Staff shortages and financial problems of neonatology departments in the audited hospitals in the Warmian-Masurian province made it difficult to provide adequate care for newborns. Between 2022 and 2023, neonatology services were stopped several times at the Biskupiec hospital. In Bartoszyce hospital, on the other hand, due to problems with hiring pediatricians and neonatologists, on-call duties in the children's, neonatal and rehabilitation wards were combined. The NIK notes that the difficult situation of neonatal wards, combined with the decline in the number of births in recent years, poses a real threat of closing these wards.
Problems of neonatal care in the Warmian-Masurian province. NIK presents post-inspection report
Published April 5, 2024 09:59
fot. Piotr Wójcik
There is a shortage of neonatologists in hospitals with the lowest levels of reference, NIK auditors have found. The functioning of neonatal wards is adversely affected by the decreasing number of births from year to year. In 2022, fewer than 10,000 babies will be born in the Warmian-Masurian province, 3,000 fewer than in 2019. (just under 13 thousand children). Importantly, the decline in the number of births does not apply only to this province, but to the whole country. According to CSO estimates, 272 thousand children will be born in Poland in 2023 (an 11 percent drop compared to 2022. - 305 thousand births were recorded then). This is the lowest number of births since the end of World War II. Due to the demographic decline, the lack of an adequate number of neonatologists and the financial problems of neonatal wards, some hospitals are temporarily halting the operation of such wards and are even considering closing them.
In the period from September 2023 to January 2024, the NIK inspected six hospitals, including four with the first degree of reference (John Paul II County Hospital in Bartoszyce, Jan Mikulicz County Hospital in Biskupiec. Jana Mikulicza in Biskupiec, SP ZOZ Powiatowy Hospital in Pisz, and Olmedica in Olecko Sp. z o.o.), one (Pro-Medica Hospital in Ełk Sp. z o.o.) having the second degree, and the Provincial Complex Hospital in Elbląg with the highest third degree of reference. The purpose of the inspection was to check how neonatal care was provided in the hospitals of the Warmian-Masurian province. The audit investigations covered the conditions for the provision of services, including the provision of an adequate number of medical personnel and equipment, the maintenance of medical apparatus in technical efficiency and the implementation of contracts concluded with the National Health Fund. The NIK audit revealed irregularities in each of these areas of audit research.
According to the Regulation of the Minister of Health of November 22, 2013 on guaranteed inpatient services, the hospital is required to provide safe conditions for medical care of newborns, including an adequate number of pediatricians or neonatologists. Failure to meet the above requirements resulted in the Biskupiec hospital halting the provision of neonatology services several times, even for a period of several months between 2022 and 2023. The entity tried to recruit medical staff, but without success. In Bartoszyce hospital, on the other hand, due to problems in obtaining pediatricians and neonatologists, contracts were concluded with doctors on a combined working time system. As a result, pediatric doctors worked simultaneously in three wards: children's, neonatal and rehabilitation.
The four hospitals inspected by the NIK did not provide adequate conditions for the implementation of services, as specified in the Regulation of the Minister of Health of March 26, 2019 on detailed requirements to be met by the premises and equipment of the entity performing medical activities. First of all, some of the hospital's premises were not equipped with a sink-and-farthing sluice, lacked beds and a separate room for newborns requiring intermediate and continuous care. In addition, one of these hospitals did not provide an adequate number of infusion pumps.
In two cases, on the other hand, the buildings of hospitals where neonatal wards operated were not subjected to annual inspections, as required by the 1994 Building Law. The Chamber stresses that the assessment of the technical condition of a building, its installations and equipment is of vital importance, as it affects the safe use of the facility.
The NIK's reservations also concerned the maintenance of medical equipment and apparatuses in technical condition. In none of the hospitals inspected was the obligation to carry out technical inspections of these devices properly carried out. Some of the equipment did not undergo inspections at all, and for others the inspections were carried out even several months late. Including in one of the hospitals, medical devices intended for neonatal resuscitation were not inspected.
In addition, most hospitals were unreliably implementing the provisions of their contracts with the National Health Fund. This primarily concerned the obligation to update data in the Information Circulation Management System provided by the NFZ. The irregularities mainly consisted in the provision of services by medical personnel who were not reported to the NFZ. In addition, medical equipment was not reported to the Fund, and diagnostic tests were outsourced to external entities that were not reported to the National Health Fund.
The NIK addressed 16 post-inspection requests to the heads of the audited units, which focused on:
Adaptation of the premises of the hospital, where neonatology services were provided, to the requirements set forth in the Regulation of the Minister of Health of March 26, 2019 on detailed requirements to be met by the premises and equipment of the entity performing medical activities;
carry out technical inspections of medical equipment at the times specified in the technical documentation;
Reliably fulfill the obligation to update data related to the implementation of the contract with the National Health Fund.
Elaborated. on the basis of: nik.gov.pl
