Amid the outcry over “unacceptable” waiting times in the Queen Elizabeth Hospital’s emergency room, the Barbados Association of Medical Practitioners (BAMP) on Tuesday set out recommendations for boosting patient care in the nation’s lone general hospital.
Public Relations Officer Dr Kenneth Connell said QEH management must improve as he also expressed concerns about the psychological impact on doctors and other healthcare providers who become targets of the anger and frustration of individuals waiting for extended periods in the Accident and Emergency Department daily.
“Let me start by saying that delays in the emergency room, although they are expected, they are also unacceptable, and extended delays are especially unacceptable…because you go to a hospital when you are at your most vulnerable,” Dr Connell, a consultant physician at the QEH, told Barbados TODAY. “People don’t usually go there just to hang out. They are sick, and should be seen within a reasonable time.”
His primary recommendation for alleviating patient frustration during long waits is better communication with patients.
“I am not talking about a PSA [public service announcement] or a news item. Someone needs to be there to update patients in the waiting area, in the cubicles as to what’s happening with their case…and I know there are patient advocates there…. Doctors, nurses, we all also have to do a better job in keeping patients abreast,” Dr Connell said.
“The man sitting there in the corridor does not know we are still waiting on the chemistry results because there is a backup in the lab, or the lady that’s sitting there waiting to be admitted, may not necessarily know that she actually is admitted. Care has started and she is under the medicine team, and there is no bed on the ward, so for (her) and her relatives, she is just waiting there and nothing is being done.”
Dr Connell, who also serves as the Consultant-in-Charge of the hospital’s Resistant Hypertension Clinic, said the QEH must also improve communication with staff, sharing information about the measures or solutions that have been implemented, rather than relying on them to hear about such developments through the media.
The BAMP spokesman further recommended discontinuing the presence of a large number of student doctors in the ER.
“There is a flood of medical students in the ER at any one point in time. Sometimes we may have as many as eight students just there,” he said, pointing out that members of the public may not be aware that these individuals are students who cannot make medical decisions that affect patients.
“The emergency room is not the best place for students to be standing around because if an emergency happens, they can get in the way. But the compromise for that, you certainly would not want a junior doctor to be first exposed to the emergency room on day one of being a doctor; that also is problematic.”
While he could not specify the ideal number of doctors required in the A&E at any given time, Dr Connell said a three or four-person shift was certainly insufficient.
“Now that being said, I know that delays are multifactorial in the hospital because I have worked in other hospitals. Some of the things that bring about delays are staff shortages including doctors, procurement issues in terms of equipment, there are also administrative issues…and all these things are going to affect workflow,” he said.
While the BAMP spokesperson was adamant that doctors will maintain their professionalism in a challenging environment with frustrated patients, he is concerned about the psychological toll it takes on them and their families.
“I don’t think that any doctor when they are working in A&E or you are working outside of A&E could be happy with patient delay in care because you want to provide the very best and safest care to patients, especially those coming to the emergency room. So it must have a psychological impact on doctors,” argued Dr Connell, who is also Deputy Dean of Recruitment and Outreach and lecturer in Clinical Pharmacology at the University of the West Indies (UWI).
“The fact that we are seen as part of the problem is also challenging, I know…because the public doesn’t see it as a shortage of doctors. They just see it as doctors in the emergency room may not be working hard enough, not recognising that they are working extended shifts, extended hours under circumstances where patients may not be as friendly to them because they have been waiting around for so long.
“I put myself in the situation of a patient all the time. I have been to other emergency rooms and I too get frustrated at waiting there and want to know why I am waiting,” he noted.
Dr Connell recommended that the QEH bosses should engage in conversations with frontline workers, especially those in the A&E, to understand how they are coping with the added burden and stress of their environment.
“I think there is a need, perhaps, for the hospital to engage in a dialogue with frontline workers to assess how they are managing the additional burden and stress of working in the ER. Sometimes there may be issues that management is not even aware of,” asserted the BAMP spokesman.
“BAMP remains committed to certainly discussing with the QEH some of these solutions. Some of our members are QEH employees, and must be concerned about their own health and wellness and safety.”
Dr Connell emphasised that the association is even more concerned about the health and safety of the Barbadian public.
emmanueljoseph@barbadostoday.bb
