Managing the bed crunch in hospitals

This story was first published in The Straits Times on Jan 10, 2014

BED shortages at public hospitals are not new, though rarely have they been this bad - with some patients waiting more than two days to get one.

Each time they occur, new procedures, facilities or stop-gap measures are introduced to meet the growing demand.

Some of the more extreme measures taken in the past decade have seen rooftop gardens converted into wards and beds placed in corridors.

By the mid-2000s, hospitals had made a major change to tackle the problem by introducing same-day admission for surgery. This saved public hospitals 17,000 bed nights a year, as previously patients had to check in the night before they were due to go under the knife.

But in 2006, the flu season sparked a massive influx of patients suffering from pneumonia that filled all the beds at Singapore General Hospital (SGH), Tan Tock Seng Hospital (TTSH) and Changi General Hospital (CGH), with some complaining of a 24-hour wait to get one.

Overcrowding at TTSH resulted in the hospital periodically closing its doors to non-critical ambulance cases, which were diverted to other hospitals.

The Ministry of Health (MOH) said the bed crunch was seasonal. Nevertheless, it planned to add 80 more beds to public hospitals.

There was no let-up in 2007 as Singapore's rising population pushed bed occupancy at some public hospitals beyond 90 per cent.

CGH faced an occupancy of 98 per cent on some days that year and had to take over a ward of 33 beds from St Andrew's Community Hospital next door.

MPs suggested that patients were unwilling to move to a community hospital or nursing home because of heavy government subsidy in general hospitals.

Then Health Minister Khaw Boon Wan assured Parliament that MOH would add 60 to 100 beds a year until the population stabilised. About 150 more were added in 2007.

Hospitals also introduced more day surgeries so patients could spend less time in the wards.

Still there was no let up the following year. In 2008, SGH and TTSH experienced a more than 10 per cent surge in patients at its emergency department, while occupancy rates of over 90 per cent were common across the country.

One patient was even told there were more than 100 people in queue for beds ahead of him

In 2010, TTSH gave a new meaning to the term C-class beds - installing temporary beds in its corridors. It also transferred 80 stable patients to Ren Ci Community Hospital.

SGH, with occupancy of 87 per cent, cut the number of non-emergency surgery to cope with demand. It also discharged patients earlier in the day to free up beds, as did TTSH.

Meanwhile, National University Hospital (NUH) dealt with the problem by offering patients outpatient intravenous antibiotic treatment instead of warding them.

Those with suspected heart problems were sent for immediate tests and warded only if they were confirmed.

It also leased a ward of 30 beds from the private Westpoint Hospital, sending its doctors and nurses there to care for patients.

With CGH juggling with occupancy peaking at 99 per cent, there was a sigh of relief when Khoo Teck Puat Hospital opened its doors early. It filled up almost immediately but eased the crunch on other hospitals.

Also in 2010, SGH leased two wards from Alexandra Hospital that year, manning them with its own staff.

Several hospitals looked to get to the root of the problem and started schemes to help "frequent fliers" - patients who are hospitalised several times a year - stay healthy. They made checks on their health or even sent staff to visit them at home, drastically reducing their need for hospitalisation.

In 2011, one year after the opening of the 550-bed Khoo Teck Puat Hospital (KTPH), public hospitals were faced with more bed shortages. Worst hit were TTSH, CGH and KTPH.

CGH added temporary beds in its therapy areas and sent patients straight for surgery while a bed was being located.

All struggling hospitals sent stable patients without a bed to Alexandra Hospital by ambulance.

TTSH borrowed close to 300 beds from Ren Ci Community Hospital, Ang Mo Kio-Thye Hua Kwan Hospital and the Communicable Diseases Centre. It even turned its decontamination area into a holding place for patients in the emergency department - though this attracted complaints about its cement floor and stuffiness.

The crunch was blamed on the growing number of elderly Singaporeans, who are more frequently sick and need to spend longer in hospital.

By 2012, CGH was sending patients recovering from hip fractures to Peacehaven Nursing Home, where they could continue to be treated by its medical staff.

In a push for greater capacity, it leased a ward of 30 beds from the private Parkway East Hospital and also converted office and shop space - as well as an unused road - into its admission transit area. This gave it space for 25 beds for emergency patients awaiting a ward bed - on top of its observation and resuscitation areas.

KTPH, meanwhile, moved skywards, converting one of its rooftop gardens into a 32-bed ward.

As dengue fever took hold last year, CGH entered into yet another agreement with the private Gleneagles Hospital for it to take in up to a dozen patients with the mosquito-borne virus.

It looks like CGH's problems are continuing unabated after hitting the headlines again a few days ago, having set up a tent to hold up to 15 patients at its emergency department who were waiting for ward beds.

And there is a sense of deja vu as TTSH places beds in its corridors again, and some hospitals send stable patients to Alexandra Hospital.

This story was first published in The Straits Times on Jan 10, 2014

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