Long waits at A&Es despite more beds

Tan Tock Seng Hospital has the busiest emergency department in Singapore, and when there is overwhelming demand for the service, patients may have to wait longer for treatment and admission.
Tan Tock Seng Hospital has the busiest emergency department in Singapore, and when there is overwhelming demand for the service, patients may have to wait longer for treatment and admission.ST FILE PHOTO

But addition of 2,500 beds has helped ease space crunch, with another 2,000 by 2020

Some patients still have to wait more than eight hours for a bed at Tan Tock Seng Hospital (TTSH), but overall, the crunch at public hospitals has eased since the days in 2014, when patients were housed in tents or put in covered carpark areas.

Some 2,500 beds have been added to public hospitals over the past three years, raising the total capacity to 10,500 beds. But when demand spikes, patients still have to be put in beds along corridors, with just curtains to give them privacy.

A Ministry of Health spokesman said the average bed occupancy at public hospitals had gone down from 88 per cent in 2013 at the height of the bed crunch, to 85 per cent last year. Last month, however, occupancy rates were hovering around 88 per cent.

Rates above 80 per cent are considered very high and can result in a shortage of space as not every bed is available for general use. The total bed count includes those in intensive care, which has beds for emergencies. Some beds are set aside to isolate patients with contagious diseases, while beds in paediatric wards are reserved for young children.

The latest available figures - for the last week of March - saw TTSH, which has the busiest emergency department (ED) in Singapore, with about 3,000 patients a week, having occupancies above 97 per cent on two days. It had a weekly rate of 93.3 per cent.

A TTSH spokesman said: "At times, when there is overwhelming demand for our ED services, some patients with less critical conditions may have to wait longer for treatment and admission."

For two days in the week in question, half of the hospital's patients had to wait more than eight hours to get a bed.

The spokesman said: "In those situations, our patient ambassadors and nursing staff will strive to attend to concerns of the patients and caregivers, and to seek their understanding. Patients who do not require emergency care are advised to seek medical attention at the polyclinics or GP clinics."

The space crunch is not limited to TTSH. The Ministry of Health spokesman noted: "Certain regional hospitals such as Changi General Hospital (CGH), Khoo Teck Puat Hospital (KTPH) and TTSH may experience higher bed occupancy rates from time to time."

All three hospitals, which have busy EDs, frequently see occupancy rates of over 90 per cent, and sometimes need to send stable patients to other hospitals to free up beds.

A spokesman for CGH said four in five of its beds are taken up by patients from the ED. This fluctuates, with surges following a public holiday. Patients who have to wait in the ED for a bed in the wards "continue to receive treatment, nursing care, clinical monitoring and other services".

She added: "Facilities at the ED include the Observation Ward and the Short Stay Unit, which enable the care teams to observe and treat patients who may not need an inpatient stay."

A spokesman for KTPH said: "To better manage variations in bed occupancy, Khoo Teck Puat Hospital has expanded its Early Diagnostics and Treatment at the Emergency Department."

This allows patients to be observed for up to 24 hours and treated without having to be admitted to a ward.

Although the median age of patients in public hospitals has gone up to 57 years, from 54 years in 2013, their stay in hospital remains consistent at about 5.8 days.

The ministry spokesman said more than 2,000 hospital beds will be added by 2020.

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A version of this article appeared in the print edition of The Straits Times on April 07, 2017, with the headline 'Long waits at A&Es despite more beds'. Print Edition | Subscribe