New Response Team To Tackle Emergency Ward’s Issues

Emergency room

The Ministry of Health has founded a new response team for Emergency healthcare services on the advice of the Director of Health. The National Hospital’s Council of Specialists has issued a statement where they declared grave worries over staffing.

According to the Health Ministry’s notice, the Ministry, the Directorate of Health, Icelandic Health Insurance, the regional healthcare institutions, and the Capital Area’s Off-hour Medical Clinic have formed a response team on Emergency Healthcare services in Iceland.

The reason is the grave situation within the emergency services but the notice also states that the reasons for this situation is complicated, but dominating factors are lack of trained healthcare professionals and lack of resources for senior citizens, disabled people and other sensitive demographics.

Among the action plans are coordination of actions and tighter cooperation within healthcare institutions, increased support to at-home nursing in the capital area and increased services of the National Hospital’s emergency ward and larger facilities.

The response team also plans for the National Hospital to reinforce the operations of the Reykjanes peninsula, west Iceland, and South Iceland regional Healthcare institutions by assisting with test results. Processes within the National Hospital will be improved to shorten the time patients spend in the emergency ward and a part of that project is to review treatment procedures in senior care and increase other specialities’ services to patients in the emergency ward.

The notice was issued on the heels of the National Hospital’s Specialist Council expressing their grave worries over the hospital’s staffing issues. The council stated that almost all professions within the hospitals were understaffed and that had a negative impact on the hospital’s services and threatened patient and staff security. Authorities were challenged to support the National hospital to ensure better services.

The head of the National Hospital’s Emergency ward Már Kristjánsson welcomes the new response team and told Vísir that such extensive consultation between healthcare service providers is a novel approach. The situation at the Emergency ward remained serious, however, and the healthcare system as a whole needed extensive review before receiving increased funding.

According to Már, the root of the problem is a lack of planning. Too many people seek out the emergency ward for mild illnesses that can wait, while others are stuck in emergency wards and other wards who should be in rehabilitation or nursing homes. “The lack of organisation within the National hospital leads to people seeking service in the wrong part of the system and that we haven’t been able to get people to the right place,” Már told Vísir.

Improved organisation and management is one of the new response team’s main goals but increased funding for the hospital had also been discussed. Már states that improving the organisation is a priority. “I think we should maximise our output within the current system and then figure out what needs improving in regards to funding.”

Thirty Nurses Laid Off, 24-Hour Medical Consultation Hotline to be Handed Over to Receptionists

doctor nurse hospital health

All thirty nurses working for Læknavaktin were laid off at the end of May, RÚV reports. Læknavaktin has been responsible for not only providing after-hours medical care in the capital area, but its nurses also staff a free, 24-hour phone line for the whole country. Starting September 1, phone consultations will be handled by receptionists at Heilsugæslan health clinics in Reykjavík, a change that Elva Björk Ragnarsdóttir, director of nursing at Læknavaktin, believes will have an adverse effect on the services provided.

Nurses at Læknavaktin have been available 24-hours a day to patients all over the country via the 1770 phone line. Currently, anyone who calls this free number is able to speak to a Læknavaktin nurse who will help them assess the severity of their situation and offer advice on how to address the matter, be that to visit a local health care clinic during business hours, go directly to a hospital emergency room, or, in certain circumstances, receive a house call from a physician.

The decision to have receptionists at the capital’s health care clinics handling these phone consultations rather than trained healthcare professionals strikes Elva Björk as a misstep.

“I mean, around 80-90% of the calls we get here need an education in healthcare to address,” she said. “The [1770] phone number has become increasingly well-known—people know they can call here, which is a good thing in many ways, because often, we can prevent unnecessary visits to the ER and the children’s ER and to Læknavaktin here.”

See also: Four Nurses Resign from Emergency Ward

The change in service will ultimately have the greatest impact on people living outside of the capital area, where healthcare services are not generally available outside of business hours.

“In that the Heilsugæslan health care clinics do not appear to be fully staffed during daytime hours, it doesn’t make sense to me to be taking on a 24-hour service that in reality, you need nurses to oversee,” said Elva Björk.

Asked if she thought services to public would deteriorate as a result of these changes, Elva Björk didn’t hesitate: “Yes, I would say so, if it’s going to be set-up the way it’s been presented to me.”

Four Nurses Resign from Emergency Ward

Emergency room

Four nurses have resigned from their positions at the National Hospital’s Emergency Ward since yesterday, citing unacceptable working conditions and strain, RÚV reports. Ten other resignations took effect last March, and ER Department Head Helga Rósa Másdóttir says staffing shortages are already affecting the ward’s operations.

The emergency ward at Iceland’s National University Hospital has 30 beds. Nearly 100 patients were registered there yesterday, 33 of which should have been in other wards that could not admit them due to lack of space. Some patients waited over five hours for medical attention.

Such days have become the norm rather than the exception, according to Soffia Steingrímsdóttir, a nurse who resigned from the ER yesterday after seven years in the position. In a Facebook post, Soffia stated that she loves her job, but has given up hope that the situation at the ER will improve.

