14 treated patients in nine hours and the same number on the phone.
It’s everyday for emergency doctor Stella Cizinsky at Örebro’s emergency department – a quiet day.
– The problem is not the patients, but that they are put in the way of the really sick.
It’s evening. An alarm goes off inside the emergency room at the University Hospital in Örebro (USÖ).
An ambulance comes in. Doctors on duty in green suits rush past.
With clean hands in the air, a doctor pushes open one of the doors with his hip into the emergency operating room.
The swing doors are left open for a few seconds.
Inside, you can see how doctors work feverishly to save the life of a man in his 30s.
At the same time as cardiopulmonary resuscitation takes place under focused gazes, paramedics roll an empty stretcher out of the room.
It is bloody and drops of blood can be seen on the hospital floor.
Works in teams
Nine hours earlier.
Stella Cizinsky prepares for a shift at the emergency department in Örebro. She is a senior physician in cardiology and director of operations at the heart and lung physiology clinic at the University Hospital in Örebro.
It is a weekday in the middle of summer, one of the periods that for healthcare is often described as the most challenging. Regular staff go on vacation, substitutes come in and waiting rooms fill up.
– Yesterday it was full of activity here, so far everything seems calm today so I thought I would start by showing around…, she says and is interrupted by the pager.
Immediately she is on her way to the first patient of the day. On the way there, she meets a colleague.
– You’ve had lunch today, haven’t you? She asks, pointing at him.
– Oh, I screwed up, couldn’t bring myself to go and buy. I took a banana, replies the colleague.
They continue together to a patient who has sought care after passing out repeatedly. The woman was referred to the emergency room by the health centre, which did not have a doctor available.
– If you take checks, I’ll start by talking to the patient a bit, says Stella to the colleague.
She has worked as a doctor for 38 years, the last 18 years here in Örebro.
Because USÖ is a university hospital, there are often many doctors and medical students in the emergency room, she explains. Stella often has one or even two doctors-in-training with her as she sees patients.
– There is never a shortage of doctors here, not with us.
Lack of experienced nurses
As recently as last November, the Inspectorate for Care and Care (IVO) inspected 27 emergency hospitals in all regions of the country. 17 of the hospitals then received criticism for a lack of nurses and few care places with corridor care and patients in the wrong departments as a result. USÖ was no exception.
– I think it looks like that everywhere right now. But is there a lack of nurses or is it because of how IVO believes we should work in healthcare? If all hospitals worked a little more organized nationally, we don’t know if we would experience such a big shortage, says Stella.
One hour into the shift, 25 patients are in the emergency room at the same time.
The phone rings and Stella leaves the room for another patient who stepped in a beehive, while the other doctors in the room continue with the first patient.
A third, fourth and fifth patient arrives, soon a sixth, seventh and eighth. Most are elderly anxious individuals with experienced chest pains or various ailments. During almost every patient visit, Stella’s phone rings and she leaves to advise other doctors on their patients.
Inside the staff room, nurse Karin Lundin sits drinking some water. She says that there is sometimes a lack of nurses in the emergency room, especially experienced ones. Several of those who work this summer jump into the emergency department temporarily from, for example, the ambulance, several summer jobs also due to study breaks.
– Today we have enough people inside, but only one nurse with long experience, i.e. three to four years, in addition to the head nurse. If two alarms come in at the same time today, it will be an immediate emergency and a shortage for us, she says.
Many patients in the wrong place
Stella says that many of the patients who come into the emergency room could actually receive treatment from the health centre.
– The problem is not the patients, they have not sorted themselves here. The problem is that the majority of those who come to the emergency room have been referred here by 1177, health centers or digital doctors for hire, explains Stella.
– This can create problems with long waiting times for those who are really sick. We simply find it difficult to prioritize completely correctly in all situations, she continues.
She believes that primary care has been fragmented and that there is a lack of continuity. That many of those who have come into the emergency room so far today could just as easily have received the same help from a health centre.
– But they have probably not had access to a competent doctor, who also knows them and their condition.
– Like 80 percent of the population has their own hairdresser, imagine if it were like that with doctors. Then you would have had a much greater opportunity for follow-up conversations with patients and had time to get to know them, their background and history.
