South medics make urgent recommendations for Health Sector

The time of mismanagement of patients is rapidly coming to an end and people cannot be kept in ignorance much longer, said the San Fernando Hospital Doctors’ Association (SHDA). While it is “en vogue” to talk about TT becoming a first world nation, the reality is this is a dream and more remote than before when the health sector is examined. Shortage of staff is a contributing factor to patients dying; wards are overcrowded; patients (including children) who require specialised care in designated areas are treated on general wards and this increases the chance of complications developing. The SHDA has looked at hospitals in TT with special reference to San Fernando General and  come up with a list of recommendations for the authorities which they would like to see implemented if the health system is to be improved. Among them, is keeping admissions to the number of patients the ward was designed to accommodate, and acceptable nurse ratios and patient to doctor ratios.

Referring to wards at San Fernando General Hosptial (SFGH), the doctors said they were designed in the 1950’s to accommodate 15 beds each, on two wings — one for male and the other for females. However, 50 patients are placed in each ward, a situation which the SHDA said cannot be allowed to continue. While admitting that the issue of staffing is complex, the doctors cited studies (LH Aiken et al “Hospital nurse staffing and patient mortality, nurse burnout and job satisfaction — JAMA 2002/ Audit Commission. Acute hospital portfolio: review of national finding: ward staffing. 2001) which showed the higher patient to nurse ratio the higher the patient deaths. Increasing the ratio of patient to nurse by one, increased patient mortality by an average of seven percent. Increasing it by 4:1 increased patient mortality by 14 per cent and 8:1 by 31 percent. In TT the patient nurse ratio is commonly 30:1. The SHDA said, “One can only image the inhumane way patients are dealt with and the stress our struggling nurses face.”

Higher patient to nurse ratios were also significantly associated with emotional exhaustion and greater job dissatisfaction. SHDA said the issue of unit time per patient has been ignored by administration and there appears to be no plan to deal with the increasing number of patients admitted to the wards since the San Fernando Hospital was opened. The doctors said all patients admitted on any given day are crowded into the admitting ward. “Extra beds are squeezed in on the medical unit until there is not even enough space to pass between beds, and patients with severe disease such as unstable angina are left sitting in the corridors.” During ward rounds the average time recommended for patients is 20 minutes. SHDA said this “implies” that no more than 20 patients should be seen on a ward by one team of doctors or else the medical management of the patient can be compromised and the doctors are at risk of litigation.

SHDA is recommending that admissions or patients in excess of 20 at the medical wards should be seen by another team of doctors. “It must be noted that each team of doctors is also responsible for doing large clinics, performing surgery and seeing emergency admissions.” SHDA is also advising the Regional Health Authorities to hire additional staff — physician assistants (PAs), phlebotomists, urology technicians and respiratory technicians. The doctors said a committee should be set up to look at recruiting additional staff because they can reduce waiting times and increase efficiency and response times. Citing the US, SHDA said in Emergency Rooms after triage, patients with minor problems (simple lacerations, abscesses, asthma) are fast tracked to physician assistants who are trained to deal with these problems. “The limits of their skills are well defined and they are supervised by medical staff. Doctors are freed to deal with real emergencies and waiting times can be reduced.”