How everyone can help ease Emergency Departments’ load

09/11/2022

The Emergency Departments (EDs) of Singapore are frankly crowded.

Good thing there’s help to alleviate this squeeze. The Government is activating more Transitional Care Facilities and hospitals will no longer set aside whole wards for Covid patients.

And we can do our individual part too — four in ten visits to EDs are for non-urgent cases.

“An expressway with very heavy traffic flow”

Minister for Health Ong Ye Kung outlined these measures for safeguarding Singapore’s healthcare system in Parliament Tuesday (Nov 8).

“I want to assure the House, for critically-ill patients, they are attended to almost immediately at the EDs, due to the way we triage patients and prioritise resources,” he said.

He also noted that for non-life-threatening but emergency cases, the median waiting times for consultation across the EDs averaged about 20 minutes from Jan – Sep 2022.

But during an infection wave, waiting times for cases requiring hospital admission can spike sevenfold — from seven hours to 50.

This results from a mismatched supply and demand of hospital beds; no beds means nowhere for patients to go.

This supply constraint, in turn, is partly due to longer hospital stays from our ageing population. and construction delays resulting from the pandemic.

It is also due to setting aside hospital beds for isolating Covid-19 patients.

“At the peak of the recent XBB wave, we set aside about 800 beds for Covid-19 patients. Ringfenced. About 80 per cent were occupied at the peak of the wave which meant we still had 160 beds unoccupied for contingency purposes,” detailed Minister Ong.

These contingency beds, though not many, impeded caring for other patents..

“We run a very high throughput hospital system. In such a system, even a very small mismatch of demand and supply of a couple hundred beds will cause waiting times to spike up very significantly,” said the Minister

“It is not very different from an expressway with very heavy traffic flow,” he added.

“All it needs is one branch fall on one lane, or half the lane. And you have a massive traffic jam.”

Everyone, clearing time’s coming.

Solution 1: Activating more Transitional Care Facilities

First, more TCFs are being activated.

“The TCFs admit medically stable patients from the public hospitals while they wait for their transfers to intermediate, long-term care facilities, or for their discharge plans to be finalised,” explained Minister Ong.

So these TCFs are key step-down care facilities. They free up acute beds in hospitals.

Three TCFs, providing about 400 beds, already operate in Sengkang Community Hospital, Expo Hall 10 and Crawfurd Hospital.

These are private operators, though, so the Government is stepping up to assure that, yes, public hospitals will help if any clinical help’s needed.

“Without this understanding, TCFs will naturally be conservative in admitting patients and there will be little movement in stable patients,” said the Minister.

“The Sengkang Community Hospital TCF run by Thomson Medical Centre is a very good example. They have a very solid partnership now with Sengkang General Hospital.”

“We will replicate this, to pair up Changi General Hospital with EXPO Hall 10 run by Raffles Medical Group, and Tan Tock Seng Hospital with Crawfurd Hospital,” he added.

And the north and west are not being left out. The Government is actively working on new TCFs there, in order to partner Khoo Teck Puat Hospital and Ng Teng Fong General Hospital respectively.

Solution 2: A flexible use of hospital beds

Second, with most residents now vaccinated (boosted too) and recovered from Covid-19, and having good levels of immunity against severe illness, hospitals will no longer set aside whole wards to cohort Covid-positive patients.

Make no mistake, hospitals will still use isolation beds for patients with infectious diseases, including Covid-19, if they’re clinically assessed to have higher propensity of infection spread, reassured Minister Ong.

“They’ve done so for many years — for influenza, for all kinds of infectious diseases. They will apply the same measures now for Covid-19 but without setting aside entire wards, which will stall their operations.

Then reserving beds and wards helped isolate these patients, reducing the chance of infecting other people.

Now, this updated and flexible use of hospital beds will help solve the bed shortage overall and at the ED in particular.  

The ED’s only for emergencies

And all of us can help too. Massively; about four in ten ED cases are non-urgent ones.

Next time anyone’s ill, then, be judicious. Your friendly neighbourhood GP can be your first point of call.

And keep your Covid-19 vaccinations up-to-date

“Today, a senior without minimum vaccination protection is still about three times more likely to end up hospitalised than one with minimum vaccination protection,” said Minister Ong.

He also noted that you may free up an additional hospital bed when you take another jab to keep your vaccination up-to-date.

So, seriously, don’t anyhow ambulance. Don’t anyhow ED.

“If we can all do our part, we will help healthcare workers earn back their normalcy of life, as they did for us and the rest of society,” said the Minister.

Cover photo credit: TTSH