The time has come to 17.00 and when Stella sits down for the first time during the work shift that has now been going on for four hours. 40 patients are now in the emergency room. She sits down to help a colleague read an X-ray. After less than a minute she is back on her feet.
How many patients can be in the emergency room at the same time, before it is classified as full?
– The emergency department has a kind of algorithm that calculates when there are a lot of patients and many in high triage (who need to be examined more urgently) or if you get an alarm and there are many patients who are not seen by doctors. But the fact that there are 40 patients in at the moment does not mean that it is full, our business is designed to cope with this, explains Stella.
Received care within 15 minutes
An ambulance comes in with an elderly man who has chest pains. The patient’s name is Olle and he says that he woke up lying on the floor at home.
– The ambulance came in 15 minutes. They took blood samples and drove right in. I think I lay here for ten minutes before a doctor came, says Olle.
He is fine under the circumstances, but says he is a little worried and shocked by the incident. Wonder if it was a heart attack.
– But everything in here has worked without friction, I have been well taken care of here. It feels safe, he says.
He remains in an open room without a door, waiting for more samples to be taken. One of the few patients today who is in the right place.
Another ambulance arrives with a patient who is also suspected of crime. The patient is placed in an open room next to Olle with police personnel outside. Another bed away lies an elderly patient sleeping. Screens divide between patients.
Patients eleven, 12, 13 and 14 come in and at 8 pm the number of patients is 38 in the emergency room.
There has been no talk of a dinner, but a toast can be made in the staff room if you feel like it, explains Stella.
– I rarely take a break, I might as well be useful when I’m here, she says.
“Problem with 1177”
Just before Stella’s shift ends, she takes a moment and sits down in the staff room with some colleagues. The problem with 1177 comes up again.
– Have you ever called 1177? They do everything to minimize risk. When you call there, questions are asked that could just as easily be asked by a robot. They follow a list, where the conclusion is basically that no one who is sick should be at home.
She believes that the personal contact between doctor and patient is disappearing.
– If you don’t know the patient, it can be difficult to tell whether it is an anxious or worried person or someone who is actually in need of urgent treatment. Things like this become calmer if you have a continuous doctor.
At the same time, an alarm goes off inside the emergency room.
– If more sick and healthy patients had their own doctor or a health center where they can feel that there is competence, then they would call there instead of 1177, which is completely independent and with the sole aim of minimizing risk.
The alarm continues to wail.
Outside the staff room in the corridor, the atmosphere immediately feels a little more stressed.
What is going on?
A nurse runs towards the emergency room’s ambulance intake.
At the same time, a push notification arrives on the mobile.
“JUST NOW: Shooting in Örebro – a person found shot at school”.
The man who was shot is wheeled into the emergency department’s operating room by paramedics.
The doctors are doing what they can for him in there.
But he dies from his injuries.
Inside the emergency department, the mood is agitated.
“We react to deadly violence of course”
Dealing with the consequences of the deadly violence that goes on outside the walls of the hospital is also part of the daily life of healthcare professionals, and generally more so now than ever before as fatal gun violence has reached extreme levels in the country in recent years.
– We react to deadly violence in the same way as to everything else of course, that is to say that we are affected by outrage and sadness. We cannot and should not react differently, then we have hardened ourselves against emotions and that is not good for us as people. Some events affect more than others, but it can also be serious illness, where we have not managed to save the sick person, says Stella.
In pressured situations, this also includes dealing with relatives and close friends who have received negative news.
– We always have the opportunity to offer those who have worked in stressful situations a moment to sit down and receive support from other colleagues. We call it peer support. We then call in colleagues who come in for this. It works very well.
According to Stella, it is rare that a person trained in healthcare is psychologically affected by what the staff sees during working hours in healthcare.
– We perceive our work as very meaningful, and it is known that it protects against negative feelings of the burn-out type, i.e. things that include alienation, bitterness and emotional coldness.
Some of the other patients still in the ER react to the changed mood, as well as the sight of heavily armed police in the corridor.
Stella decides to stay at the hospital, although she is actually quitting now.
– I am needed here so I will stay for a while, both to help and take care of the staff, she says, and disappears to her colleagues.