Sunday, January 16

In Norway, almost only the specialists are admitted to the intensive care units. Sweden let in more when the infection ravaged the worst.

Who will be allowed to work in the intensive care units? Oslo University Hospital believes that one must consider how to staff them in the future.

A coronary patient will receive treatment at Karolinska University Hospital in Stockholm in the spring of 2020.

Why is Norway unable to increase the number of intensive care units as much as the crisis plans estimated it could? The debate about intensive capacity in Norway has been going on for a long time.

Access to intensive care nurses is pointed out as the most important reason. These are authorized nurses with special training to treat critically ill or emergency patients.

It is mainly the intensive care nurses and specialized doctors who work in the intensive care units at Norwegian hospitals. This is not the case everywhere. And not when the crisis strikes.

On Tuesday, the website mentioned Minerva how the Swedes solved it at Karolinska University Hospital.

While Helse sørøst informs Aftenposten that nine intensive care nurses are required to operate one place all year round, they manage according to Minerva with five per. bed in Sweden.

Brought in employees from other departments

Karolinska University Hospital has 32 intensive care units in a normal situation without corona, confirms Björn Persson, who is head of intensive care and thoracic surgery at the hospital, to Aftenposten.

When the pandemic peaked in Sweden on April 20, 2020, they managed to increase the number to 139.

Björn Persson at Karolinska University Hospital.

– It was an extraordinary situation. Operations were postponed and employees working in the operating wards, such as surgery and anesthesia nurses, helped in the intensive care unit, Persson writes in an e-mail to Aftenposten.

He says employees worked long shifts under a separate agreement for crisis situations. Persson describes the effort as fantastic.

The upscaling resulted in fewer intensive care nurses per bed as has been taken into account in the crisis plans in order to be able to do the same in Norway.

– When Karolinska increased the number of places from 32 to 139, what consequences did it have?

– The employees were heavily burdened and this autumn the hospital has continued to work on measures for them to recover. The situation did not affect how many survived, but when the situation was at its worst, it was not possible to maintain the same high standard of care for patients as in a normal situation, Persson writes.

Today, Karolinska University Hospital is back to normal with 32 intensive care units. In Sweden, 106 are admitted to intensive care units. There are a few fewer than in Norway now and less than a fifth of what you had at most.

– Should be open to other types of healthcare professionals

– This is like comparing apples and pears, says Dag Jacobsen, head of department and professor at the Department of Emergency Medicine at Oslo University Hospital.

He thinks of the comparison between Swedish hospitals that need five intensive care nurses per. place, and Norwegians who need nine nurses per. place.

Chief physician Dag Jacobsen works at Oslo University Hospital. He believes that it should be possible to open up for other types of health personnel to work in the intensive care units, especially when there is a shortage of intensive care nurses.

In Norway, there are intensive care nurses and regular nurses who work in the intensive care units, says Jacobsen. In Sweden, there are several different types of health personnel.

– At Swedish hospitals, there are also “assistant nurses” (auxiliary nurses with additional education) at the intensive care units. My Swedish colleagues who also work in Norway, say that this works very well, says Jacobsen.

He points out that in other European countries there are even more types of health personnel who work in the intensive care units. In Norway, the types of health personnel who can work at such a sharp department are more limited.

Jacobsen is not in favor of other types of health personnel also being able to work in the intensive care units.

– If there is a shortage over time, then one should open up for other types of health personnel to work in intensive care units, says the department head.

At his department, they have an intermediate solution. In the absence of intensive care nurses, they take in new nurses who are trained internally in the ward.

He points out that in the Norwegian professional communities there is disagreement about which doctors and other types of health personnel should work at the intensive care units.

– We should take this discussion – especially when our intensive care units are in short supply and a possible increased education will only give results over time, says Jacobsen.

Opens to change

When asked directly if it could be done, as in Sweden, to staff with “assistant nurses” at the intensive care units, Anders Beyer, press officer at Oslo University Hospital, answers the following:

– No, not here and now. But in the future we will have to consider other ways of staffing Norwegian intensive care units than is the norm today. This is also something that should be considered in the light of experiences from other countries with which we can compare ourselves.

He says that OUS could have managed to staff in the same way as Karolinska did in April 2020, but that would have affected the quality.

High admission rates

This autumn, Norway has had far more people admitted to the intensive care unit compared with Sweden. Aftenposten has collected figures from the Swedish National Board of Health and Welfare and the Norwegian Directorate of Health showing the number of patients admitted to the intensive care unit with covid-19 detected from September last year.

Until mid-October, the Swedes had more intensive care patients than Norway, but then the hospitalization numbers skyrocketed in Norway.

Reached the pain threshold

In Sweden, the goal is that there should at all times be no less than 20 percent capacity in the intensive care units. But in the autumn of 2020, 13 of 21 regions in Sweden had fallen below this target.

– We have reached a kind of pain threshold, said Taha Alexanderson in the crisis preparedness at the National Board of Health and Welfare, to Swedish Today’s Medicine.

Before the Swedes scaled up the number of places, Sweden had 526 intensive places. Karolinska staffed from 32 to 139 intensive care units.

An emergency plan from April 2020 outlined how Norway’s largest health trust, Health Southeast, can handle more than 2,500 covid-19 patients with about 700 in intensive care.

– The plan described high risk in the implementation and reduced quality in patient care. All planned treatment would be postponed, and no one wants such a scenario, said CEO Terje Rootwelt at Helse sørøsts websites.

In a normal situation, Norway will have 300 intensive care places, according to the Norwegian Directorate of Health. When Norway was closed down in the spring of 2020, it was informed that between 1,200 and 1,400 intensive care places could be put in place. This, however, turned out not to be the case.

A later survey showed that in an exceptional situation, 925 intensive care places can be mobilized. Last year, on the other hand, health director Bjørn Guldvog stated that for a short period, 1,200 intensive care patients can be treated at the same time.

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