek urgent care directly from their GP at the health center often need to follow up via a phone call rather than two visits, as the GP is already familiar with the condition.

3. There is a lack of clarity with too many levels of care. The Stockholm area has health centres, intensive care units, emergency departments and also the highly specialized emergency room at Karolinska University Hospital. The functions of a health center and a nursing home overlap to a very large extent, although there are also individual procedures that take place in a nursing home rather than in a health centre. For patients, it becomes unclear where to go, especially when nearby clinics are open at the same time as health centres. We believe it would have been better and clearer if the pre-existing public emergency rooms which were open from 5pm to 10pm on weekdays and 8am to 10pm on weekends had been retained as a complement to the health centres.

Although close-ups are comforting to us in primary care, we are willing to support the decision to close close-ups at Hötorget. We can even think that it is wise to close all nearby roads in the area. But the resources that are then freed up in the form of money and doctors have to be transferred to the health centres. As Stuart Beck and Faxen write, waiting times at a health center can sometimes be unreasonably long. There is no doubt that we prioritize difficult cases, such as suspected pyelonephritis or heart problems, but if everyone today seeking emergency care were referred to their health centres, it would mean that waiting times for patients with non-severe problems would increase even more if more Resources. It did not increase either. Therefore, we share our colleagues’ desire to analyze risks and impacts.

The disaster scenario is for the region to close Narkoten and replace it with “nothing.” We want the district to report where the money is going when this closure is made. For care to do its job, the majority of the money must go toward staffing in care centers. In addition, the region needs to develop a plan for how to reintroduce emergency rooms to general practitioners as a complement to health centres, rather than mid-level emergency rooms.

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Difficulty of access when S Närakut Hötorget is closed

Lakartidningen.se 2023-11-21