Simpler care settings would improve the situation in the emergency room

Summer in the country’s emergency departments was the most stressful of all, Michael von Schekfuss said recently in an interview with Läkartidningen. As president of the Swedish Society for Emergency Medicine (SWESEM), over the summer he heard “poetry-speaking stories about looking for a place, staying in the emergency room and potentially unsafe trips home” from different parts of the country.

This image was shared by Daniel Wilhelms, Lecturer in Emergency Medicine and Scientific Secretary of SWESEM.

– Sure, I hear the same things in my network. There is clearly increasing pressure at the same time as there are fewer care places than ever before.

Among other things, Daniel Wilhelms researches how the quality of care is affected by a large workload and divides his time between Linköping University and the city’s emergency department.

Linköping takes advantage of the fact that it is not a summer town, many people travel from here during holidays instead. It was our salvation this summer. But although we are quieter than some of the others, we still have several days where patients have had to stay all night, and it often happens that we are completely lacking in the places of care available.

According to Daniel Wilhelms, there is a significant contradiction between the research community’s view of the lack of places of care and the discussion in the community.

There is usually a lot of focus on waiting times. It’s a convenient scale for time-critical patients or the oldest and most fragile, but I miss the nuances of the debate, he says.

Before condemning an extended stay in the emergency room, it is important to ask what is actually happening while the patient is there.

– If during the stay you underwent a fracture scan, x-rays, plaster cast and also received a planned follow-up, this is a valuable time. If good things happen in the emergency department, it doesn’t matter that sometimes the length of stay is longer.

It is quite a different matter if the patient is lying on a hard couch while waiting for the place of care without the possibility of any other interventions.

Then waiting is, of course, a sign of poor quality care, says Daniel Wilhelms.

He himself suggests a simple and cheap measure to improve flows in emergency departments. It all boils down to simpler care settings, where you can do fairly basic efforts, such as administering medications, providing quality care, and organizing care planning.

The type of care settings that hospitals actually have are often highly specialized. When the internal medicine or geriatric wards are full, we have to put patients with minor illnesses in highly specialized care settings, which means these beds are not available for those who really need them.

Daniel Wilhelms says creating more care places is “financially painful” in the short term, but it doesn’t have to be too costly in the long run.

Checking out this care site also costs us money, because patients end up just about anywhere and not receiving optimal care.

Despite the fact that “all emergency medicine in Sweden” agrees that more care places are needed, it is difficult to reach politicians, says Daniel Wilhelms.

I think that from a political point of view, you avoid initiating changes that extend beyond your tenure. But few of the most effective solutions to health care problems are quick.

Daniel Wilhelms is increasingly frustrated with how care has changed since he began working as a physician.

Many things that were easy seven or eight years ago are now very challenging. An elderly patient with urolithiasis is easy in theory, but now we may have to spend four hours finding a place to care. It is sad that the quality is declining, compared to what we were able to offer previously.

He believes that more air in the healthcare system is the way forward for better-performing care – and happier staff.

I think there is a widespread sense of desperation in emergency departments. That feeling would be reduced if we had better conditions to provide quality care, says Daniel Wilhelms.

Read also: SWESEM: A very difficult summer in the emergency room

Lakartidningen.se 2022-08-08