A critical situation has arisen in Tallinn in recent months, with ambulances sometimes forced to wait for several hours outside hospitals in order to admit patients requiring emergency medical attention. On several occasions, patients have had to be taken 100 kilometers away to regional hospitals to receive treatment.
The Estonian Health Board (Terviseamet) is now launching an investigation into why some of the capital's hospitals are unable to fulfill their obligations.
On Tuesday evening, 13 ambulances were sat outside the emergency department (EMO) of the North Estonia Medical Center (PERH) in Tallinn, waiting to admit the patients they were transporting to the hospital. The situation was so critical, that two of the patients had to be sent to Järva County hospital in Paide in order to receive the required medical treatment.
Head of Järva County Hospital Külvar Mand was on duty on Tuesday, when one patient with lung and heart problems and another suffering from hip and back pain, who had been waiting outside the doors of the PERH, were transferred to Paide.
"This has become a trend since the period after midsummer. Here in Paide, it's already the fifth or sixth time [this has happened]," Mand said. Of the eight patients admitted to Järva County Hospital from Tallinn in the past six months, five required hospital treatment, two needed surgery, and three were discharged after undergoing tests.
"The patients (we had) in summer, who got casts put on because of fractures, either arranged their own transport or went back (to Tallinn) by taxi," said Mand.
Mand is concerned about how patients will be able to travel the 100 kilometers back home after receiving treatment in Paide, and has also approached the city of Tallinn regarding the issue.
Head of Tallinn Emergency Medical Service (Tallinna Kiirabi) Raul Adlas said, that each trip the capital's ambulances have to make to other counties makes the situation in Tallinn more difficult.
"First of all, the ambulance has been waiting for a couple of hours and then it goes off to Järva County for about three hours," explained Adlas. However, with new emergency calls being made in the Tallinn almost every five minutes, demand for ambulances in the capital is high.
"Any (ambulance) unit, which is out of service should be in Viimsi, Maardu or Lasnamäe, serving patients," Adlas said.
The Tallinna Kiirabi chief said, that the ambulance service is doing its best to alleviate the problem, though the underlying cause of the bottleneck is the hospital being unable to accept patients once they arrive.
"Maybe it's a bit alarming to say this, but in November we had a situation where 18 out of 22 of our ambulance teams were standing outside the (hospital) doors, so we couldn't actually go to some really, really serious calls," Adlas said.
The problem has been getting worse in recent months. According to Ragnar Vaiknemets, head of the Estonian Health Board's healthcare organization and resilience department, one of the root causes is a shortage of doctors in the emergency department (EMO).
"Reportedly, eight out of ten emergency medicine trainees change their specialty before completing their studies. If a trainee goes to an emergency department and sees that the workload there is so high, with no relief, then they have no interest in going (to work) there," Vaiknemets said.
According to Vaiknemets, the workload in has increased, both for emergency departments and the ambulance service, as more people turn to them for assistance with problems that should fall under the remit of a family doctor.
However, he also admits, that people may have no other choice than to turn to emergency medical centers, due to the difficulties in making timely appointments with a GP.
Health Board launches supervision procedure for hospitals
The Health Board has now decided to launch a supervisory investigation to find out why hospitals in Tallinn are unable fulfil their obligations as outlined by ministerial regulations.
According to Vaiknemets, one of the solutions being discussed involves changes to the current funding model. However, that will not happen this year.
It is not only in Tallinn, where hospitals are experiencing issues. On Tuesday evening, one patient reportedly had to wait for three and a half hours outside Rakvere Hospital before finally being able to speak to a doctor.
Vaiknemets said, that the situation was most critical on January 4, when an ambulance was forced to wait between four and five hours outside the hospital entrance.
Editor: Michael Cole