A&E units flooded with non-emergency cases

Such cases make up more than half of A&E patients in four public hospitals

Singapore public hospitals' repeated reminders to people not to dash to their accident and emergency (A&E) departments for every little ailment are largely falling on deaf ears.

Latest figures from Singapore General Hospital (SGH), National University Hospital (NUH) and Changi General Hospital (CGH) show that non-emergency patients make up more than half of their A&E cases.

But the worst is at Khoo Teck Puat Hospital (KTPH) in Yishun.

Last year, of the 400 A&E patients it saw daily, about 70 per cent were non-emergency or what the hospitals call P3 (Priority 3) cases.

These are patients with mild ailments, such as a sprain or stomach ache, that can be treated easily by a general practitioner (GP).

The stubbornly high proportion of P3 cases has driven the Government to plan yet another public education campaign for later this year.

It has been doing so for more than 20 years.

The last was in 2010, when a six-month drive stressed that the A&E department is for medical conditions that can result in complications or death.

Every hospital has also taken to installing real-time signs that show the expected waiting time.

Most, like KTPH, have posters as well at the entrance of the A&E department, advising patients to visit their GPs for mild conditions.

CGH, in addition, lets GPs hold teleconferences with an emergency medicine specialist for P3 patients the hospital has referred to them.

But figures show that these messages have yet to sink in.

This, despite P3 patients having to wait from one hour to as long as seven hours to see a doctor, as priority is given to critically ill P1 and P2 (Priority 1 and 2) cases involving say, fractures and persistent vomiting.

Most non-emergency patients tend to be down with low-grade fever, the common cold, a sprain or a muscle strain.

Cleaner Chew Juat Noan, 56, is a typical example. She went to CGH last Wednesday because "my husband felt I should get an X-ray as I've been coughing for three weeks", she said.

Two common examples of non-emergencies are: gastrointestinal problems with symptoms such as diarrhoea and vomiting - a GP can take care of such cases; and upper respiratory infections, like colds, which would usually disappear without treatment.

Hospitals gave several reasons for people making the A&E their first stop for any aches or pain.

KTPH, as the only tertiary hospital in the northern part of Singapore, inevitably becomes the place for residents anxious for a swift solution to their medical problems, said its spokesman.

CGH's emergency medicine chief Mohan Tiru blames the phenomenon on the popular perception that hospitals are a one-stop shop for a comprehensive range of services, and that they provide better care.

Also, patients believe that they will be referred eventually to the hospital. But only about 0.5 per cent of the P3 cases require admission, he added.

Ministry of Health (MOH) figures show that only fewer than 10 per cent of mild to moderate cases need to be hospitalised.

NUH's emergency medicine head, Associate Professor Malcolm Mahadevan, pinpointed the ageing population as a reason, saying more patients with chronic conditions head to the A&E for their minor ailments.

But, the head of Tan Tock Seng Hospital's emergency department, Dr Tay Seow Yian, noted that an elderly person with the same ailment as someone who is younger and healthier would require more attention.

His hospital, mainly for people living in central and northern Singapore, tends to have patients who are 10 years older than those in other parts of the island.

Overall, public hospital emergency attendance is on the rise.

Every year for the past five years, it has been going up by 5.4 per cent, which is an additional 36,000 visits, said an MOH spokesman.

Last year, the six restructured public hospitals treated more than 785,000 A&E cases.

CGH is seeing more P1 cases as well. In 2006, the daily average was 26. Last year, it was 43.

Patients pay a flat fee of about $95 for A&E consultations, which include medicine, basic tests and X-ray services.

While a gradient of fees has been discussed, doctors like Associate Professor Mohan are against it.

"Certain conditions, like heart attacks, need to be treated quickly. Price differentials can cause delays in getting medical help," he said.