Just before the summer, Oslo University Hospital (Ous) closed several intensive care units for children who need ventilators. – We were shocked when it arrived. Because this violates the UN Convention on the Rights of the Child, says union representative Anne Holmberg. She speaks on behalf of the senior doctors at the intensive care unit at Ullevål. They are worried. So worried that they now feel compelled to report the conditions at their own hospital. During the summer, Holmberg together with other shop stewards sent three reports of concern to the Statsforvalteren. Ullevål chief doctors Christina Schøndorf (from left), Anne Holmberg and Per Kvandal are shop stewards in the Medical Association. They have now sent a notice to the State Administrator. Photo: Bård Nafstad / news All apply to the intensive care unit at Oslo University Hospital (Ous). The shop stewards believe the offer is medically unsound. In short, there are three things they are worried about: More moving of children between hospitals That children are distributed over several departments (for adults) Fewer intensive care places in general – We are very worried about how children will be cared for in the future until the new hospital is ready, says Holmberg. Ous responds to some of the criticism further down in the case, but does not directly comment on the allegation of a violation of the Convention on the Rights of the Child. The state administrator says they cannot review internal decisions in Ous, and does not set up supervision. But they take the information with them further, says the reply to the superiors. The reports of concern about the intensive care unit Three alerts have been sent to the State Administrator due to fear for life and health, with Oslo University Hospital (Ous) and Helse Sør-East (HSØ) in copy. One has also been sent to the Patient and User Ombudsman in Oslo and Akershus and the Children’s Ombudsman. Notice of increased movement of children because the ventilator places at the children’s intensive care unit at Ullevål were closed at the beginning of June. Sick children are moved back and forth between Rikshospitalet and Ullevål, depending on whether they need a ventilator. The senior doctors believe the move is unnecessary and unjustifiable. The warning applies to intensive care of acutely injured children in intensive care units which were previously only for adults. The shop stewards believe this violates both the law and Ous’ own guidelines on the treatment of children. The shop stewards warn of reduced intensive care capacity at Ous, which they believe is professionally unjustifiable. In the notice, they claim, among other things, that patients are sent home to local hospitals to free up places, even though they should stay in the intensive care unit. Show more Lower ventilator places At the Ullevål intensive care unit, they treat, among other things, children with major injuries, severe pneumonia, sepsis and infections. There are children who are so ill or badly injured that they need round-the-clock monitoring. Until June, they had their own respirator places there. But now intensive care children who become so ill that they cannot breathe on their own have to be moved. A respirator is not just a machine. Respirator places require special expertise, which the superiors fear will be weakened at Ullevål. Photo: Camilla Salas-Gulliksen / news The severely injured children are moved to other intensive care units at Ullevål. And the critically ill ventilator children are taken to the National Hospital. – This applies, among other things, to children with infections and neurological children, children with epilepsy, says Anne Holmberg. Children become “parcel mail” This is particularly what the supervisors react to. – There is an unnecessary risk for the children, this transport, says Holmberg. Moving is usually something you try to avoid, she explains. Due to the increased risk to the patients. Nevertheless, now critically ill children must be moved back and forth between two hospitals. First to Riksen to lie on a ventilator. When the children are off the respirator, it goes back to Ullevål. – Here they plan for transport between two hospitals, which we believe is really unnecessary. “The transports must be carried out with existing ambulance capacity with the risk that the transports to the National Hospital will be delayed due to other urgent tasks are prioritized first. There will be frequent changes of treatment team, which makes it difficult to detect changes in clinical status and makes communication with relatives difficult.” Delay treatment Severely injured children on ventilators remain at Ullevål. In departments that have until now been for adults. – The children are now spread over three departments in the worst case, says senior doctor and team leader Per Kvandal. Then the doctors have to deal with two hospitals, and several departments and teams. At the same time, they may have to prepare for the transfer of children to the National Hospital. – All these are time wasters which mean that some of the treatment becomes firefighting, says Kvandal. – You simply don’t do a good enough job. “Recently, 4 severely injured children were admitted on the same evening and distributed to these three wards. One of the children required the pediatric anesthetist to be present in the ward almost continuously – it was virtually impossible to attend to the other three children. Previously, everyone would have been in the same department so that the doctor could follow all four closely.” In the worst case, children may be left lying in bed longer than they should, the superintendents fear. – We are afraid that it could lead to worse outcomes for the children, if we do not get examined and start treatment quickly, says Anne Holmberg. Pushing patients out On top of it all, the children who are moved to adult wards “push” other patients out. This summer, more people were going to the neurointensive care unit. – They haven’t been able to stay there, because we haven’t had room