This Tuesday morning (10), I spoke to the doctor Michael the Archangelboss Hospital da Restauração (HR), the largest public emergency in northern and northeastern Brazil. In this interview is Talking about terms of serviceWith Crowded lanes and lanes on the ground. “Are we going to refuse service? We can’t. This is unacceptable. Often people beat those who work hard and generally nothing happens to those who don’t work, because no one even knows that they can contribute to society,” says Miguel Arcango, who is at Twelfth year as HR Manager. “Society must understand that it’s not our organization’s direct fault that we have so many patients. This is my life, it’s HR. I’ve had critical moments here, but we’re here to help.”
JC – One week after Water pipe leakage and plasterboard falling into the shock unitHow is the hospital with the opening of the back beds by the state government, would the burdens of service have been cancelled?
Michael Archangel – everything Within the normal life. The A neurology emergency is a clinical emergency, one on the ground floor. It is the annex building of the hospital, where the old outpatient clinic opened in 2010. This emergency receives clinical neurology patients and gastrointestinal bleeding patients, as well as those with accidents. Today, we have a number of back beds that have increased a lot; It is a unit close to 80 beds. It caused quite a stir. The number of patients arriving at the clinical emergency remains the same, but we have managed to transfer more (to Hospitals with spare beds, such as the one recently opened in Prado, Western District of Recife). We already had 100 patients in the lanes (in clinical emergencies), and today we have less than 50 patients. You have improved a lot. But the pipe accident happened on the first floor. This is where we come across a trauma emergency – which, at the time, was filled with a lot of patients. So we had to do more to get rid of the burden. The state government is now seeing a proposal to place the former Alpha Hospital (hospital in Boa Viagem, southern district of Recife) as a back-guard in neurosurgery, which has already been deactivated from COVID-19. This is what we need for emergency vent on the first floor.
JC – So, in Pernambuco, there are no spare jobs in neurosurgery?
Michael Archangel – Hospital da Restauração does not have spare beds for neurosurgery. We are the only reference for Neurosurgery in Pernambuco; We have received patients from Petrolina so far, except for other countries. Since we have a hemodynamic service that operates from Sunday to Sunday, and all procedures are performed by hemodynamics, many patients are referred because they have a brain aneurysm, and need to undergo arteriography and dynamic embolization. We are the only public center that does this in the state.
JC – How is the occupation for emergency and trauma today?
Michael Archangel Our Clinical Emergency has a theoretically proven capacity of 110 patients. Today (10th Tuesday) we had nearly 160, an increase of 50%. In the trauma unit, we have a forecast of 120 patients, and we are currently approaching 200 patients. This is the current thing. Clinical emergencies have greatly improved, but they still need improvement. Therefore, we are working on improving the back beds, which are rehabilitated. Prado Hospital, which receives our patients, now has 40 beds. But he has the ability to double the number of beds. But it is necessary to rehabilitate the hospital, which has been disabled. Our patients (from HR Neurosurgery) are very complex and therefore cannot go there yet. Hospital do Trsentinario (in Olinda) has helped us a lot. Regarding these spare beds, as the number increases and, above all, the quality of the bed improves, there are fewer restrictions (to receive patients) because we are able to transport patients. With regard to neurosurgery, it is urgent, general and known that we need spare beds.
JC – How many surgeries are performed in HR?
Michael Archangel – Here at the hospital, we perform about 3,000 surgeries a year. We perform, in hemodynamics, about 500 neurosurgeries annually. Therefore, there are approximately 3,500 neurosurgeries annually. It’s a very large capacity: we have four full-time neurosurgery rooms, however, we cannot meet the needs of the community. In this regard, it is essential that you have a place to take off the burden, as in the case of vascular surgery, a specialty in which we have in the past 50 patients in the emergency room. There are currently less than 20 patients in this sector and the flow is very fast. The same thing happens with shocks. In the vascular room, several large posterior beds were opened, which could receive complex patients. Vacancies have been opened at Hospital Barao de Lucena in Portuguese and at Mestre Vitalino in Caruarro. When opening a family, the HR department doesn’t focus on everything. Vascular were HR and Getúlio Vargas. Traumatology is located in HR, Getúlio and Otávio de Freitas. But neurosurgery is only human resources.
