FEATURE/Under pressure: On the front line of Taiwan's ER overcrowding crisis

By Sunny Lai, CNA staff reporter

[Editor's Note: This is part two of a two-part series examining Taiwan's recent ER overcrowding crisis.]

While President Lai Ching-te (賴清德) lauded Taiwan's health care system as the world's best in late February ahead of the National Health Insurance (NHI) system's 30th anniversary, firsthand accounts of medical staff facing emergency room (ER) overcrowding issues tell a very different story.

As the crisis spirals into what feels like an OHCA case beyond resuscitation, CNA spoke with ER medical staff and a health policy expert to share what it has been like in these overcrowded pressure cookers and what could be done to ease the strain.

How an ER doctor sees it

The ongoing crisis is "far from what a well-functioning health care system should look like," said Chen Liang-fu (陳亮甫), an attending physician in emergency medicine at a Taipei medical center.

He noted that in his recent shifts, he has been caring for three times as many patients -- around 30 -- compared to before the crisis arose.

With too many patients waiting in the ERs, "we often have no choice but to 'stay and play' -- continuing with routine care and only intervening when the situation worsens significantly," Chen said.

"I honestly feel like I've reached the point where I worry every day about whether I've missed something about [the treatment for] a patient," he confessed.

From an ER nurse perspective

Echoing Chen, Andy Kuo (郭豐慈), an ER nurse at National Taiwan University Hospital, said that the likelihood of medical errors is "certainly higher" when overcrowding occurs.

"Even if no medical accidents occur, it doesn't necessarily mean a better outcome, as the quality of care is not solely defined by the absence of errors," he said.

Kuo also said he had encountered cases where patients waited in the ER for a month, as well as cases where the lack of ICU beds prevented surgery for brain hemorrhages.

"From a medical standpoint, most treatments yield the best outcomes when administered early ... [delayed treatment] is very likely to not benefit patients," Kuo said.

A nursing shortage at medical centers has also hurt ERs, the 35-year-old said.

Decades of studies have shown that a decline in the nurse-to-patient ratio leads to higher mortality rates, but that risk is "something everyone has to bear" given that there is "no limit" on admitting patients to ERs.

Chen said the overall situation has led to other negative consequences.

For patients who are not critically ill but still require inpatient care, they and their caregivers may experience emotional distress from being unable to transfer to a proper ward with an assigned bed, forcing them to remain in the ER or even in the hallway, Chen said.

Such frustration can sometimes lead to conflicts with medical staff, further adding to the stress faced by doctors and nurses, he said.

Doubts about remedies

To those on the front lines, government measures to address the problems, especially the nursing shortage, have fallen short.

At a press conference on Feb. 24, the Ministry of Health and Welfare (MOHW) said NT$6.685 billion (US$202.3 million) from the government budget would be allocated per year to "retain nursing staff in hospitals."

Kuo questioned whether such funding would be sufficient to achieve the target, given that last year's NT$4 billion allocation for incentives for all night-shift nurses at hospitals around Taiwan was "nowhere near enough."

Once that money was allocated, Kuo said, some ER and ICU nurses at other hospitals were left with "nothing at all."

What can be done?

Chen suggested as a starting point freeing up doctors' time with a better way to communicate between medical centers on the availability of resources in real-time.

Chen explained that when an ER patient requires surgery, but the hospital lacks the capacity to perform it, ER doctors must make multiple calls, searching for another hospital that can take the patient.

The process involves explaining the patient's condition and waiting for the receiving hospital to confirm the availability of a surgeon, an operating room, and an ICU bed -- a time-consuming and often frustrating administrative task, he said.

"We are relying on a very traditional and inefficient method for this kind of communication, and there's no guarantee that it will even work," he said.

Meanwhile, Lee Wui-chiang (李偉強), vice superintendent of the Taipei Veterans General Hospital, urged people who were not in real distress to seek emergency care at institutions other than medical centers -- the top-tier hospitals such as National Taiwan University Hospital and MacKay Memorial Hospital.

Lee said going to regional or district hospitals would likely mean faster care, and he hoped that the health care system and the public will undergo positive changes after experiencing the ongoing ER overcrowding challenge.

"A crisis also presents an opportunity," he said.

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