We spent the day in the pediatric emergency room. Instead of fractures, desperate nurses treat coughs

After hours of nursing, the four nurses meet for lunch in the late afternoon. They leave the chaos of hospitals behind the door for a while. The calm atmosphere disappears within a few minutes when an ambulance appears outside the nurse’s room window. “So what will it be? Cough or temperature?” guessed one of the older nurses. A mother with a three-year-old girl then gets out of the ambulance. “He has three jackets, so the temperature,” notes the nurse, who has barely finished her meal, with a sigh.

The staff already knows in advance that this is not a serious case. In those cases, the paramedics send a notification in advance so that they can prepare for the emergency room. Recently, the number of cases where an ambulance trip is unnecessary has been increasing. Most often, people call like this because of temperatures, coughs, diarrhea or the removal of a tick. According to the head of the department, Jitka Dissou, 20 to 30 percent of patients arrive by ambulance.

“We are not saying that it is useless for them to go to the doctor. But it is useless for them to go by ambulance. They have a temperature for an hour and they come by ambulance. This is nonsense,” explains one of the nurses. “Not that it’s a delay, but the staff here gets burnt out. They’re trained for really serious cases and then they’re here five times a day educating people about the temperature. It’s quite demotivating,” adds Dissou.

However, it is not only parents who unnecessarily burden emergency income. The local staff also points to the problem of ambulance trips to schools. In many cases, it would often be enough to call the parents. Even during the day when the reporter spent over nine hours here, three ambulances arrived from the schools. In the case of a boy with a broken nose, the trip is justified.

The other two cases where the child had a minor ADHD episode could be resolved with a phone call to the parents. It is with this type of trips to schools that the staff meets more and more often. The teachers do not know what to do with the child, so they prefer to call an ambulance. “Nowadays, schools are afraid of lawyers and actually parents too. But why should we take it away?” asks the primary teacher.

There is the sound of the automatic doors opening again, another ambulance is arriving. In addition to the girl in three jackets, a three-year-old boy with laryngitis is also waiting for treatment. The ambulance was called by his pediatrician, with whom he was being examined. Headmistress Dissou first goes to see the boy with the confirmed diagnosis.

According to the local staff, cases where pediatricians unnecessarily send their patients to the emergency room or emergency room have also increased in recent years. “Since the time of covid, when they didn’t want infected people to come to their doctor’s office, they treat over the phone. We are really desperate about this,” says one of the nurses who has worked here for over twenty years. He describes the current situation as one of the worst. “They will call the pediatrician, but they will come here,” adds the head nurse.

After examining the boy, it is the turn of the girl with a temperature. Her mother felt like she was suffocating during a coughing fit. “Oh yeah, can’t some ordinary broken arm come?” someone in the office declares out of earshot of the patients. The girl is really messing up a bit. During a standard exam, Dissou asks the mother if her daughter turned blue during the seizure. He shakes his head. Although it is clear to the first lady at that moment that it was a completely unnecessary trip, she patiently explains to her mother how such a common cough is treated.

Trying to avoid long ordering times

While the misuse of children’s emergency admission ranges between 20 and 30 percent of patients here, it is more than 50 percent in the pediatric emergency department. By visiting, parents most often avoid long appointment times, visiting or searching for their own pediatrician, which has been in short supply in the Czech Republic for a long time.

“The emergency room from four in the afternoon is a disaster,” says one of the nurses. “They arrive at eleven in the evening with a rotten thumb, which they have been cultivating for fourteen days. Or their back hurts for a month and they arrive at midnight. Or they arrive at two in the morning and have already had a cough for fourteen days,” the nurse lists specific cases. According to the staff, a significant part of the problem is represented by foreigners who do not know how the Czech healthcare system works.

Due to unnecessary visits to the emergency room, the waiting time increases significantly. On some days, the nurses even have to put a sign in front of the entrance warning that the emergency room is overcrowded and the waiting time can reach up to five hours. A long wait often leads to conflicts and aggressive behavior. “It also happens to us that instead of waiting here, they climb in front of the barracks and call an ambulance,” he adds.

Moto is no exception

To some extent, most large hospitals in the Czech Republic deal with similar cases every day. The university hospital in Motola is therefore no exception to abuse. Similar numbers to Motol also have the emergency department of the Faculty Hospital of Královské Vinohrady, where about 40 percent of the patients are. According to hospital spokesperson Tereza Romanová, this is a long-term problem.

The hospital in Olomouc, for example, is facing the same situation, where about 30 percent of patients are affected. “There are also exceptional days and nights when – if we do not count the intensive examination room – none of the treated patients need immediate help,” says Hynek Fiala, deputy head of the emergency department.

Doctors see the solution in a possible increase in the fee for treatment outside normal office hours. It currently amounts to 90 crowns. However, proposals for an increase of up to 500 crowns are coming from the ranks of doctors and hospital staff. However, the Ministry of Health rejects this proposal. “Setting strict measures, for example barriers to access to care, whether financial or organizational, is associated with the risk that someone will not get care, even if they really need it,” explains ministry spokesman Ondřej Jakob.

However, the fee only applies to emergencies outside office hours. When a patient unnecessarily calls an ambulance, he only pays for the service if he is not insured or is a foreigner. Otherwise, the basic trip, which costs six thousand crowns in Prague, is covered by public health insurance.

According to headmistress Dissou, inspiration from abroad is a possible way. “In Israel, for example, it works in such a way that they take everyone away, but then they send a medical report to the reviewing doctor, who decides whether it was an abused trip, which the patient must pay back,” he explains. The Czech Ministry is not currently considering anything similar.

Minister Vlastimil Válek (TOP 09), on the other hand, plans to have a so-called triage nurse working on urgent admissions. This would classify all patients into those who need urgent help and those who need to be treated by a general practitioner only the next day.