Sat | Feb 27, 2021

Garth Rattray | Improve emergency room experience (Part 2)

Published:Monday | December 2, 2019 | 12:00 AM
Our problems were compounded in 2008 with the introduction of the ‘No-User-Fee’ policy.

Emergency Rooms (ERs) are understaffed. And they must accommodate patients (even in chairs) until beds are available on the wards. Sometimes this takes several days.

A certain well-known and heavily subscribed ER has only 50 per cent of the complement of nurses needed and is rapidly approaching the same figure for doctors.

People who don’t take advantage of the regular health centres, with their extended opening hours, choke up ERs. The medical staff is overworked and overwhelmed, and patients’ patience run thin. The atmosphere quickly becomes toxic, as nerves are frayed and tempers flare. Everyone wants to be seen immediately. Everyone believes that their problem is an emergency and more urgent than anyone else’s.

Many come armed with Google diagnoses and attempt to dictate what investigations and treatments they need. Doctors and nurses are sometimes viewed as callous obstructionists who delay or deny treatment.

ERs, globally, have adopted a triage (separating out) system to ensure clarity of thought and efficiency of care. Very simply put, the Emergency Severity Index (ESI) is a five-tiered tool for assessing ER patients.

• Level 1 patients require immediate attention to save their lives. A few examples are penetrating wounds with circulatory system shock, cardiac or respiratory arrest, airway obstruction.

• Level 2 patients are seriously ill and need to be seen quickly, but their condition is not immediately life-threatening. Examples are angina and stroke.

• Level 3 patients are stable but complex because their medical condition will require several resources (lab tests, X-rays, ECG, etc).

• Level 4 patients are also stable but need only one resource. They are usually fast-tracked but can wait.

• Level 5 patients are not in need of urgent care or any resources. They may need a prescription or a referral.

The presence or advent of severe pain, distress, confusion or lethargy, to name a few, will influence the ESI level, despite the original assessment.

In our current ER atmosphere of oversubscription to medical services and understaffing, along with sparse equipment and beds, overworked and stressed-out doctors are only interventionalists and have no time to explain enough to assuage anxieties and fears.

We need to employ medical staff to constantly explain the ER procedures, explain findings and decisions, and assist in guiding patients going forward. We also need more, visible security personnel circulating among waiting patients.

ER medical staff need scheduled lectures in dealing with anxious and/or aggressive patients/relatives. They also need counselling to cope.

Despite the best efforts of our health and wellness ministry, our people continue to suffer and die as a direct result of a financially strapped and, therefore, deficient medical service.


Our problems were compounded in 2008 with the introduction of the no-user-fee policy. It was a political masterstroke but was not properly thought out and has worsened our situation. It swamped our already-overburdened public health sector.

Jamaica does not have the replacement income for a no-user-fee policy, yet both political parties have clung to it tenaciously out of fear of severe political backlash if it is terminated.

In 2008, the loss of revenue from the relatively few who paid part or all of their public-sector healthcare bill was almost $2 billion annually.

The Government has convinced the health insurance industry to bend their rules so that their subscribers pay for service while others pay nothing to access the public health system. I believe that the no-user-fee service should remain but become a voluntary (opt-in) policy. Our financial situation would greatly improve.

Until we can significantly increase healthcare staff and facilities, hospital beds and functional equipment/machinery, we have a system where the facilities can only offer long clinic appointments, suboptimal hospital care and overstretched emergency services. We desperately need to prioritise coping strategies and customer service.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to and