GT hospital’s A&E is not for primary care

| 29/04/2015 | 11 Comments

featured comment 200In reading the response from the HSA and the post from Mr Miller, I am glad he brings the issues to the table. However, There is a much larger issue and it is the public at large and the HSA that needs to take some responsibility for our current system and how it functions. An emergency room is just that. It should be utilized for acute injury or illness that requires immediate attention that cannot wait.

Unfortunately, the GT hospital emergency room is used as that as well as a primary care clinic. Individuals are seeking care in the A&E for what should be primary care visits. This creates a bottleneck within the system, creates longer wait times and is costly to both the HSA and the consumer. In some cases, individuals who are chronic abusers of the system know if they come in with a complaint of a serious nature or call 911 they will get seen quicker. This behavior takes up critical bed space and ancillary resources (lab, radiology, ems, etc.). This is a common occurrence in any A&E, adding insult to injury on an already overloaded system.

One must also consider the serious and potentially fatal health risk for individuals who use the A&E as a source for primary care. The key to remaining healthy is to “manage your health”. This cannot be done in an A&E. Individuals presume if they see an A&E doctor that they are looking at their overall health. That is NOT their role in the healthcare pyramid. It is in fact to treat the acute illness or injury then pass it to either the patient’s primary care physician for follow-up or to a specialist for more critical specialized care, and once stable on to the primary care provider for long term management.

The HSA needs to create a campaign that promotes the use of the General Practice Clinics, possibly expanding the hours to accommodate working individuals. They need to educate on the benefits of seeking a primary care physician as well as the serious risk of not having one. It is nice that they have the acute clinic at the GT A&E, however the uneducated consumer may not understand the difference. In their mind they are sick and they came to the emergency room to get better.

The government should invest in a “minute clinic” centrally located in a 24-hour pharmacy and educate the consumer that this is where you go for minor illnesses or injury after hours or if you cannot be accommodated by the primary care physician during working hours. It further needs to educate the consumer of why it is important to use the system properly to avoid overcrowding in the A&E. The HSA can utilize their website/social media to provide the average wait time in the A&E for non critical patients and at the same time promote what other clinics can be utilized for a quicker response.

The consumer must own their part on our over-burdened system. In a country with high numbers of individuals with obesity, diabetes, heart disease, cancers, stroke, renal impairment and mental health issues, we cannot afford to be passive in regards to how we manage our health. We as consumers should demand education on when and why to seek the emergency room, when to call 911, when it is appropriate to go to a clinic for a minor illness, what defines the differences between the need for A&E or a clinic and that seeing a primary care physician regularly may not only save you money in the long run, it may save your life.

Our issues of healthcare cannot be cured overnight. Ongoing education must reach every consumer at every access point of our healthcare system. In every system there are critical education access points. We do not utilize this process in our system. The process is not a costly one, however it is labor intensive and time consuming to implement, but once in place becomes practice. It starts with standardized procedures, access identification points, individual & family education and promotes continued follow up. It places ownership of health onto the patient and caregivers, it reduces patient fears, provides flawless continuity of care, reduces cost, reduces polypharmacy and creates empowerment within the consumer and partnerships with medical care providers.

Healthcare is a business. It is the healthcare providers’ job to provide safe, effective, efficient services, care and education to the consumer and it is the consumers’ responsibility to manage their health to the best of their ability. That means seeing a regular doctor annually, following up on recommendations for improved health, completing and following up on recommended testing or specialist visits, knowing our medical history and what medications we take, what they’re for and what our game plan is to maintain our health.

The best for-profit hospitals pride themselves in not only patient satisfaction, but provider satisfaction. They require staff to round on patients asking if they have any needs or suggestions and give their staff the power to provide it within reason and actions to take if the request cannot be solved.

They require senior staff to round on employees daily asking them if they have the tools and resources to do their jobs and are expected to address the issues with action. They utilize patient education as a way to manage cost and provide resources, education and continuity of care post discharge to manage re-admission. They provide respite services to families who have no help and may otherwise “dump” family members at a local hospital to get a much needed and deserved break. It is amazing that a simple gesture of a blanket or a pillow to a patient can make the difference between a good experience and a bad one. But turn the table and think of the frustrations of the provider who does not have access to a pillow or a blanket to make their patient more comfortable. It’s a two way street!

