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Emergency room
Photo: Golli. Staff in emergency attend to a patient.

State of Emergency in National Hospital

Neither the lodging conditions nor the staffing at the National University Hospital of Iceland’s emergency room meet regulations on minimum professional standards, according to an assessment carried out last month. RÚV reports that current conditions are such that the ER cannot ensure patients’ rights regarding care. The assessment, carried out by the Directorate of Health, says understaffing and lack of space are the main issues.

Ignored alarm bells

The report states that although staff and management have been attempting to raise the alarm on the situation their efforts have received insufficient attention. “Now it has come to pass that the problem is of such magnitude that we cannot let these conditions go on. It can create grounds for unexpected incidents and the risk of additional staff dropout.” The problem is now of such magnitude that it requires immediate action – and is beyond the power of the National University Hospital to solve on its own, the Directorate asserts.

Longer stays in ER

The assessment found that the ER handled patients with acute problems efficiently, who are usually released in 4 to 5 hours. This average has not increased despite an increase of cases in recent years. Such is not the case, however, for patients waiting to be admitted to other wards. Their average length of stay in the ER has increased to 23.3 hours this year, from 16.6 hours at the same time last year. The longest wait for admission when the assessment was carried out was 66 hours, but there have been cases of patients waiting more than 100 hours in ER after they have been admitted. Those who wait longest are usually elderly people, patients with multiple issues, and patients in isolation. Wait times could become even longer as flu season hits.

Lack of space has led to cases of patients being treated in hallways and patients with conditions requiring isolation to be housed with others. Patients are also often placed in wards which lack the specialists needed to address their health issues simply due to a lack of space. The pulmonary ward in particular houses many long-term patients that could be at home, if not for a shortage of specialised home-care services.

Stressed staff

The audit cites stress on staff as a particular concern, with a shortage of nurses said to increase the risk of errors. It is reported common among hospital staff to miss meals or even stay overtime as their departure is considered dangerous for patients in their care. Many staff report feeling guilty both toward their families and their workplace due to the pressure.

Suggestions for improvement

As a result of the assessment’s conclusions, the Director of Health has suggested to the Ministry of Health to increase staff, particularly nurses, in the short and long term. It is clear that the wages and working conditions of nurses need to be reconsidered.

A nursing home in Seltjarnarnes scheduled to open in February should also be opened sooner if possible, as well as a nursing hotel scheduled to open on April 1. The assessment report suggests considering whether to outsource the operation of temporary care facilities to competent bodies. Other suggestions include reinforcing home care and in-home healthcare services, as well as elderly care.

Patients’ safety threatened

The evaluation was carried out after a specialist in emergency treatment notified the Directorate of Health that conditions at the National University Hospital of Iceland’s ER were threatening patients’ safety. The hospital’s CEO and Chief Medical Officer seconded the specialist’s concerns. The evaluation was a partial audit, examining factors considered crucial, rather than a comprehensive assessment.

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