Sixty nurses at the Mater Dei Emergency Department - 83% of the total - have written to Health Minister Joseph Cassar to complain that conditions at the department are still unacceptable.
The letter was sent at the end of a course in pre-hospital care. It was announced hours after hospital CEO Joseph Caruana said the number of people visiting the Emergency Department was rising, but the hospital was coping thanks to better bed management.
In their letter, the nurses said:
"We would like to take this opportunity to thank you and all those involved in the
organisation of the PHEC course. This was truly a golden opportunity for all of us to improve our practice, learn new skills and update ourselves with the latest
developments within the area of pre-hospital care. We hope for and encourage
further similar initiatives not only in relation to pre-hospital care but also in relation to other areas of our practice.
"However while the provision of training is positive and necessary, the current situation still leaves much to be desired.
"It is very de-motivating for nurses who have been trained so as to provide a better service, to be unable to do so. The lack of appropriate legal structures to safeguard our practice prohibit us from practising what we have learnt and been certified to do.
"At times this can be detrimental to our patients. A typical example is the problem encountered when administration of life-saving drugs is required in the pre-hospital field. The ideal way forward would be to amend the current legislation in order to be in line with current European standards.
"We would also like to take this opportunity to express our concern about the current state of affairs within the A&E department. The most pressing problems of bed shortages, overcrowding, and insufficient human resources to meet current demand are causing undue stress on all of us. We acknowledge that some effort has been noted within the primary care sector to relieve some of the extra load from our department. However these efforts seem to be half-measures or unsuccessful.
"As mentioned several times in the past, patients who have been admitted to Area 2 and the paediatric corridor are being cared for in unacceptable conditions where sanitary facilities are lacking and basic safety is a long forgotten luxury. This situation is having long term repercussions. The overcrowding (22 patients in area 2 instead of 6 patients) is leading to inadequate care delivery and the inevitable situation of cross infection, owing to the type of admissions being catered for in a limited space.
"It is very frustrating to admit a patient who is elderly and frail on a ‘chair’ rather than in a bed. This when considering that such patients would have been waiting for a bed for hours on end. Moreover, this situation puts such patients at increased risks of complications such as pressure sores. Such complications prolong hospital stays and increase the financial burden incurred to care for these patients.
"Additionally this worsens the current bed shortage situation. This bed shortage leads also to prolonged stays in the A&E department of patients who no longer need emergency care. In the meantime, inflow of new patients who require urgent and immediate care continues incessantly. With thirteen nurses in each shift, human resources are stretched to their limit when it comes to providing
care to newly admitted patients to A&E department and those awaiting a bed.
"Emergency nurses have signed this letter to express their concern about the
situation in the A&E department and to bring to the attention of the Health
Department the immediate need to take serious and prompt action. These problems have been highlighted several times but to no avail. Therefore we request that a suitable and long-term solution be found to avoid such situations from continuing to occur, particularly as they are putting patients’ health and nursing staff at risk."
Earlier, Mr Caruana said that while 18,309 patients visited the Emergency Department last December and January combined, 17,782 visited in December 2009 and January 2010. This was a 9.3 per cent increase.
Emergency admissions under the care of medical consultants increased by 8.7 per cent last December compared to December 2009.
However, there was a drop over the same month last year - from 1,421in December 2010 to 1,370 last December.
This reflected a change in practice by hospital staff who worked at the department.
Mr Caruana said that only 23% of those who called at the Emergency Department were admitted to hospital. Around 30% of those who went to the department were not even classified as emergency cases.
Mr Caruana said that although there was more to do, the hospital was coping. He said that patients were being transferred from Mater Dei to Karin Grech Hospital for rehabilitation - thus creating bed space at the former.