Cayman is a very reactive society. Healthcare is designed to be proactive. Both the system and the consumer must take responsibility and own their own part in its ineffectiveness. Until the HSA provides the ONGOING education, resources and structure, we will continue down the same path. In regards to the consumer, we must educate ourselves and take responsibility for our health and how we seek organized healthcare. It is then and only then we will see true changes is cost, satisfaction and a healthier Cayman.

This comment was a response to Hospital to step up urgent care service

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Comments (11)

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  1. Concerned Citizen says:

    The healthcare in the island is on the brink and everyone knows it. Including those who contribute to the problem. The problem starts with the comfortable upper class, meaning healthcare providers and their beneficiaries. How much longer are we to tolerate these old, territorial physicians who still practice with 19th century standards, enjoy their 10-4 work hours and a 2 hour lunch in between, while making money? At what point do the needs of the community comes before a cushy lifestyle?

    Why should these sub-standard providers keep practicing and the qualified and competent ones be kept out? It is embarrassing for a country with a high GDP, to be having a third world healthcare.

    It is up to us to demand new blood in form of new qualified and competent healthcare providers who are willing to work and put the needs of the community first. There are a few who are dedicated but their numbers are too small to make a difference.

    The “old guard” is enjoying a nice lifestyle at our expense. It is up to us to remind the old guard that they chose a noble profession but a big responsibility comes with it. They don’t practice good medicine while they don’t allow any new personnel to enter and become competition to their lifestyle. Medicine should not be treated as a business.

    Healthcare is a basic right, not a privilege to be enjoyed by, and catered to, a few with good insurance and deep pockets. We have to demand this from our healthcare providers at ground level as well as governmental stage.

  2. Anonymous says:

    Where I am from, “district clinics” and GPs don’t take the last appt for 4:00 p.m.! They are well aware that a lot of people need to see a doctor after their working hours and many are not able or allowed to leave work to see a doctor. I suspect that many people who go to the ER would not turn up here if they had a GP they could see late afternoon/early evenings.Also, many countries have a rotation of GPs who are on call/duty for “after hour” services (evenings, nights and weekends and they are able to look after non-serious illnesses and injuries (flues, small flesh wounds etc) and prescribe some meds to get the patient through the night/weekend. There is a hot line you call where it will list the doctor on call for xyz date. If something like this was to be set up in Cayman, it may aid to keep the ER from being clogged up enabling the staff to look more efficiently and effectively after the real emergencies.

  3. Anonymous says:

    I just brought my 2 yr old child to ER at the GT hospital, I brought him there coz I called the pediatric clinic but they said they can’t utilize the needs of my child, they recommend me to the ER coz he might need further examination. When we arrived there, we have to line up to register. Then wait for 4 hours to be seen by a doctor. The doctor just examine him for like 5-10 minutes then that’s it, we were released. I’m glad it was not a serious case, how much more the woman with his husband that time. The woman was crying as what I’ve heard from her husband when registering that she was 3months pregnant and her tummy was hurting so bad. the nurse let them wait on the waiting area for like 20-30 minutes before she entertain them. She didn’t even check her tummy first. This is just really a poor management. hope the woman felt better and hopefully the baby was fine.

  4. Anonymous says:

    Here’s a thought, open a 24 hour urgent care unit to deal with the issues which may not be a life threatening situation but still requires urgent care i.e. not having to wait for an appointment at the General Practice.

  5. Anonymous says:

    It is not for ANY care. Poor Lizette, given a big job and then surrounded by these so called over-educated fools. She has no say, but there are some sinister senior staff who appear to be in control. It is known who they are, but no one will say. I would suggest that Lizette follow the other excellent nurses who have recently quit and let the fools that control the place become manifest.

  6. Anonymous says:

    Medics have called on the Government to urgently invest in ambulance services after new figures revealed complaints about delayed emergency responses have soared in the past year. Demand for ambulance and patient transport services has soared in recent years, and emergency services are increasingly having to leave low-priority patients waiting for hours for a paramedic response. General complaints about patient transport including ambulances were up by 43 per cent, totalling nearly 500 complaints against the ambulance sector in 2013/14. Ambulance service is finding it takes longer to dispatch resources to calls that are of a less serious nature. When a patient or relative is experiencing these long delays of an hour or longer, it is the medic on scene who is at the receiving end of this frustration and anger. It is difficult to explain to a patient that they’ve had to wait because medics have been seeing a patient with a more serious problem. We need more paramedics and Emts!
    The huge increase in complaints for ambulance crews is particularly worrying alongside lengthening response times and queues of ambulances outside A&E . Instead of denying there is a problem, ministers need to urgently get to grips with the crisis developing in the ambulance service. We have been hearing stories of patients being picked up late and missing appointments, of long delays for those waiting to be taken home and in some cases incredibly vulnerable people being told they no longer qualify for the service due to changes in the eligibility criteria. Ezzard and Alden please look into this matter.

