BASSETERRE, St. Kitts – FREQUENT grumbles about the waiting period at the Joseph N. France Hospital’s Emergency Room (ER) would be resolved if the public was more aware of what injuries/illnesses constitute emergencies.
It has long been a complaint that persons who visit the ER are forced to wait hours for treatment, even while in obvious pain. This has led to some leaving, before they could have been examined, to seek relief elsewhere.
ER patients are initially inspected by a nurse who will inquire about their illness. They must then wait for the resident doctor to finish other emergency cases before they are formally treated.
According to JNF Medical Chief-of-Staff Dr. Cameron Wilkinson, the ER is run on a triage system which allows for the most seriously ill patients to be seen first.
JNF’s ER uses three categories to determine the order in which persons are examined.
Those suffering from severe burns, seizures, head injuries, haemorrhage, chest pain, multiple trauma, severe asthma and cardiac arrest are classified as Emergent, and will always jump to the top of the line regardless of the number of others waiting.
Fevers, abdominal pains, severe headaches, child dehydration, drug overdoses, fractures and mild asthma fall under the Urgent category, so afflicted persons will be seen when the Emergent cases have been dealt with.
The lowest in the priority line is the Non-urgent category, which consists of abrasions, animal bites, strains, sprains, coughs and colds, and minor cuts and lacerations. Persons with these conditions will be treated last, even if they were present before persons who fall under the other two categories.
Another exception is made for patients travelling to the hospital via ambulances and assisted by emergency medical technicians (EMTs). These patients, who are usually in critical conditions, are admitted through the ER’s back entrance and examined immediately.
“The determination of who goes first is made by the triage nurse. Persons with life-threatening conditions will always be examined first,” said Wilkinson. “They’re not necessarily seen in the order they come in. That might be why someone with a cold could end up waiting for a while if there are persons with more serious afflictions. That’s always how the ER has been run.”
The doctor explained that the ER’s policy was to see all emergency cases, highlighting that no patient who came to the hospital with what he/she perceived as a real emergency would be turned away. The room is staffed by several nurses, EMTs, a clerk and a doctor who is on call every day of the week.
However, when asked to address concerns about the extended waiting time, Wilkinson said that the patients themselves were the cause of their own frustration.
“There are no barriers to anyone coming in. Whatever the complaint is, we see them. But a lot of the cases are deemed Non-urgent after assessment. If we keep spending so much time looking after these cases, which really can be treated outside the ER, then it takes away from our ability to see patients in a speedy manner.
“You have people coming with headaches or toothaches, or things of a similar nature. All these illnesses can be treated by a trip to their local health centre or to a private physician. They don’t necessarily have to visit the ER.”
While Wilkinson noted the hospital did its best with the resources available, he stressed the need for more public awareness about the functions of the ER and what constitutes actual emergencies.
“We will continue to educate about the differences among the Emergency Room, health centres, and private doctors. We are constantly trying to upgrade and improve our services in the provision of speedy, quality healthcare,” he insisted.
SKNVibes paid a visit to the ER in March to monitor the flow of traffic and observed that no one patient was made to wait for more than 90 minutes before being examined.
However, none of the cases appeared to be in the Emergent or even Urgent categories, and there was an instance where a senior citizen, having waited for an hour before seeing the triage nurse, was told she had come to the wrong place because she thought she could have used the ER to fill her medical prescription.
Local medical practitioner Dr. Garfield Alexander agreed with Wilkinson’s view, stating that “80 percent” of local ER cases were not actually emergencies as many of the illnesses could be privately treated.
Alexander suggested that some persons were taking advantage of the ER’s free treatment and medicine to avoid paying costly medical bills.
“The doctor’s examination is free, and any drugs they give you up there are free as well. That could be another reason why people use the ER instead of private physicians...to save money.
“I don’t think we’d ever be able to bar ER use only to persons suffering from life-threatening afflictions. Everything here is so politicised, and it may not be in some people’s best interests to do that. That’s why things won’t work here.”
Alexander said the way forward was to increase public education and to train nurses in being more assertive with patients.
“If you want change, it’s all about education. People have to first understand what the ER is really there for, and that will immediately cut down on the number of patients and therefore the wait that people have to go through.
“But a lot can also be done in terms of the role played by nurses. Triage nurses should be able to stand up to persons and let them know when they are unnecessarily holding up the system by coming to the ER with a non-emergency.”
