“There is a huge growth in the number of patients with problems … – publico

                 

                         
                     

                 

 
                         

The hospital emergencies continues to be excessive in Portugal and chaos in the emergency room is a cyclical problem, not a Portuguese exclusive, but could be reduced with some measures, believes Luis Campos, president of the National Council for Quality in Health, vice president of the Portuguese Society of Internal Medicine and author of “Intervention Writing in Emergency Care and Emergency”, presented at the end of 2014, in connection with a review of the National Health Plan. “This is a complex problem and, as such, does not have a magic formula, “says.

                     

                          He was part of a committee that outlined the reform of emergency in 2008. It is assumed that your work aimed, among many objectives, the chaos of situations experienced cyclically in the emergency room were not so frequent nor so extreme. Why do you continue to repeat from year to year?
Emergencies are the confluence of health and social problems of people with all system dysfunctions health, but at the same time, respond effectively, resolving or referring people’s problems. The current situation is, above all, the drag of a problem that is cyclical, is complex and, as such, does not have a miracle solution around the corner, requiring a systemic response to its multiple causes. There are some simple measures that could alleviate.

But the situation is no worse than in the recent past?
The worsening of the health problems of the people, which necessarily occur in all people that deplete, and restrictions in the National Health Service (NHS) dictated by the economic crisis, which have hampered the responsiveness certainly be contributing this year to the worsening of this problem, but it seems unfair to say that all the blame is the state and is due to the collapse of the NHS crisis.

reform of emergency should not have prevented this type of situation? Is it because it has not been implemented?
Our reform was implemented almost entirely but could not prevent the current problem of emergency because it was essentially a structural reform. The objectives of the 2008 reform were the redefinition of the emergency network in order to improve access to such services, equity in access and quality of care, ensuring that hospitals or health centers had responsiveness to level of urgency in them was based. This reform was also defined who, in practice, the current network configuration of acute hospitals, leading to a concentration of these hospitals, which increased from 73 to the current 41. With the additional proposal of 45 emergency room Basic, the which are working 41, managed to get more than 90% of the population is less than half an hour from any point of urgency.

But then the current problem is excess demand emergency room or decreased responsiveness?
The number of emergency has not increased over the years, unlike what has happened in other European countries, while still excessive. Increased only in winter, but not more than the last winter. However, the severity of the patients has been increasing in recent years and the number of hospitalizations. This year there has been a lower response capacity, which is worrying because we are not yet even in peak flu.

Why do you say that is excessive the use of emergency and how do you explain this excess?
In fact, every 10 Portuguese will, on average, six times a year at a hospital emergency. In England, for example, will only three times. In addition, in Portugal, 40% of cases could be solved in primary care. To this contributes one million people without family doctor, more difficult access to medical health centers that were not covered by the hospital reform, the absence of other experts or access to complementary tests in health centers. But there is also a lack of alternatives in the hospitals which do not stipulate vacancies in consultations for patients not programmed or make a full use of day hospitals. Then the lack of a proactive integrated response to the chronically ill, particularly the most vulnerable, the elderly and many co-morbidities, which are major patrons of emergency and consume more than half of health resources. F inally, a small percentage of patients is directed to the emergency room only for reasons of proximity, or in the interests of time, they do not want and can not miss the job.

But he said there is a decreased responsiveness. For lack of doctors?
The limitations in hiring have affected many hospitals but also the decrease in payment of overtime has discouraged many professionals for the provision of emergency care, a highly demanding job physically and emotionally. Added to this is the use of internal, unskilled doctors or physicians contracted to companies that fall in banks “Parachute”, to which the fixed teams use and decreased the most experienced physicians in the front line. This reduces the decision-making capacity in the area of ​​highest risk in emergency and one in which the experience and competence of doctors can further accelerate the flow and decrease the error. But the accumulation of patients in emergency for lack of beds in the wards, mobilizing much of the team’s ability that is in urgent, is also one of the most important causes.