Tallinn Children's Hospital hires additional ER doctor to cut waiting time

Tallinn is aiming to shorten the waiting times at the emergency department (ER) of the Children's Hospital by hiring an additional doctor. On one hand, children will indeed be able to see a doctor more quickly. On the other, doctors see a potential risk that this could encourage more people to visit the ER for minor health concerns.
Starting this week, the Children's Hospital emergency department (ER) in Tallinn has an additional doctor on duty during evenings and weekends to reduce waiting times for children. The city is covering the cost of the doctor's salary for this initiative.
The additional shifts are being handled by the hospital's own pediatricians or residents. In just the first three days, 40 children with minor health issues were seen more quickly, two of whom were found to have conditions serious enough to require hospitalization.
"One pediatrician in the ER can realistically examine no more than four children per hour. Normally, one doctor handles all children classified under the green triage category. If between 4 p.m. and 10 p.m., 30 children with green triage cases arrive, ideally, that doctor should see all of them. Now, life is a bit easier because there's another doctor in the adjacent room doing the same job, which means children can see a doctor faster," explained Liis Tõnisberg, head of the pediatric clinic at Tallinn Children's Hospital.
Green triage refers to the least urgent cases in the ER. According to Tõnisberg, these cases at the Children's Hospital typically involve viral illnesses such as colds, coughs, ear infections or stomach bugs.
"From a parent's perspective, every visit to the ER is justified. But from the on-duty doctor's perspective, clinically or medically, not all of these visits may be appropriate for this time or place. I believe that most of these cases should actually fall under the family doctor's scope," said Tõnisberg.
While Tõnisberg is pleased that the workload for on-call doctors is easing, she also expressed some concerns.
"Our staff's big fear is that people might misunderstand this project and start coming to the ER even more readily for minor issues. We already feel that many visits are unnecessary and if this initiative leads to even more cases, we could overwhelm ourselves with patient volumes we can't handle," Tõnisberg noted.
Previously, the Children's Hospital ER was busiest during the winter viral season, but now doctors find themselves just as busy during the summer months.
Family doctor Diana Ingerainen is highly critical of Tallinn's initiative.
"This is really about patient safety. If we have top specialists dealing with issues that could often be handled by a family nurse, and those specialists are then unavailable for more complex cases – that's a problem. When an actual critical situation arises, the specialist could be tied up with less urgent tasks and overwhelmed by other duties," Ingerainen said.
Ingerainen also questioned what problem the city is trying to solve by funding additional shifts. She noted that ER doctors are already exhausted from handling minor cases but must continue to do so.
"The question is why hospitals have to process so many patients and why it's not possible for them to operate sustainably with a normal patient flow," she added.
Deputy Mayor Karl Sander Kase (Isamaa) pointed to inconsistencies in the quality of family doctor services as one of the reasons for ER overcrowding.
"Currently, the law does not prevent family doctors from being open in the evenings, but for some reason, everyone knows that it's impossible to see a family doctor after 4 p.m. That's a choice family doctors make," said Kase.
While Kase agreed that not every health issue requires a trip to the ER, he emphasized that raising public awareness and improving access to family doctor services will take time. Meanwhile, the issue of long ER waiting times must be addressed immediately.
One solution, Kase suggested, could be to deter people from going to the ER by increasing the patient visit fee. Another option is to guide people to alternative services through nudging and creating more accessible choices.
"I believe that nudging and creating softer alternatives to shorten queues is the better approach, rather than forcing people out of the ER. For instance, the ER is not the right place to go for a cold. But if a child has a cold on a Friday evening, cannot see a family doctor over the weekend and their fever is rising, a solution must be found for the worried parent. The balance lies in ensuring the child doesn't have to wait five or six hours in the ER, but only two or three. I think that's the balance we're aiming for," Kase explained.
For four years, Tallinn tried to reduce ER and ambulance workloads by funding home visits by pediatricians on weekends. On average, five children received home visits each weekend. However, both the city and the Children's Hospital now admit that the project was not an efficient use of doctors' time or city funds.
The fate of the newly launched additional doctor project, which began on Monday, will be determined by the end of the year. The trial is expected to cost Tallinn €200,000.
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Editor: Marko Tooming, Marcus Turovski