    Know the Truth

  7. Anonymous says:

    oh my goodness where shall I start. First with certain insurance! Cinico for one. How much of this country is on Cinico? Ok. now you have to work, but your child is sick. You must use HSA due to coverage. You call clinic for appt—they tell you they are full for the day. You have the option of going to GP clinic and waiting for someone to not show up orgo to the A & E–and join the party. Third option you pay for private doctor visit, and because lunch is only an hour, and you have work to do, and your unable to schedule an appt, you end up paying a private doctor. This isnt just for paediatrics, that goes for all. Now come my favorite. You dont want to go to work, you need a sick note, so you fake a migraine headache and go to the A and E. There at are least 3 to 5 of those a day. That hospital needs a walk in clinic, with 3 to 4 doctors to handle CINICO ONLY. 2 doc’s for kids, 3 for adults. And this clinic should be for the cinico patients ONLY.And should be able to schedule a appt in the morning cuz your sick. Im not on Cinico, but this alone would decrease A and E visits. MORE THAN 1/2 THIS COUNTRY IS CINICO —THEY MUST USE HSA—WELL BY NOW YOU SHOULD HAVE CREATED A FAST TRACK OFFICE VISIT FOR THEM.Hire Nurse Practitioners, physician assisstants that dont need to be paid high salaries, who work under a doctor—hello—wake up people.

    Ok, now for noninsured—well A and E will always be their refuge. I have no answer.

    and Third and most important. Insurance companies almost beg you to go the A and E. Lets see you have 400US for the year in office visits, then a 350.00 deductible, and then 80/20 coverage. After people meet that 400 for the year—and they then get 100% coverage if they go to the A and E—all insurance companies cover A and E 100% almost—well by all means why go anywhere else—you may have to wait all day/noc—just get a sick note from the doc and bring mom/dad/grandma in. Yes folks 100% COVERAGE FOR ALL ER VISITS UNDER ALMOST ALL COMPANIES. WHY GO ANYWHERE ELSE.

    HSA BIGGEST OFFENSE!!!! THEY HAVE COMPUTERIZED CHARTING. BUT ONLY USE IT MINIMALLY. ALL CHARTING AND PHARMACY THE WHOLE PROCESS SHOULD BE 100% COMPUTER CHARTING. REASON—HELPS QUICKEN BILLING. DIAGNOSIS ARE ADDED IN,, YOUR CODES FOR BILLING FOR SUPPLIES ARE ALL IN THE CHART AND DONE IN QUICK TIME. —but if you ask me—when you add computers—you at times eleminate jobs—someone saw this and delayed the process. Hence forth—there is a billing nightmare at HSA and it is constantly broke.

  8. Anonymous says:

    I am still a caymanian student nurse whose finishing his final year, so I do not have all the answers but I’ll try and give suggestions I suppose. My clinical instructor and other teachers stress how many patients doctors have and the amount of work they have, so I have been given a lot of training in communicating with them. In the few hospitals that I have been in there is a standard of communication called SBAR, which is: Situation, Background, Action, Recommendation. Through this mode of communication you can detail who the patient is, what is the problem, what you have done, and what you would recommend be the next step. I know it is different for different hospitals but this is generally accepted. In terms of really lazy and apathetic doctors, there is typically a hotline where you can anonymously make complaints. It is really discouraging as a student when I hear that there are doctors like that out there.

  9. Anonymous says:

    Right on! At least someone recognizes what needs to be done for this country.

    • Shhhhhh. says:

      To sort out A&E Dept. plumbing, you have to clear the clogged pipe at G.P. Clinic which is not at all “Walk-in-friendly” with walk-in waiting times of up to two hours. With an appointment, you will likely wait one hour. So, what happens is that the people with kids etc flood A&E ever evening rather than go to a private GP doctor or the A&E Clinic. And those without insurance, guess where they go knowing they will not be turned away. THAT IS PLAIN ENGLISH FOLKS.

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