Hospital emergency rooms struggling to cope with numbers

More than 4.7 million patients are estimated to visit the emergency departments of Greece’s understaffed and cash-strapped public hospitals every year, with doctors arguing that 60 to 70 percent of that intake could be avoided if the primary healthcare sector were better organized.

The problem is especially acute in the Greek capital, where the biggest hospitals often receive more than 1,000 patients in a single 24-hour emergency shift.

Apart from putting an enormous strain on doctors and nurses struggling to cope with such volumes after a decade of staff cuts, overcongestion also means that patients may have to wait as long as eight hours to be examined.

“I have been on call for 30 years and I can tell you that every doctor is completely exhausted after six hours on emergency duty,” says Ilias Sioras, a cardiologist at the capital’s downtown Evangelismos Hospital and head of the union of that hospital’s workers.

Evangelismos receives between 1,000 and 1,800 patients in a single emergency shift, of whom 200-250 will need to be admitted. “It’s like we’re in a war,” Sioras says.

“We’re terrified when we get called down to the emergency room; it’s perturbing. On the one hand, there’s the stress from the speed with which we need to deal with every case and the aggression of the people who vent their frustration on anyone in a white coat. On the other, we need to be good-tempered and kind with our patients, and focused. The small number of staff, the crowds and the shortage of space create conditions in which any doctor can lose his or her concentration, cannot think and stay calm, which is exactly what is needed.”

The Attikon Hospital in Haidari, western Athens, handles similar volumes, according to the head of its workers’ union, Michalis Rizos, who adds that a shortage of beds means that, during the winter period especially, dozens of patients have to be treated on gurneys as the wards are full, while others can wait for up to six hours to even be seen by a doctor.

“The situation had eased in August, meaning that we had around 20 to 30 patients on gurneys during the emergency shift. Now we’re at around 70. There are all kinds of complications associated with treating someone on a gurney. For example, you can’t use a gurney from the surgical ward to accommodate a patient with an infection.”

Rizos says that the biggest problem at the Attikon is delays in seeing patients, and especially those who do not come to the hospital by ambulance and are thus given priority.

“The unacceptably large intake, which even the best of systems would have trouble handling, is the main reason for the delays. People have nowhere else to go because we don’t have an organized primary care structure that can deal with simple emergencies,” he adds.

“Almost 60-70 percent of the cases that come into the emergency department are cases for the primary healthcare sector,” says Sioras. “If these people had a 24-hour medical center that was well staffed and equipped with labs where they could do some basic blood and imaging tests nearby, it would relieve a great deal of pressure on hospitals. It is a solution that could be implemented in Attica and quite quickly.”

In the absence of such facilities, doctors are calling on the new government to bolster staff numbers with fresh hirings.

“Under the previous government 416 positions for emergency department doctors were announced, but only half of them have been filled,” says Matina Pagoni, president of the Union of Athens and Piraeus Hospital Doctors. “This is the only way to deal with the huge delays.”

Pagoni is a doctor at the Georgios Gennimatas Hospital in northern Athens, which sees an average of 1,200 patients during every emergency shift.

“We have about 50 to 60 admissions every shift to the pathology department alone and often have to accommodate people in other departments and clinics that have available beds. One pathology department with 25 beds may also have an additional 45 patients in other parts of the hospital. This is terrible for the doctors, who have to rush around the hospital to see their patients,” she says.

“The demand for more staff and a reorganization of the emergency departments dates back several years. Steps taken to this end in previous years have either been left unfinished or scrapped by conflicting decisions,” says Panos Papanikolaou, the secretary general of the Greek Federation of Hospital Doctors’ Unions and a neurosurgeon at the General Hospital of Nikaia, which saw 123,000 emergency patients in 2018.

“We are asking for the pending appointment of doctors to be completed under the last call for positions and for another 1,500 posts, at least, to be opened up for emergency doctors and paramedics, as well as more nurses,” he says.