The enhanced treatment 'hoax' at hospitals and why it is dangerous
When there are not enough intensive care beds, high-risk patients are placed in beds located in close proximity to the nurses' station in regular wards—and they call it 'enhanced care.' The problem, however, is that the medical staff is more limited, lacks proper training and does not have the necessary equipment to deal with those patients.
Hospitals in Israel face a severe shortage of beds in intensive care units. Having no choice, they put high-risk patients in regular wards. This could cost patients their lives, as while intensive care units have two nurses for each patient, the regular wards have a nurse for every 30 patients, and the number of doctors is much smaller as well.
The medical staff in the regular departments also lacks the required training possessed by the ICU. For example, regular departments are not allowed to give adrenalin, which is a drug that may save lives in the event of cardiac arrest.
In addition, the regular departments are not equipped with life-saving machines that can be found in intensive care, such as dialysis machines or devices for treating shock, and there is no equipment for continuous monitoring of patients. "These are critical things that patients who are hospitalized in the enhanced units do not receive," warn the resident physicians, who for the first time are exposing the problem and its hefty toll.
"Every day we have to make fateful decisions about who to let in and who to take out," said Dr. Sharon, a resident surgeon at a hospital in the Shfela region. "The patients' families are not aware of what stands behind these decisions. They have no idea that their loved ones had been placed in 'enhanced care' since there is no bed for them in ICU, and that the so called enhanced care may risk their lives. They are in deep distress and the system is exploiting that. There are many problems in the health care system, but the intensive care issue must be resolved as soon as possible."
"We had an 81-year-old patient with cerebral hemorrhage and we tried transferring him to intensive care but there was no room," he added. "We appealed to nearby hospitals, but they were also full, so we put him in an internal ward with no chances of recovery. Had he been placed in intensive care, he would have at least had a chance.
"In another case, a 75-year-old woman treated with blood thinners came in with a head injury, and according to medical protocol, she was supposed to be in intensive care. But in the absence of room she was hospitalized in the enhanced unit. The problem is that the staff is not equipped to deal with such a patient. They're not trained in diagnosing neurological symptoms… The patient deteriorated and they weren't even aware of that. Fortunately, I had visited her every half hour, and early in the morning, I saw that her level of consciousness was deteriorating and in need of immediate surgery. She was a hair's breadth away from death."
Dr. Amichai, another resident in an internal department at a hospital in the north, experiences the same issues every day: "About two weeks ago, a 46-year-old man came to us in a state of shock due to a heart condition. If the problem is not addressed immediately, the patient's chance of survival is very low. Because there was no room for him in intensive care, he was transferred to our internal department. The problem is that such a patient must be constantly monitored, receive medications that we are not allowed to administer, and perform an echocardiogram, which we do not have access to.
"When I saw this patient, I went pale. He was like a ticking bomb. Only after many hours did I find a place for him in intensive care, and that was only because they took someone else out of there. Eventually, this patient was out of danger, but it was a matter of luck. If I hadn't insisted, this guy would no longer be alive."
Dr. Yifat, a surgical resident in a large hospital in the center of the country, revealed what everyone in the medical community knows about these issues. "If an adult, over the age of 80, comes in with co-morbidities, he is likely to be hospitalized in a 'small-time' intensive care unit. They tell us not to waste a bed on him. We know he needs intensive care, but we understand that we have to prioritize—and in most cases, we are told to give up on someone who has a lower chance of recovery. We are not bad people, but we have no choice."
But it is not only the patients in need of intensive care who pay the price for this 'invention.' Patients in the regular wards to which ICU patients are admitted are also paying the price as their treatment is impaired. "I, as a doctor, know that I have patients in the enhanced care beds, in whom I have to invest much more time, and that's at the expense of other patients who are in serious condition," explained Dr. Yifat.
If that's not enough, the patients in the 'enhanced care' are patients who have been exposed to more antibiotics and are therefore carriers of resistant bacteria, which they transmit to patients in the internal and surgical departments.
The Ministry of Health said in response: "Intensive care beds are beds intended for the most intensive and monitored treatment of patients requiring this, both in general and specialized intensive care units (cardiac, respiratory, neurosurgical, etc.). That said, there are additional beds that provide enhanced treatment, which is adapted to patients, such as recovery wards, intermediate units, and enhanced care."
(Translated and edited by N. Elias)