JC – In an effort to resolve the neurosurgery case, how is the communication with the State Department of Health?
Michael Archangel – The Secretary’s suggestion is to open the posterior beds to Neurology at first (which is already being done)Because the neurosurgical patient is the most complex in medicine. Chassis needs. To give you an idea, all of our neurosurgery patients who are electively operated on have dedicated ICU beds. Each microscope we have here cost the state more than 500 thousand riyals. Today, the price has practically doubled. Therefore, it takes time because of money, and everything should have a bid. The Secretary’s proposal (Andre Longo) is to open the posterior family in neurosurgery as soon as possible, and I hope this will be possible within three months.
JC – What is the current size of ICU and ward beds in HR?
Michael Archangel – Regarding vacancies in the intensive care unit, there are 30 years, 20 neurosurgeons, 17 pediatrics. The hospital has 833 beds, taking into account the total number of vacancies, including those in the emergency room, which have patients spending more than 24 hours in the unit.
JC – With nearly a thousand beds, considering the total number of vacancies, the HR department is still collecting patients on stretchers in the corridors…
Michael Archangel – This is the biggest challenge for human resources. When we succeed in opening the back beds, we will service the residents more quietly. Many patients in the emergency room shouldn’t be there anymore. They must spend only 24 hours in this sector, 36 hours maximum, and they are taken out of the emergency situation and allocated to other sectors. In addition, we need other units that do not have an emergency situation to develop more effective work for people’s relief. It’s not just about creating a back bed. There are large hospitals that can make a greater contribution to society. But it all revolves around these big three: HR, Getúlio Vargas and Otávio de Freitas. Capital hospitals have limitations. In the HR Trauma Unit alone, there are more patients in Miguel Aris, Dom Helder and Bilobidas. We understand that residents are complaining, it is their right. In no way did we want patients to be in the lanes designated for traffic. They are not for patient mode, and we are fully aware of that. This is being discussed extensively with the state health department. We don’t share that (having patients in the corridors). At the same time, we also do not have the moral right to refuse to serve the population.
JC – The patient should be received anyway…
Michael Archangel – There, in case of emergency, the so-called “zero vacancy”. Even if the unit is complete, you must bring the patient, because it is the service profile. The citizen has had a stroke or hemorrhagic stroke, he has a brain tumor, gastrointestinal bleeding, and we are crowded. Should we refuse service? We can not. this is unacceptable. People often hit those who work hard and usually nothing happens to those who don’t, since no one even knows they can contribute to society.
JC – How can the problem of overcrowding in HR be solved, with dozens of stretchers and patients in the corridors?
Michael Archangel – It is necessary to install the entrance and increase the exit (patients). And how is that done? First, there is the Hospital Regional do Agreste in Caruaru (Agreste do Estado), with a neurosurgery service with two neurosurgeons on duty 24 hours a day, seven days a week. Unfortunately, this hospital is running very little. It needs a minimum number of accepted surgery. In this way, decentralization can be applied to a good proportion of neurosurgery and trauma patients. Secondly, it is imperative to have a support hospital to receive extra oncology and aneurysm patients who are in HR and have nowhere to go, as they have to wait for surgery queue. Third, university hospitals should start performing highly complex surgeries by all standards. Hospital das Clínicas (HC da UFPE) and Oswaldo Cruz (HUOC) do not perform neurosurgery. In fact, HC even works, but little. There are many ways that can greatly help in decentralizing the work of everything related to human resources. Here we have a park with four CT scanners, one MRI, one hemodynamics unit, eight ultrasound machines and an on-call radiologist 24 hours a day, every day. So any citizen who arrives here after a serious traffic accident, for example, is treated within 20 minutes. He is examined by the general surgeon, vascular surgeon, traumatologist and neurosurgeon, and a full-body CT scan is performed when necessary. So, in short, the problem with HR is not with HR. The hospital is doing its part and doing its job very well. Of course, it always needs to be adjusted, like everything else in life. But the HR problem is in the network, in the system. We try to do the best. Society must realize that it is not the direct fault of our institution to have so many patients.
My life is this, it’s HR. I’ve had awkward moments here, but we’re here to help.
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