Health Ministry / Internal Medicine Department Crowding Making Patients Sick

Internal medicine wards up to 150% occupied in winter; state comptroller back striking doctors' cause.

Internal medicine wards in some of the country's hospitals are up to 150 percent occupied during the winter months, forcing patients into hallways or other irregular locations, the State Comptroller reported yesterday.

The nation's doctors, who have been intermittently striking for weeks to achieve better wages and work conditions, got a boost from Comptroller Micha Lindenstrauss, who warned in his report on the health system that the difficult work conditions in the internal medicine departments are deterring medical students from seeking internships in internal medicine wards.

hospital - Eliyahu Hershkowitz - May 18 2011
Eliyahu Hershkowitz

"Because of the heavy workload ... interns are not interested in working in the internal medicine wards and there are hospitals where almost no new interns have been taken on in these departments," Lindenstrauss wrote.

During an audit of internal medicine wards conducted between January and August 2010, the comptroller found that this situation was detrimental to patients.

Patients, he said, were at risk of receiving inadequate care that might later be deemed malpractice, being infected by antibiotic-resistant bacteria, and being released from the hospital too soon, as a result of which they were more likely to be readmitted.

Some 20 percent of internal medicine admissions in 2008 were readmissions, "raising the suspicion that some of these readmissions were the result of a previous premature discharge," Lindenstrauss wrote.

Despite the overcrowding, some 15 percent of patients in internal medicine wards are there unnecessarily, because they are waiting to be sent home or moved to other wards. This situation is exacerbated by the fact that the health funds have hospitalization agreements with various hospitals that provide a financial incentive for hospital stays over visits to local clinics.

A year ago, when Health Ministry director general Dr. Roni Gamzu assumed his post, he "declared war" on hallway hospitalizations and reached an agreement with the ward nurses not to permit admissions that would push occupancy over 120 percent. The Health Ministry says it plans to restrict this to 110 percent during 2012.

But this policy has generated its own problems, the comptroller noted. To avoid going over the limit, patients that ought to be admitted to internal medicine wards are now being shifted to other departments where they don't belong. Other patients are simply being kept in the emergency rooms because the internal medicine wards are full.

Gamzu is quoted in the report as admitting that "Under these circumstances, the quality of care is affected, because the attending staff isn't properly trained and doctors are unavailable for examinations."

The government has approved the addition of 960 beds to the hospitals over six years, but the results of this decision will only be seen a few years hence, the comptroller noted.

"If the State of Israel doesn't make this a top priority ... the situation will deteriorate and there will be more deaths," Lindenstrauss wrote.

The Health Ministry welcomed the watchdog's report yesterday, noting it had been complaining about the shortages of doctors, nurses and beds long before the nurses and doctors launched work sanctions.

"It's time that the country's elderly residents - who are most of the patients in the internal medicine departments - be hospitalized respectably," the ministry said.