Cuts elsewhere impact emergency services

Helga Rósa told RÚV she is concerned it will be impossible to fully staff the ER this summer when many of its regular staff go on vacation. Staffing shortages are already affecting the department, which cannot utilise all of its space because it does not have enough staff to monitor the entire area. Helga says cuts elsewhere in the healthcare system come down on the ER, which ends up with patients on its hands that should be treated elsewhere but are turned away for lack of room.

Emergency ward staff have been vocal about the ward’s situation for years, stressing that staffing shortages and poor conditions put patients at risk. In 2019, a partial audit published by the Directorate of Health found neither lodging nor staffing conditions at the emergency ward fulfilled regulations and that the ward could not ensure patients’ rights regarding care. In the wake of the audit, the Director of Health recommended increasing staff at the ward, particularly nurses, as well as reviewing their wages and working conditions.

Activists Call for Clearer Regulations on Drugging and Sexual Assault

The emergency ward has handled 131 cases of sexual violence this year, already more than the 130 cases it handled in all of 2020. Nineteen people have gone to the emergency ward due to gang rape so far this year, a rise from 13 in 2020, Fréttablaðið reports. Activists are calling for clearer regulations in support of victims of drugging.

Drugging and sexual assault have been prominent in public discussion in recent days. The rate of gang rape (defined by having two or more perpetrators) has risen since last year, and Hrönn Stefánsdóttir, project manager for victims of sexual offences at the emergency ward, stated that this year has also seen more offences committed by a friend or acquaintance of the victim. Hrönn states that could be one reason for the low rate of police reports in such cases. Of the 130 cases the emergency ward dealt with last year, only 43 were reported to police.

“It can make it even more difficult for victims to report when it’s a friend or acquaintance, or even a family member,” she stated. “Society often asks why people don’t report or take the ‘proper route,’ it’s just not that easy. Even when people report, only 12-20% of cases are prosecuted, cases are dropped even though people have taken all the proper routes.” The emergency ward places emphasis on caring for the physical and mental injuries sustained by victims, collecting forensic samples, and photographs. Samples are only stored for one year.

Most victims who sought help in the emergency room last year were 18-25 years old (52 out of 130), while another 32 were between 26 and 35 years old. Nineteen victims were 16-17 years old while six victims were between 10 and 15 years of age.

Victims of drugging dismissed

Steinunn Gyðu- og Guðjónsdóttir is a spokeswoman for Stígamót, a centre for survivors of sexual violence. She told RÚV there have been cases where victims of drugging have not been provided with an ambulance when they have called for one. Stígamót also helps many victims of drugging who were not victims of a sexual offence afterwards.

“People come to us regularly that have been drugged without having experienced another violent offence afterwards, such as rape or some other crime. They often experience complete confusion and helplessness. Call an ambulance and don’t receive assistance or go to the hospital and don’t receive blood tests, because there was no other violence afterwards,” Steinunn explains.

Over 130 victims of drugging and sexual violence have been sharing their stories in a Twitter thread started last Sunday. Many state that authorities attributed their condition to their own consumption of alcohol and even refused requests for a blood test. Ninna Karla Katrínardóttir of activist group Öfgar says clearer regulations are needed within police, the healthcare system, and the emergency ward in dealing with such cases. Ninna says nightclubs can also clarify their procedures and train staff to recognise signs of drugging and react accordingly.

Justice Minister responds

In an interview published by Vísir, Minister of Justice Áslaug Arna Sigurbjörnsdóttir underlined the importance of the justice system taking drugging cases seriously and holding perpetrators responsible, but stated one of the main obstacles in such cases was obtaining evidence. Drugging is a crime according to Icelandic law and Áslaug does not believe that regulations necessarily need to be changed to address it differently. It could help, however, to review procedures in the healthcare system in such cases.

Emergency Ward Staff Shortage Puts Patients at Risk

emergency department hospital

Management at the National University Hospital of Iceland is working to address the doctor and nurse shortage at the hospital’s emergency ward, RÚV reports. This summer 500 shifts at the ward are expected to have a shortage of nurses and four doctors at the ward have resigned so far this year. While staff has been vocal about conditions at the ward for years, Director of the Emergency Doctors’ Association Bergur Stefánsson says staffing issues have never been worse.

Bergur says Iceland’s Director of Health has sent around five reports and memoranda to the Minister of Health since 2018 addressing the emergency department’s issues. Despite those communications, “The situation has definitely not improved.” He adds that staffing issues among physicians have never been worse and if conditions at the ward do not improve, it will be impossible to ensure patients’ safety. “And with that, we are putting them at risk.”

Partial Audit Gave Ward a Failing Grade

In 2019, a partial audit published by the Directorate of Health found neither lodging nor staffing conditions at the emergency ward fulfilled regulations and that the ward could not ensure patients’ rights regarding care. “Now it has come to pass that the problem is of such magnitude that we cannot let these conditions go on,” the audit stated. “It can create grounds for unexpected incidents and the risk of additional staff dropout.”

National Hospital representatives have stated they are working to address the expected summer staff shortage as quickly as possible. The 2019 audit however stated that fully addressing the ward’s issues would require broader support from authorities. Bergur says emergency doctors have requested a meeting with the Minister of Health and the Parliamentary Welfare Committee, but have been rejected. “We need real action to be taken, real improvements.”