Kuressaare Hospital coronavirus audit fails, new clinical audit ordered

Kuressaare Hospital.
Kuressaare Hospital. Source: Margus Muld/ERR

The Health Insurance Fund (Haigekassa) began investigating the treatment of coronavirus patients at Kuressaare Hospital at the height of the emergency situation in April but the fund admits they did not receive a sufficient overview of treatment quality and a new clinical audit is in the works.

The director of Saaremaa's main hospital Dr. Edward Laane was notified of the Health Insurance Fund's investigation in the end of April. The goal of the audit was to assess the quality of treatment provided to patients in coronavirus wards and to compare the treatments to guidelines provided by the Health Board (Terviseamet), the hospital itself and the latest science articles.

Maivi Parv, board member of the Health Insurance Fund, told ETV's "Aktuaalne kaamera" on Wednesday: "We must admit we were not able to draw all conclusions. We have been able to map who the patients were, their profiles and what was done to them, but a treatment quality assessment - whether it was good or bad - can not be made with these methods."

To achieve an overview of the hospital's actions, doctors from the Health Insurance Fund investigated the hospital's actions during the emergency situation. The hired doctors, however, lacked the necessary competence to assess treatment quality, which has led to the fund deciding to order a new clinical audit from infectious disease specialists at the Estonian Doctors' Association will also investigate the treatment quality of other hospitals who provided treatments to patients with coronavirus.

According to the conducted audit, 62 percent of the patients in Kuressaare Hospital were given hydroxychloroquine, a medication used to prevent and treat malaria, sold under the name Plaquenil. In addition, every third patient treated for COVID-19 in the hospital was treated with vitamin C. These two treatments in particular raised questions about treatment in Saaremaa, also leading to a petition being created to remove Laane as the hospital's manager. The petition did not end up a fruitful one, as only 24 signatures were collected.

Laane commented: "The main difference was that our treatment guideline, as was in the article of a French scientist, saw Plaquenil being given for 10 days. When the Estonian guidelines came out in April, it was four to five days. We changed that right away, most patients got five days."

Chief of emergency medicine at the North Estonia Medical Center (PERH) Dr. Arkadi Popov said there is no scientific proof of the malaria medication working, as two studies claiming it useless were recalled. At the same time, a recent study conducted in Belgium showed that it could reduce mortality rates in certain dosages.

Popov, who is working with the Health Board as another wave of the virus is imminent, added that COVID-19 treatment guidelines will be updated soon. "There is no magic medication for it, unfortunately. There are two relatively certain medications that we use, one being remdesivir and the other being dexamethasone in small dosages. But these also have certain restrictions," Popov said.

The fund started its audit on the treatment of coronavirus patients at Kuressaare Hospital on April 20. The hospital was required to submit all medical records and medical records, which were compared by the fund with both the medical staff and the hospital's own treatment guidelines and the latest scientific articles on coronavirus treatment.

Initially, the fund's audit was due to be completed by the end of May. At the end of May, however, it became clear the doctors in the auditing workgroup evaluating the medical records, needed more time than anticipated because the work was carried out alongside other work. The deadline was then pushed back to before-Midsummer.

Kuressaare Hospital bore the brunt of coronavirus treatment in spring as the island of Saaremaa was the hardest hit region in Estonia during the peak of the COVID-19 pandemic in March and April, with travel between the island and mainland Estonia suspended in March.


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Editor: Kristjan Kallaste

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