NIK positively evaluates the service of rescue workers and doctors working at emergency medical units and in Hospital Emergency Departments (HEDs). According to auditors, this is one of the best functioning links of the health care system in Poland. More than 90 percent of ambulances reach the people in need within the statutorily defined time (15 minutes in the city and 20 minutes outside the city). The HEDs effectively ensure continuation of rescue actions, offer proper diagnostics, therefore making sure that the decision to continue treatment can be taken. Equipping the HEDs with 23 new helicopters resulted in improving the scope and capabilities of the Air Medical Emergency Services. That purchase allowed for night missions which could not be carried out on Mi-2 helicopters used to date. Currently, the major area of Poland is under the protection of the Air Medical Emergency Services. At the end of the year a decision should be taken on potential increase of the number of bases that would be ready to work at night (as for now only one of 17 bases - the one in Warsaw - is on 24-hour standby).
The tasks performed by the HEDs’ staff go beyond interventions in emergencies. The fear of refusing help to people who have difficulties getting through to a doctor makes HEDs admit all people reporting there. In this way they do the job of general practitioners, medical specialists and ambulatory care units. The audit findings revealed that in extreme cases even eight in ten patients of emergency departments were persons who should first seek help with the basic medical care, specialist outpatient clinic or night and holiday emergency help.
The need to care about patients who do not need it delays the work of HEDs and poses a threat to the people who really necessitate urgent help. For instance, in Bielański Hospital in Warsaw on average only 40 of 160 persons admitted on a single day required emergency treatment. It was similar in the Provincial Specialist Hospital in Olsztyn and the City Hospital in Poznań where every second and every third patient respectively did not require any emergency procedures. An extreme example is the HED of the Provincial Hospital in Zielona Góra where 80 percent of patients who were admitted and diagnosed, should not have come there at all.
In that way, the money from the HEDs’ pool, earmarked only for rescuing the health and life in emergencies, is used for the diagnosis and treatment of people who should seek advice of a general practitioner or a medical specialist in the normal course. For the HEDs it is a problem because the National Health Fund - although it includes all the admitted patients in lump-sum - pays only for emergency procedures. As a consequence, the HEDs’ deficits grow considerably and hospitals have to cover their losses from the profits of other departments.
The number of ambulance runs in the audited period was growing. However, a lot of them - in some cases even 30 percent - were not related to sudden threat to the health or life. The interventions concerned ordinary stomach aches or mild alcohol abuse. The emergency squads were also used to confirm somebody’s death or for inter-hospital transports.
Such a big number of unjustified calls is a consequence, like in case of the HEDs, of gaps in the basic medical care system: long queues in outpatient clinics and ineffective system of night and holiday help. Accounts of emergency medical units’ employees are alarming. They say that some people call for an ambulance and signal exaggerated or untrue symptoms. In doing so they follow the suggestions of the personnel of an outpatient clinic where they had no chance to get through to a doctor or have medical tests done in a short time. Of 1800 analysed ambulance runs from Meditrans Station in Warsaw as many as 19 percent were related to other than life-saving services. Of 207 audited calls in Opolskie Emergency Medical Centre, 39 evoked some doubts.
The headcount in emergency medical units not always corresponded with their real needs. There was a shortage of doctors, nurses, rescue workers and dispatchers. NIK points to a dangerous solution used in case of staff deficits: sending incomplete specialist rescue squads (e.g. without doctors), especially on holidays.
At the same time, directors of the audited emergency medical units, when pursuing to sign a contract with the National Health Fund, showed headcount guaranteeing full manning of teams. Otherwise, the Fund would not have concluded contracts with them. According to the directors’ explanations, subsequent staff changes had no impact on the rescue squads’ manning. In case of a doctor’s absence, his or her duties were taken over by another one, in line with the relevant provisions of the civil law contracts. NIK points out, though, that in that way some doctors worked even a few hundreds of hours a month. In an extreme case which occurred in Meditrans Station in Warsaw it was 662 working hours. It means that the doctor had about 2-3 hours left for rest per day. Similar procedures were used with rescue workers, drivers and dispatchers, uninterruptedly, even in 12 subsequent months. According to NIK, such a big number of working hours, even if it is the so-called standby in part, threatens the health and safety of the staff and may have a negative impact on the quality of services provided by them.
The network of Injury Centres was opened. It includes the departments handling the most difficult cases of multi-organ injuries. A part of them encounter the first problems. Against clear provisions, light injuries are nowadays also sent to the Centres, although should be cared for in other hospitals.
The emergency notification system does not function yet. The tasks of number 112 are performed by the Police and Fire Service. The following deadline for launching the system has been postponed until December 2013.