because of the children, says senior doctor Christina Schøndorf. – We stretch the elastic, says senior doctor Christina Schøndorf about everyday life in the intensive care unit. Photo: Bård Nafstad / news These are often young adults who have, for example, been in accidents, say the superiors. Just in the first three weeks after the change, 11 people were transferred to other departments, according to their figures. Some have ended up in noisy rooms with several other patients, according to senior doctor Anne Holmberg. – If you have a serious head injury, you are completely dependent on keeping calm and being protected. “We recently had one case in the neurointensive care unit where an awake child who had just finished ventilator treatment together with his parents had to share a room with another critically injured patient where life-saving treatment was taking place. These are frightening experiences for children and parents, which will lead to an increased incidence of anxiety disorders, including post-traumatic stress disorder.” Fewer intensive care beds This “game of chairs” is happening because more people have to share the same intensive care beds, the superiors believe. The wards that now have to accept ventilator children have not been given more places or resources. In practice, there has been a cut in the number of intensive care places, the superiors believe. – The capacity has been poor. And they have said that they will develop this. Whereas what we see is the opposite here now, says clinic trust representative Erik Høiskar. Erik Høiskar is concerned about cuts in intensive care places. Photo: Jenny Dahl Bakken Not only are the respirator places for children gone. Last year, the cardiac surgery department at Ullevål was moved to Rikshospitalet. Also then, an intensive care place disappeared. – And it is quite clear that it goes beyond preparedness. That you build down Ullevål bit by bit, says senior doctor Anne Holmberg. The whole country And it is demanding, say the superiors. – We are not a hospital that can choose the patients who come here, says senior doctor Christina Schøndorf. Ullevål does not only accept patients from Oslo. Trauma patients from all over the country are transported to the hospital in the capital. Intensive places fill up quickly when something happens. Which is almost every weekend, according to Schøndorf. Perhaps it will be no more than a notice in the newspapers: a traffic accident on the E18. – And then there was surely a small traffic accident on national highway 3. And suddenly, there were quite a few patients going to Ullevål, she says. Here at Ullevål, several senior doctors have now sent messages of concern about the intensive care unit. Photo: Espen Willander, pilot; David Haugen, photo / news Aerial photo And in the middle of it, the doctors and nurses are on duty and have to deal with everything that comes their way. Both children and adults. In that case, it is important to have experience and knowledge, the superiors believe. They fear it will disappear now. It is a big concern, says Schøndorf: – How we here at Ullevål, who now get to treat very few children during the day, are suddenly supposed to look after the very sickest children who come in the evening and at night on weekends. “Increased and different workloads have caused considerable unrest among employees, and several intensive care nurses have resigned from their positions as they find the working conditions unacceptable. […] We are very concerned about how we will manage to recruit and retain qualified personnel in these sections until the new hospital is ready in 2031.” Clinic manager: Less risk to move Manager Øyvind Skraastad at the emergency clinic does not share the superiors’ concern. He believes the solution they have chosen is the best for the children. – At least it is a safer treatment. Because having patients on ventilators is inherently risky, he says. Clinic manager Øyvind Skraastad believes it is safer for the children to be treated at Rikshospitalet or in the adult intensive care unit. Photo: Bård Nafstad / news There is one particularly important reason why the changes had to be made, he believes: the Ullevål intensive care unit has had too few ventilator children. At the same time, they have struggled with recruiting employees. Hiring has been necessary to fill the duty schedule. This makes it difficult to ensure stable competence in the department over time, explains Skraastad. And ventilator treatment requires round-the-clock expertise. – Then we had to look at other and safer ways to treat these patients. Even if it means moving critically ill children on ventilators to the National Hospital, or to adult wards. – Do you think it is more risky for the children to be on ventilators in the intensive care unit here? – Yes, I think it is a risk to have patients on ventilators when you do not have a sufficient number of competent nurses in the section. Skraastad adds that not many children have been moved between hospitals. He also says that they bring in nurses from the National Hospital if necessary. The man in the picture is a healthcare apprentice at the neurointensive care unit at Ullevål. They now also accept children on ventilators there. – Not closed He does not fully agree that they have “closed” intensive care beds. Because even if children are moved when they need a ventilator, there is still intensive care for children at Ullevål. – The majority of patients are still there, in the same number of beds as we had, he says. – But we have a different distribution of tasks between the sections in the new arrangement. Read also: Tip me! Hello! Do you have tips or ideas for something I should address regarding health and hospitals? Send me an e-mail, then! I have written several articles about hospitals, the healthcare system and hospital economics, such as these: Published 09/09/2024, at 15.16 Updated 09/09/2024, at 16.29
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Have to send terminally ill children to another hospital
