With well-thought-out moves, the leadership of the Ministry of Health is making changes in the most difficult and overloaded area of public hospitals in Attica, the Emergency Departments (EDs). It is here where long waiting times of up to 8 hours are recorded, stretchers are set up, the endurance of citizens and hospital staff is severely tested, and congestion hits red levels.

More than 4.6 million citizens visited the EDs across the country last year, with 28% of them concentrated in the EDs of 30 hospitals in the Attica region. During each shift, large general and university hospitals receive between 700 and 1,200 patients. More than 1,200 patients arrive at the emergency hospitals in the Attica region on a 24-hour basis by ambulance, while over 1,000 rush to the EDs on their own.

Renovations of the aging building infrastructures, which started with funding from the Recovery Fund, signaled the start of the process two years ago, and last November the new system for the organization of emergency hospital shifts in Attica was introduced. The next steps include targeted staffing, the utilization of technology in selected areas of the National Health System (NHS), the creation of the National Trauma Management System, the Stroke Management Network, and the strengthening of the National Ambulance Service (EKAV).

Changes

In the past six weeks, organizational changes have been made, meaning the redistribution of hospitals on emergency shifts every four days, and at the same time, the emergency departments of large (core) hospitals opened their doors in the morning for the public, which was previously only allowed for ambulance cases. The Ministry of Health assesses the changes as positive, but the hospital staff, however, express the opposite opinion and protest the changes made without their involvement.

Indicatively, at the hospitals “Thriasio,” “Attikon,” “Tzaneio,” and “Agia Olga,” there was no change, and their operation remains difficult and overloaded. At “Gennimatas” and “Laiko,” visits to the EDs significantly increased, while at “Alexandra,” “Sismanogleio,” and “Erythros Stavros,” visits during shifts decreased by 32.6%, 26.7%, and 9.3%, respectively. The implementation of the new system is dynamic, with Deputy Minister of Health Mario Themistocleous closely monitoring it and intervening where necessary to improve accessibility and patient service.

The next move is now being planned, which will utilize technological capabilities. According to the plan, starting in January, EDs of large hospitals will welcome patients wearing a special bracelet with a tracking device that records their path within the laboratories and examination rooms. This was described by Health Minister Adonis Georgiadis last May at the “THEMA” Health Conference and ygeiamou.gr, immediately after his visit to a hospital in Israel. The patient tracking and recording system, when fully developed, will give operational bodies a clear picture of shifts in each hospital and will serve as a basis for corrective interventions and changes.

“We are at the beginning of the operational plan aimed at improving the image of the EDs. The following interventions are included: 1) Renovation of building infrastructures with completion targeted by the end of 2025. 2) Targeted staffing. Specifically, within December and January, we will proceed with the recruitment of auxiliary nursing and other staff, while the process for recruiting doctors for the EDs in Attica is also underway. 3) Organizational changes in the emergency teams. 4) Utilization of technology. We are creating a patient tracking and recording system and investigating the use of Artificial Intelligence as a support tool for the staff in the EDs. Large hospitals are already collaborating with universities both in our country and abroad to implement these technological applications. 5) Creation of systems for managing serious conditions such as the National Trauma Management System and the Stroke Management Network. These will be combined with the strengthening of EKAV and the reorganization of the airlift system,” stated Mr. Themistocleous to “THEMA.”

The operational plan for the Emergency Departments is a top priority for the government and the Prime Minister. The first assessment will take place in April, by which time much of the renovation work in hospitals will be completed, and dysfunctions in the emergency shift system will have been addressed. This includes problems already caused by the exclusion of “Evangelismos” from morning shifts due to building renovations or problems that will be caused by the seasonal flu in the first two months of the new year in hospitals, both in the EDs and in the internal medicine and pulmonary departments.

Special emphasis is placed on staffing. The complications in emergency shifts are caused by the lack of doctors in all specialties and the reduction of laboratories. Hospital teams (should) be created based on the availability of specialties, but reality often differs. For example, in a recent joint shift of the “Sotiria,” “Hippocratio,” and Nikaia hospitals, there was no simultaneous availability of a cardiologist and a pulmonologist in any hospital.

A major problem also remains with the laboratories. There are significant shortages in microbiology, cytology, and imaging laboratories, which eat up valuable time during patients’ stay in the EDs. It is almost certain that data from the portable devices of patients in the Emergency Departments will reveal delays in test results, which allow doctors, along with the clinical condition of patients, to decide on hospitalization or not.

Health Centers

At the same time, Health Centers have become a point of contention within the Ministry of Health. Until recently, there were discussions about extending their working hours and staffing them with medical specialties on emergency shifts to handle less urgent cases. In fact, the 1st and 2nd Health Districts of Attica and Piraeus & Aegean (YPE), respectively, had submitted proposals for upgrading six Health Centers, including those in Alexandra, Maroussi, Kallithea, and Keratsini.

Recently, there has been a proposal to staff them for preventive examinations of citizens and to operate them exclusively for pre-symptomatic screening. However, the lack of primary or secondary care structures is a long-standing issue, as reflected in the data: of the 1,200 daily ambulance transfers to the EDs in Attica, 720 result in admission and hospitalization. Forty percent of them are not urgent cases.