Ricardo Makyn/Staff Photographer
The Accidents and Emergencies Unit at the KPH is abuzz with action as relatives of patients seek information from nurses and doctors at the department's front desk and security personnel look on.
Tyrone Reid, Staff Reporter
THE ACCIDENTS and Emergencies Unit at the Kingston Public Hospital (KPH) is facing an emergency of its own as it is severely under-staffed and under-equipped.
"A rough estimate for the equipment needed for the Unit is in excess of $20 million, and this does not include staffing,' said David Dobson, hospital administrator.
DIRE NEED
When The Sunday Gleaner visited the Unit on Friday, the team of doctors and nurses cited a dire need for several equipment. "There is a need for a lot of mainly diagnostic and other state-of-the art equipment that can assist in accuracy and timeliness of the services delivered," said Mr. Dobson. He said a Portable Ultrasound Machine alone costs about $10 million. There is also a need for new stretchers, one of which costs more than $100,000, to replace the five existing examining beds. There is also need to upgrade the current laboratory services.
While equipment is a major glitch in the smooth flow of the Unit's operations, the major problem is the inadequacy in the staff complement.
Current staff complement is 'way below' the requisite level. "In fact we have to employ sessional services to cover the shifts adequately, meaning overtime... the same doctors you have to ask to work additional hours but we have to really rely on sessions to cover the shift to provide that minimum standard," he said.
As it now stands, there are 21 doctors on the Unit's roster, 10 of whom are interns. Also, there are two Sisters, seven staff nurses and six enrolled assistant nurses. According to doctors and nurses on the ward who spoke with The Sunday Gleaner the ward needs more than 40 doctors and about 12 to 14 additional staff nurses to be operating at an acceptable standard.
Mr. Dobson explained that the growth in the population was not met by additions to the staff at the hospital, which is one of the major reasons why the doctor to patient ratio is out of sync.
"We have an established cadre of staff that we should have. But that established cadre has been (here) for a number of years and the population has outgrown that cadre from way back in the '60s or further than that."
THE LONG WAIT
He said the staff shortage contributes to the long wait patients sometimes have to endure.
"We do have a need and it is something we would like the public to understand because people believe yes it is there and it is open 24 hours but we operate by a system where we must first see those people who are critical," said Mr. Dobson.
He said the administrators had made a number of proposals to improve the cadre but with the advent of the freeze on employment (consequent to the signing of a Memorandum of Under-standing), it means that the situation is unlikely to change in the near future. "The MoU has put a hold on the creation of new posts but we do have a complete document that proposes the relevant improvement in staffing levels that we require," said Mr. Dobson.
"It is somewhat ironic however that despite the staff and equipment problems, the Accidents and Emergencies Unit is arguably the best on the island.
"We have set a high standard for ourselves and we want to maintain a standard that equates with any First World setting. We believe already that we are pretty much there and are pretty much comparable. But in terms of the state-of-the-art equipment all it means is that it requires more on the judgement of our clinicians. It can also create some delays," said Mr. Dobson.
"The level of staffing that the KPH A and E uses to accomplish the volume of work is far less than anywhere else. An audit was done about three years ago by the Ministry of Health and it pretty much revealed that even counterparts as close as the University Hospital and others overseas, when you look at the staff to patient ratio, the KPH A and E is way below. But when you look at the volume of work in terms of number of patients, we exceed them in some instances."
A&E wish list
Presented to The Sunday Gleaner by doctors and nurses
Defibrillators Pulse OxyneterElectrocardiogram Machine Portable Ultrasound Machine State of the art stretchers among others
...The real 'ER'
ALMOST 80 per cent of the patients who enter the Kingston Public Hospital are admitted through the Accidents and Emergencies Unit. As the name implies, the department is geared towards dealing with accidents and emergencies and not for treating minor illnesses.
No patient spends 24 hours on an A and E ward.
"A and E is just that initial intervention to save your life, stabilise you and move you on," says David Dobson, hospital administrator. "We either treat you and send you home or we refer you to an out-patient setting or maybe admit you to the hospital, which is an in-patient setting. Or you may die.
"Those are the different means of disposal when you come into A and E but you must come out, one way or the other. Any service that requires you stay more than a 24-hour period within A and E means you must be an in-patient, and once you are referred, a different team takes over your management."
Although the department is not into long-term treatment, some patients are sometimes granted a second opportunity to return to the ward for tests. Still, staying indefinitely is a no-no.
Many years ago, the A and E Unit was known as the Casualty Department. "It was changed from Casualty to A and E quite a number of years ago with the focus of dealing with real emergencies and not those minor things that people come for such as scratches and bruises and having this pain long ago," explained Mr. Dobson.
MINOR INJURIES
He encouraged persons with minor injuries to utilise their primary health care centres. He added that the A and E covers natural illnesses, all accidents, gunshot wounds, stab wounds and all trauma-type situations. The A and E Unit is one of the "main responses to any form of disaster happening in our country," and as such the hospital has a contingency plan in place that will kick in if the need arises.
Mr. Dobson says that over the years there has not been a lot of change with regards to infrastructure or services, as the building that now houses the Unit has been there since the 1980s. "The name is pretty much the main thing that was changed ... to reflect the nature of the type of services we wanted to offer."
However, he said that millions of dollars have been pumped into the purchasing of equipment plus there has also been configuration changes to ensure smooth flow in the department.
The performance of the A and E Unit is measured by outcomes, that is, the number of persons admitted to the ward versus the number who die, or any major disability caused that could have been remedied.
CASUALTIES AVERAGE
Data out of the hospital indicate that for the first quarter of 2003, an average of 4,904 persons where admitted to the A and E Unit with an average of eight casualties. For the corresponding period in 2004, an average of 4,538 persons where admitted to the ward with an average of 11 casualties.
Deaths are inevitable on the ward and as a result some counselling is made available to the staff.
But for an institution which sees more than 4,000 patients in A and E for the first three months of the year, when The Sunday Gleaner visited last week, only a few persons were seen there.
However, while walking towards the Unit, the team heard heart-rending wailing and high-pitched screams. Mr. Dobson quickly pointed out that such behaviour was commonplace on the A and E.
- Tyrone Reid
