Speaking on the morning show "Terevisioon," Marit Märk, head of the emergency department at the North Estonia Medical Center (PERH), said the decline in emergency room visits is primarily due to a drop in self-referred patients.

Although the emergency department visit fee increased from €5 to €20 on April 1, Märk said this is not the main reason for the decline.

"It's more likely the result of public information efforts we've made in the media — emphasizing that patients should first turn to their family physician or the family doctor advice line where they can get immediate help for milder health concerns. That's where the decision is made about whether an emergency room visit is necessary," Märk explained.

PERH's emergency department sees about 81,000 patients per year. Compared to last year, the number of visits over the past nine months is down 7 percent.

"That's a relatively modest percentage for us, but I still see it as a trend and I sincerely hope the numbers will be even better next year — meaning that primary care will become more accessible and patients will be able to get help from their family doctor," she added.

Since April, specially trained nurses, known as nurse practitioners, working in Estonia's emergency departments have been authorized to treat patients in the green or blue triage categories, which indicate milder conditions.

"A nurse practitioner is part of the emergency care team and is equipped to handle patients with minor health concerns," Märk said. "A patient who comes in with a blue or green triage category and has not been referred by a family physician will first be assessed during triage to determine the category. From there, they'll be seen by a nurse practitioner, who will provide counseling, perform tests if needed and map out the next steps for treatment."

According to Märk, nationwide standardization of triage procedures would help ease the burden on emergency departments.

"Currently, triage only happens in emergency departments, but it could be expanded to the family doctor advice line and primary care or health centers. That way, we'd triage patients using the same criteria across the board and identify those who truly need emergency medical services," she said.

Ahead of the holidays, Märk also urged people to take steps to avoid ending up in the emergency room.

"Keep an eye on how your elderly family members are doing at home and be attentive. Make sure you've picked up your medications so that chronic conditions stay under control during the long holidays. And please drink alcohol in moderation," she said.

Healthcare influencer of the year

Marit Märk was named Medical Influencer of the Year in 2025. Under her leadership, the operations of the PERH emergency department have seen significant improvement. As department head, her first priority was to reduce ambulance crew wait times and relieve system overload — something she quickly realized could only be achieved through hospital-wide cooperation.

Thanks to initiatives led by Märk, nurse practitioners have begun independently receiving patients with milder health issues. This change has reduced wait times, balanced workflow and freed up doctors to focus on urgent cases.

The emergency department has also added physiotherapy consultations, which help trauma patients recover more quickly and reduce the likelihood of repeat visits.

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