Coronavirus wards are taking a huge bite off of Israeli hospitals’ internal medicine wards, leaving them with insufficient medical staff and beds.
Leading doctors say the situation has dealt regular departments a harsh blow and adversely affects the treatment of regular patients.
“We are forced to release patients home faster. I have to shorten hospitalization time all the time. I’m in constant fear of not having place for the next patient,” says a deputy internal ward director in one of the major hospitals in the center of the country.
Some 50 of 111 internal medicine wards have been turned into coronavirus wards and more than 1,500 out of 3,300 beds are now occupied by COVID-19 patients.
“There’s always pressure from the emergency room to admit patients to the ward so that the emergency room isn’t clogged up, and at least once a day there’s a patient with verified COVID-19 who is sent to the ward before his test results come in,” she says.
The pandemic is affecting the way admitted patients are processed in the ward. The process takes longer and the doctors are banned from examining the patients before the coronavirus test results are received, she says.
Thinning out the internal medicine wards means that the race to discharge patients begins as soon as they are admitted.
“It means releasing patients even in clinically ‘grey’ situations. For example, if a patient needs antibiotic treatment for seven to eight days, he’ll get it for seven days and then be discharged,” she says.
The coronavirus also changes the interaction with patients’ families. “There’s no contact with the patients and their relatives. Any family member is a potential coronavirus patient. I find myself having talks with the families in the corridor, with no physical contact. So on quite a few occasions I have to give the family bad news in the corridor or in a crowded lobby. You can’t really sit with them in a respectable way,” she says.
Due to the ban on more than one visitor, the doctors are forced to police the goings on as family members try to enter the ward with various excuses, she says. The physical and mental erosion is greater as well. The work is intensive and I haven’t taken time off in nine months. It wears one down,” she says.
Politicians don’t see it
At a press conference of the Israel Medical Association on Wednesday, the heads of internal medicine departments warned that the wards are in a difficult situation. They warned that the critical shortage of skilled staff is causing harm to hospitalized patients.
“Regrettably, the politicians and most of the media don’t understand what’s going on in the hospitals, the significance and consequence of the huge shortage of beds and medical staff in the internal medicine wards,” said professor Avishay Elis, the union’s chairman.
“What the public and the decision-makers don’t see is the drastic reduction in hospitals’ ability to treat regular patients, because we don’t have sufficient internal medicine doctors, we don’t have enough nurses, and we don’t have enough paramedical and auxiliary staff. We don’t have enough hospital beds because we don’t have enough wards,” he said.
Even measures like stopping elective surgery or hospitalization in private hospitals won’t change things fundamentally, he says.
The internal wards constitute the Israeli hospital system’s spine and most hospital patients end up there, suffering from diverse diseases as a matter of routine. The population growth and longer life expectancy have resulted in older patients with more complex conditions, some with eight or nine background diseases in these wards.
Also, these wards’ occupancy has been rising constantly, peaking in the winter, when it sometimes doubles.
“The treatment of patients in the internal wards is characterized by compromise,” says Dr. Ayelet Raz, director of an internal ward in Rambam Hospital in Haifa.
“It means sending home patients we used to keep in the hospital, to complete the medical ascertainment of their condition and discharge them in good health. It means causing harm to regular patients, patients with diabetes, high blood pressure, cancer, brain disease, contagious diseases and others,” she says.
With the current reduction of 40 percent in the beds and medical staff, there’s no other way, she says.
“I want to talk about Sara, who was hospitalized in my ward in recent weeks thin, pale, with low appetite and significant weight loss. One doesn’t have to be a doctor to understand that her situation must be looked into. We tried to ascertain what it was through her Health Maintenance Organization, but I don’t even want to tell you the date she got an appointment. The examination requires tests like gastroscopy, colonoscopy, stomach CT. Obviously so many tests in the current situation will require a relatively long hospitalization of at least a week. Due to her condition we didn’t want to send her back for assessment to the HMO, and despite the load we gave her an appointment for tests in the hospital. We released her until the tests, which are due in a few days,” Raz says.
Another patient of hers, Amos, underwent a bone marrow transplant. “He went to the emergency room because he had fever, chills and a cough. He was diagnosed with pneumonia and sent to the ward for intravenous antibiotic treatment and to be kept under constant respiratory supervision. When he entered the ward, he realized he wouldn’t have a single room but would have to share with two other patients.
“Fearing for his health due to his weak immune system, he decided to go home and take his medicine orally. After two days his condition deteriorated and he was rushed to the emergency room with low blood pressure and was hospitalized immediately. He was one who chose to leave the hospital due to the situation, but certainly not because he got better,” Raz says.
Dr. Hagit Yonat, director of internal medicine ward A at Sheba Medical Center, Tel Hashomer and codirector of the hospital’s coronavirus emergency room, says the incompatibility between the number of wards and staff in the internal wards and the number of patients was known before the pandemic.
“The medical roster in public medicine was last set in 1977. At the time the population was about 3.5 million. Since then only about 10 internal wards have been added with no change in the number of doctors – 11-12 doctors, about a third of them specialists. Clearly so few staff aren’t enough to treat a population that has grown a lot, has aged and has the right to advanced medical treatment that prolongs life and enables treatment of various diseases,” she says.
A considerable part of the internal wards’ staff now works in the coronavirus wards. Professor Dror Mevorach, the coronavirus ward and internal ward director at Hadassah Hospital says: “In the current wave of the disease, my patients are younger than they were in the first wave. We have many patients in their 40s, 50s and 60s. Despite a higher mortality rate among 70-year-olds, there’s significant amount of illness and sometimes prolonged hospitalizations of young people.
“We’re used to see the numbers of patients in mild, fair and critical condition, but there’s a number that isn’t counted: patients who have recovered from coronavirus,” he says.
“Apart from the fact that their [test results] turned positive, they are hospitalized in the regular internal wards for a long time, or go to the general emergency room and quite a few of them will have to enter a long rehabilitation period,” he says, adding, “If there’ll be any rehabilitation beds.”
Header: A doctor in an internal medicine ward at Ichilov hospital, Tel Aviv, April 21, 2020. Credit: Ohad Zwigenberg
Original: Ido Efrati – HAARETZ