Possible Tallinn emergency room expansion likely to become clearer in 2024

A Tallinn ambulance.
A Tallinn ambulance. Source: Jenny Va / ERR

According to both the Estonian Health Insurance Fund (Tervisekassa) and the Estonian Health Board (Terviseamet), the root cause of long ambulance waiting times outside Tallinn's emergency rooms is staff shortages. The Health Board is already of the opinion that emergency departments should be expanded. However, the Health Insurance Fund is still assessing whether this would be the best solution.

The Estonian Health Board (Terviseamet) is set to launch an investigation to establish solve the issue of long ambulance waiting times outside some emergency rooms at Tallinn hospitals. "The procedure has not been launched yet, but we have decided to approach it from the hospitals' perspective (to establish) to why the lines are so long," Ragnar Vaiknemets, head of the Estonian Health Board's healthcare organization and resilience department, told Vikerraadio.

According to Vaiknemets, the issue is not a new one. "This problem came up in 2022, but it has also been a concern in previous years too. Usually, the problem arises on Mondays, when patients have not been able to go to their family doctors over the weekend. If their health problems worsen, they go to the emergency room on a Monday morning or even call an ambulance," Vaiknemets said.

The decision to launch the investigative procedure into the issue was prompted by the failure to so far find a suitable way to resolve it.

"We have called the ambulance, the Health Insurance Fund and the Ministry of Social Affairs to the table four times over the last year. Unfortunately, we have not been able to find quick solutions and the waiting times for ambulances are still between three and a half to four and a half hours, which is unacceptable. The aim of the investigative procedure is to find out what the real concerns are, what the hospital can do and also what the state can do," Vaiknemets said.

According to Vaiknemets, one solution would be for hospitals to temporarily increase their capacity by transferring health workers from other departments to the emergency room. A second option could involve moving patients to beds in other departments, where they could remain under observation after receiving primary treatment in the emergency room.

"They have (already) recruited more triage nurses, but there is definitely still room for improvement," said Vaiknemets, adding that referring patients to hospitals for tests ought to be a last resort.

However, ultimately the root cause is a shortage of health workers. "This is particularly evident in the case of emergency room doctors. The reason for this, is that the workload is very high and a third of patients (there) should not be in an emergency room," he said.

"Our hospitals are not designed to cope with (the demands of) an ever-increasing population, which is already close to 600,000 in the Tallinn region. Along with the experts, we think that the capacity of emergency rooms should be higher," Vaiknemets said.

Health Insurance Fund still examining whether it is worth expanding emergency rooms

Marko Tähnas, head of the Estonian Health Insurance Fund's (Tervisekassa) partner relations department, said that the capacity of emergency rooms should only be increased, depending on continuous and actual needs, rather than solely based on the number of people waiting at the door at any given time. In Tähnas' view, the potential expansion of emergency rooms is also closely linked to the availability of necessary medical resources.

"According to the study conducted by the National Audit Office (Riigikontroll), around half of the patients do not actually need to go to an emergency room. This is the first thing that needs to be pointed out, so that people think carefully about whether or not they actually need to go to an emergency room," Tähnas said.

The second part of the problem, according to Tähnas, is how best to help those people who are already in the emergency room. He explained, that such patients either need to receive treatment on the spot, provided with medical advice in order to treat themselves at home, or be taken to hospital.

Tähnas added, that increasing the number of nurses on duty at emergency rooms would naturally mean higher numbers of patients could be assisted and more quickly.

According to Tähnas, the Health Insurance Fund is now reviewing the funding model for hospital emergency rooms, a process which is expected to be completed by 2024.

"The challenge, of course, is, that even if there is more money for staff, will there actually be the staff available to take on? The Health Board has already given an overview, that suggests, perhaps there is not an unlimited number of staff, who can be recruited," Tähnas said.

"We have seen an increase in funding (available) for emergency rooms, but a comprehensive review is (also) currently) underway and will be implemented in 2024," said Tähnas.

"At the moment, we are talking about fundamental changes, which depend not only on how many patients there are in the emergency room, but also on the kinds of (medical) concerns they are there for," he added

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Editor: Michael Cole

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