Emergency rooms in Estonia's larger cities have been struggling with overload for a number of years.

Around six in ten patients who go to hospital emergency rooms do not have serious enough health problems to warrant doing so. As neither information campaigns nor an increase in consultation fees have eased the problem, the Ministry of Social Affairs has now prepared a draft bill that would mean patients can be sent home from the emergency department after a preliminary assessment.

"This is an option, not an obligation. It is not the case that people will now be sent away from the emergency room; everyone will still receive an initial consultation," said Minister of Social Affairs Karem Joller.

"They will receive a recommendation about where to go. The main idea is that people who are seriously ill or have more serious health problems will receive professional help more quickly," Joller added.

In addition to Tallinn's emergency medical services, Tartu and Pärnu are also currently struggling with an overload of patients. According to Joller, the change has been made at the request of the medical staff themselves.

However, in the view of the Estonian Nurse Directors Association (EstNDA) the proposal is ill-considered and could endanger patients.

"The problem is that the current draft repeals the existing triage guidelines, and the ministry is not providing anything in their place," said EstNDA board member Aleksei Gaidajenko.

According to Gaidajenko, the change will result in triage nurses spending at least half an hour longer on each patient in order to properly document their decision to discharge them from the emergency department.

"Triage nurses, whose job is to decide quickly what kind of triage is needed according to the guidelines, will not be able to continue with their work," explained Gaidajenko.

Joller disagreed with the nurses' criticism. In her view, triage nurses are very experienced, and sufficient guidelines are already in place.

"However, if we were to wait for these guidelines to be updated, the emergency rooms would simply not be able to cope with the workload," said Joller.

According to Marit Märk, head of the emergency department at North Estonia Medical Center (PERH), this new option can be applied at times when the workload is very high.

"Neither the regional hospital's emergency department nor East Tallinn Central Hospital's emergency department can serve all the patients who come in on their own. This is because the emergency department operates as a single entity and we serve patients who have been brought in by ambulance. From the regional hospital's point of view, our primary service area is trauma patients and those with ear, nose and throat issues," said Märk.

According to Märk, one in three people who come to the emergency room could get the medical care they need from their family doctor, the family doctor's advice hotline (1220), or a pharmacy. That information is frequently communicated to the person when they arrive at the hospital.

At Tallinn Children's Hospital, most visitors to the emergency room are children with minor health problems. However, the hospital does not plan to start turning them away.

"At the moment, the children's hospital can cope with the emergency room lines, and currently, we do not believe we will go down this route, because children are not just small adults," said Liina Harjus-Soostar, head of nursing and patient experience at Tallinn Children's Hospital.

"Sometimes, parents just need good advice, and we want to take the time to give it to them. Triage may not always be the best option for that," Harjus-Soostar added.

The children's hospital does, however, plan to refer some young patients to a specialist rather than a doctor in the future.

The draft regulation was made public on Monday. The deadline for amendments is Friday, with the changes expected to come into force on April 1.

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