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Karolis Kilčauskas, resident physician in emergency medicine and chairman of the board of directors of the Young Doctors Association (JGA), has recently attracted a lot of attention due to a post on a social network, in which he described the difficult situation facing faces while working at the Kaunas Clinic.
It does not hide the fact that, as a result of the pandemic that is now taking a second breath, the confusion inevitably affects medical institutions as well.
“It just came to our knowledge then. The challenge is enormous and requires both extraordinary administrative skills and expert knowledge. But there are certain principles that can be overlooked: this is communication in the health sector between individual participants, between institutions, between departments, between clinics within an institution. If these problems existed before, they only got worse during the pandemic, “said the young doctor.
He described the situation in the hospital quite pessimistically: “the ship is sinking.” From what you are writing, do you have the impression that the control of the coronavirus in the country is spiraling out of control?
That situation is complicated. It is much more complex than it was in the spring. And these are not just some numbers in the statistical tables, but they are very much reflected in our daily practice. The emergency department has now become a buffer zone, as institutions are forced to continue scheduled outpatient services and at the same time have to deal with all the logistical challenges posed by the coronavirus, it is that is, how to separate patient flows. And in that way, that emergency department becomes a kind of fulcrum for the entire system.
You said that the wards are not always sufficient to accommodate urgent patients who are admitted and who have not been screened for Covid-19. The system appears to be overheating.
The main logistical challenge today is precisely the isolation rooms. It is probably necessary to imagine here such a compromise between what must be met for scheduled outpatient services and between emergency care that must be provided in the here and now.
If before, before the coronavirus, we could only have vacancies, pavilions in pavilions and put patients there, now everyone is traveling without taking a coronavirus test through an isolation pavilion. It’s like a “bottleneck” here. Sometimes those isolation pads get “stuck” and then patients have to go to the emergency department.
Another thing that may be specific in Kaunas, but in any case it is a sign that it may happen in other places later. When an entire city has more than one hospital, but certain specialized departments “go out” of normal operation due to an outbreak, they need to isolate the staff or those rooms are completely full, this occurs in a situation such as at night when that patient and remains in the emergency department.
And then, is there a delay in providing the patient with the necessary help?
The Kaunas clinics remain a group center, the highest level of help is provided, so it is not the case that the patient is not helped. Wherever the problem arises, it is an additional burden on the personnel working in the emergency department.
And those situations are different. Next time there are 8 empty rooms in the compartment, but all the isolation rooms are occupied. This patient is still in the emergency department.
It is not enough to get to the emergency department on normal roads. For example, it may be the case that sick people or people in very close contact end up with a serious multiple trauma. Then the “red” trauma teams are activated, many resources are discarded, which can sometimes disrupt the work of the department.
This had already happened in a similar way during one of the last shifts when the patient crashed into a car. As a result, the staff left, some have to change, it takes time, the patient needs to be cared for and return. When some employees leave, another takes on a heavier burden. These are the challenges that are very individual today. So far, we are dealing with it, but there are already situations where quick logistical decisions must be made to help the patient separate from the patient. clean areas.
And how many of those isolation rooms do the Kaunas clinics have at least?
Of them, the berods are more than 200 (as specified by the Kaunas Clinic – 272, – aut. past.), but this has yet to be clarified. The fact that we are losing them is not every hour, every day. We face it sometime in the day, sometime, it could be the weekend.
But every week we are faced with the fact that somewhere it is already a problem. There is a system as if there is no isolation room in one room, you can place the patient in another. If it is not there, it is transferred to the patient. But so far we are dealing with very individual cases where we need to discuss with colleagues, find out which manager’s order is valid, and the like. It’s just an unnecessary bureaucratic burden. We would like a clearer system and communication from the administration itself, so that we do not end up arguing about some bureaucratic command lines when it comes to treating patients.
Not long ago, some of the profile clinics of the Kaunas clinics had to temporarily suspend their work due to outbreaks. What is the situation now?
Fortunately, so far the emergency departments of the Kaunas Clinics have been quite successful in preventing outbreaks. They had already passed in the Surgery, Gastroenterology, Nephrology clinics. But again, there are some signs and symptoms that the situation is much more complicated.
Another thing is that new challenges are emerging that did not exist in the spring. For example, the increase in the number of positive COVID-19 patients in the so-called in a clean area. As patients are classified since the beginning of quarantine, their epidemiological history is collected: it is clarified if they have been in contact, if they have been absent or if they have a fever, and finally the temperature is measured.
If all these things are rejected, the patient falls into clean zone. Yes, there are also people with masks, personnel with respirators, shields, etc., but in autumn we already have a situation that is repeated often – and in that in a clean area Increasingly, positive responses are found for those who did not meet the above ranking criteria. As a result, there is an additional risk to both the staff and the surrounding patients.
More and more treatment facilities are becoming hotspots for coronavirus. In your opinion, why is this happening? Are the doctors not protected or the patients?
You can speculate on these things, I don’t know if there is an internal investigation, some kind of team investigating those things. But in general, what has to do with the health sector, that culture of safety, the analysis of some type of adverse event, is absolutely skeptical.
When I don’t say this to the doctors, to the participants of the internal system, people are very surprised. Yes, it is true that, in general, there is very little analysis of adverse events in medicine, that is why it is repeated.
All the more so since I don’t know if other institutions have taken action to find out why these outbreaks are occurring. At least we haven’t been able to do that so far, maybe Covid will push to make some decisions.
Resident physicians are on the brink of this pandemic; Are you not promised any additional payment for the surcharge?
I can only emphasize that the Emergency Department does not have these problems, it is being handled successfully. But the Young Doctors Association is getting such information that all the nuances are resurfacing in other clinics.
For example, there were outbreaks in the Kaunas clinics last week and many had to isolate themselves at the Surgery Clinic. This amounts to such information that it was not entirely clear whether residents who work on overloads would be compensated.
This is very concerning because that problem is not entirely new. Before I was in the Santara clinics, now it seems that the problem was fixed last year. But he remains in the Kaunas clinics.
The Young Doctors Association has always been active in raising issues relevant to them. What kind of dialogue do you expect from the new government, where we see the highest priorities?
Managing a pandemic will clearly be the highest expectation. Other important issues, the changing form of medical education that has finally moved, are the tiered competencies that will require finalization of the legislation.
Of course, the issue of mobility of the residents themselves is important and, of course, there will be no escape from pragmatism: we will have to sit down again on the issue of wages. Currently, the basic amount on which the salaries of resident doctors are calculated is € 2 next year. But this means that with inflation next year, the salaries of resident doctors will sadly even decline.
Thank you for the interview.
The Kaunas clinics also expressed their position
The portal tv3.lt recalls that in response to the information that appeared on the social network, the director of the Kaunas clinics for medicine and nursing and the head of the Emergency Medicine Clinic doc. Dr. Kęstutis Stašaitis also expressed his position.
“We encourage all of our employees to have their say on how health care services can best be organized and responsive. It is a pity that this doctor wrote his comments in exactly this way, “he said.
A representative from the clinics stressed that the information had been carefully analyzed, but clarified some of the facts presented and commented on the general situation at the hospital.
He observed that the doctor who described the events did not rely on his own personal experience but on the accounts of third parties, so that the specific situations described were not exactly as they were presented.
At the same time, K. Stašaitis emphasized that emergency medicine residents work in one position and have not worked overtime this month.
However, he noted that in other countries, the Covid-19 pandemic is forcing flexible solutions:
“Experience in other countries shows that young doctors are being mobilized to work in emergency departments and other wards because they are low-risk patients with severe Covid-19.”
The full comment can be viewed here:
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