Call of the emergency physicians in the face of the flu crisis that is collapsing hospitals and health centers and that has already mobilized several communities and to the Ministry of Health, which will propose that the use of masks be mandatory in centers. respiratory infections have caused a 35% increase in influx in the emergency room compared to the same time last year. A percentage that has not yet reached its peakalert the Spanish Society of Emergency Medicine (SEMES) this afternoon. Recommend to patients do not go to these services “unless absolutely necessary.” Their biggest problem, they say, is the drainage of sick people (pending admission to the hospital) that can turn the centers in “patient warehouses.”
SEMES cites the latest ‘Weekly Surveillance Report sentinel of IRAs and SARI: Flu, COVID-19 and other respiratory viruses’, published on January 4, with data from December 25 to 31which indicates that, during week 52, the flu hospitalization rate stands at 9.5 cases per 100,000 inhabitants (5.9 cases per 100,000 inhabitants in the previous week).
Regarding covid, in that week, The hospitalization rate stands at 3.5 cases per 100,000 inhabitants (2.4 cases per 100,000 inhabitants in the previous week). Likewise, adds the scientific society, “the flu circulates with greater intensity than the rest of the respiratory viruses and continues with a growing trend in the field of hospital emergency“.
Income at the limit
According to data from SEMESIn communities like La Rioja, attendance has increased by 30% and income by up to 50%. The same thing happens in Castilla y León, with a 25% increase, Murcia, which has reached 50% more attendances; just like Euskadi or Comunitat Valenciana or Asturiaswhich on these dates has reached historical records with a 20% increase compared to to November 2023 and December 2022.
In the Balearic Islands, patients waiting for a bed have increased by 60% and care times have increased by more than 4 hours.
On the other hand, in the Balearic Islands, There is “a great saturation” of the Emergency Services “due to lack of patient drainage”, -that is, pending incomewhich offers those images of patients in line collapsing the corridors of the Emergency Room – which is why they have been activated saturation contingency plans for several days. Likewise, patients waiting for beds have increased by 60% and care times have increased by more than 4 hours, reports SEMES.
One of the main problems that Emergency Departments (EDS) have now is that lack of drainage. On the other hand, they say from society, “they are necessary updated structured contingency plans, essential to confront these crises.” The EDs, their managers point out, “first serve those patients with the highest priority according to triage level. Therefore, lower triage levels will have time of delay”.
Admission pending
Dr. Tato Vázquezpresident of SEMES, explains that “the EDs function to meet demand, but they cannot guarantee this assistance.” if there is not enough drainage. That is, if the patients pending admission do not do so in a timely manner as established by all the quality indicators.”
The dignity and privacy of patients is not guaranteed, since an admission must be made in less than 4 hours from the moment this decision is made.
President of SEMES
Vázquez assures that, if it is not done this way, they become “patient warehouses”which makes it impossible to attend new entries, apart from statistically increasing mortality. Likewise, in this situation, “the dignity and privacy of patients is not guaranteed”, since an admission “must be made in less than 4 hours from the moment this decision is made.”
He adds that it is the managers’ job to “reschedule the daily activity to guarantee these income from the Emergency Department following quality standards and thus allow the rational functioning of these fundamental services”.
Primary Derivations
On the other hand, they warn that the first level of care is made up of Primary Care and “HES should be reserved for severe cases once a first evaluation has been carried out by this first level. In addition, emergency coordination centers can give telephone recommendations and correctly manage what to do and where to go.” However, they warn, 70% of emergencies are not referred, they come on their own initiative.
“Going directly to the ED means delaying care for the most serious patients. Healthcare is everyone’s right and taking care of it is everyone’s duty,” they report from society. They highlight that the referrals made from Primary Care to the ED will be “for the urgent care provided in these services, not for attend to other specialties/services“.
Levels in hospitals
Some of the recommendations from emergency physicians based on this are: at level 1with 5%/7% of global emergency admissions awaiting hospitalization: generate notice about the increase from management to all Hospital services or study the opportunity to reinforce home or short-stay hospitalization units.
If it is a level 2: (7%/12% of overall emergency admissions waiting to be admitted to the hospital), they recommend reinforcing the units and services considered, paying special attention to those that can expedite home discharges and admission to the ward; daily meetings with those responsible for the ED and those services with the greatest drainage problems to agree on measures such as staff reinforcementmanagement of hospital infrastructures, etc.;, adaptation of surgeries to healthcare needs or planning expansion areas for urgent care and hospitalization.
Already at level 3 (12% to 15% of global emergency department admissions awaiting hospitalization), emergency physicians suggest suspension of surgical activity except urgent interventions or priority 1; opening of expansion areas for urgent care and hospitalization and that all necessary hospital services be reinforced.
Besides, after three days with a 10% increase in demand for urgent care (respect to the average of the last 6 months) derived from a flu outbreak, the need to reinforce will be studied EDs according to a plan previously agreed upon between the center management and those responsible for these services.
recommendations
Among the recommendations from those responsible for hospital emergency departments to avoid the spread of the flu: wash your hands frequently: before eating, handling food, after leaving the bathroom and after blowing your nose or coughing; cover your mouth and nose when sneezing or coughing o avoid kissing and very close contact, as well as sharing glasses, cutlery, towels and other objects that may have come into contact with saliva or secretions.
The use of a mask is only recommended in the following cases: people who are sick or have started with symptoms compatible with flu when they are in the presence of other people, especially in poorly ventilated areas. Of course, as already stated by the Ministry of Health to the communitiesin healthcare centers its use is recommended in waiting rooms to avoid contagion to vulnerable people.
Responsibility of the population
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Flu complications are not common and they occur especially in elderly patients, or those with chronic diseases, doctors add. “To avoid saturation of health centers and hospitals, SEMES recommends that patients suffering from flu and covid not go to the emergency room unless absolutely necessary.” Those responsible for SEMES call to “the responsibility of the population” so that they come only when there is a series of certain circumstances.
They mean when you are a vulnerable population, such as babies, the elderly or people with special pathologies; if you have a feeling of lack of air, suffocation or difficulty breathing normally; if you have chest pain with a very intense cough, vomiting or diarrhea that does not stop; alterations of consciousness or high fever for 48 hours that do not subsides with usual medication. Also, if you belong to a sensitive group such as pregnant women, immunosuppressed people, people with heart disease, chronic diseases or diabetes.