Updated: Nurses complain conditions at Emergency Dept still unacceptable
30% of cases not classified as emergencies
Video: Mark Zammit Cordina
Sixty nurses at the Mater Dei Emergency Department - 83% of the total - have written to Health Minister Joseph Cassar to complain that conditions at the department are still unacceptable.
The letter was sent at the end of a course in pre-hospital care. It was announced hours after hospital CEO Joseph Caruana said the number of people visiting the Emergency Department was rising, but the hospital was coping thanks to better bed management.
In their letter, the nurses said:
"We would like to take this opportunity to thank you and all those involved in the
organisation of the PHEC course. This was truly a golden opportunity for all of us to improve our practice, learn new skills and update ourselves with the latest
developments within the area of pre-hospital care. We hope for and encourage
further similar initiatives not only in relation to pre-hospital care but also in relation to other areas of our practice.
"However while the provision of training is positive and necessary, the current situation still leaves much to be desired.
"It is very de-motivating for nurses who have been trained so as to provide a better service, to be unable to do so. The lack of appropriate legal structures to safeguard our practice prohibit us from practising what we have learnt and been certified to do.
"At times this can be detrimental to our patients. A typical example is the problem encountered when administration of life-saving drugs is required in the pre-hospital field. The ideal way forward would be to amend the current legislation in order to be in line with current European standards.
"We would also like to take this opportunity to express our concern about the current state of affairs within the A&E department. The most pressing problems of bed shortages, overcrowding, and insufficient human resources to meet current demand are causing undue stress on all of us. We acknowledge that some effort has been noted within the primary care sector to relieve some of the extra load from our department. However these efforts seem to be half-measures or unsuccessful.
"As mentioned several times in the past, patients who have been admitted to Area 2 and the paediatric corridor are being cared for in unacceptable conditions where sanitary facilities are lacking and basic safety is a long forgotten luxury. This situation is having long term repercussions. The overcrowding (22 patients in area 2 instead of 6 patients) is leading to inadequate care delivery and the inevitable situation of cross infection, owing to the type of admissions being catered for in a limited space.
"It is very frustrating to admit a patient who is elderly and frail on a ‘chair’ rather than in a bed. This when considering that such patients would have been waiting for a bed for hours on end. Moreover, this situation puts such patients at increased risks of complications such as pressure sores. Such complications prolong hospital stays and increase the financial burden incurred to care for these patients.
"Additionally this worsens the current bed shortage situation. This bed shortage leads also to prolonged stays in the A&E department of patients who no longer need emergency care. In the meantime, inflow of new patients who require urgent and immediate care continues incessantly. With thirteen nurses in each shift, human resources are stretched to their limit when it comes to providing
care to newly admitted patients to A&E department and those awaiting a bed.
"Emergency nurses have signed this letter to express their concern about the
situation in the A&E department and to bring to the attention of the Health
Department the immediate need to take serious and prompt action. These problems have been highlighted several times but to no avail. Therefore we request that a suitable and long-term solution be found to avoid such situations from continuing to occur, particularly as they are putting patients’ health and nursing staff at risk."
Earlier, Mr Caruana said that while 18,309 patients visited the Emergency Department last December and January combined, 17,782 visited in December 2009 and January 2010. This was a 9.3 per cent increase.
Emergency admissions under the care of medical consultants increased by 8.7 per cent last December compared to December 2009.
However, there was a drop over the same month last year - from 1,421in December 2010 to 1,370 last December.
This reflected a change in practice by hospital staff who worked at the department.
Mr Caruana said that only 23% of those who called at the Emergency Department were admitted to hospital. Around 30% of those who went to the department were not even classified as emergency cases.
Mr Caruana said that although there was more to do, the hospital was coping. He said that patients were being transferred from Mater Dei to Karin Grech Hospital for rehabilitation - thus creating bed space at the former.
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John Scerri
Feb 3rd, 12:52
Q: Are there statistics recording:
1: How many cases were referred to emergency from health centers.
2: How many cases were accepted at emergency because an ambulance was called.
3. How many cases went to emergency on their own accord.
4. How many cases went to emergency after waiting for a long time trying to be their own doctors for thier own children and resorted to emergency after it was too late and things got worse...especially during the night or when it starts getting dark .
5. How many cases could have been sent back home under supervision by family members but for some reason the family members insisted there is noone to take care of their elders.
It is true ....Mater dei cannot cater for a heavy influx of patiences
It is true ...Karen Grech hospital is being used for convalescent patients and social cases.
It is also very true that some medical practitioners take the easy way out and send the patients for x-rays , ultrasound, MRI .... at emergency when their cases are not life threatening.
One must admit and appreciate that every case which is life threatening is always dealt with top priority at Mater Dei...and sometimes patients waiting their do not understand that there is danger when there is chest pain, heavy bleeding, and blocked airways and they must wait for priority first.
All the staff are under pressure and they have also to put up with certain arrogant characters who even threaten them .
All The staff at Mater Dei deserve respect .
Some individuals expect everything and anything , as fast as possible and are ready to grumble and grumble at anything.
Joseph Borg
Feb 3rd, 13:06
1: How many cases were referred to emergency from health centers.
le Sur Scerri ghax meta xi hadd prova jzomm record ta kemm pazjenti jigu riferuti l isptar ghalxejn, gew imwaqqfa immedjatament mil MAM!!!! tafu x qalulhom???? mhux etika li qed tigbru studies fuq kollegi ohra taghkhom!!!
John Scerri
Feb 3rd, 13:45
Dear Joseph ...what you stated is a really symptom of mis management...
When one gathers information in order to make improvements one does this to study a system and not an individual ...It is called a 'method study'
isimha maghha ....'method study' ....you study the method not the individual...you optimise the method and introduce a new more efficient method which is more cost effective .
Unfortunately although many private industries and employers use this type of study to be more competitive and efficient. our governments (all of them) tend to be stuck to the old system where if anything moves it is the indvidual to blame and not the system.
PITY. govt . needs more method study and time and motion study persons ...who could ...using modern LEAN methods to reduce costs.
Joseph Borg
Feb 3rd, 12:29
Let's face it. The real problem is thr primary health care and no one is really doing anything to improve this apart from the usual BS.
Jiena bhala persuna li kont fil qasam tas sahha ghal numru sostanzjali ta snin malajr nista nsiblu miljun soluzzjoni lis CEO kif inaqqas dawk it 30% milli jmorru l emergenza "ghalxejn"
1) Ghammar 3 centri tas sahha MOSTA, PAOLA u FLORIANA sura ta nies li jistaw jahdmu 24/7
2) Ghallem in nurses jaghmlu numru ta proceduri li jsiru l-emergenza jew il privat bhal ECGs u Gibs (Plaster of Paris) baziku
3) Ghamel sistema li l x rays huma available 24/7 f dawn ic centri tas sahha (anki jekk wara nofs il lejl tohloq sistema ta on call bhal ma jigri fil privat)
4) Investi f magni POINT OF CARE li jistaw ituk rizultati tad demm importanti DAK IL HIN STESS bhal ma ghandhom fil privat u sahansitra f certi spizeriji.
5) Nehhu l burokrazija grassa li hemm u meta GP jirreferi persuna ic centru tas sahha xorta jrid jghaddi min tul ta process li mhux neccessarju.
b dan il punti biss li lill gvern jiguh jiswew ftit eluf ta liri biss jaqta dawk it 30% li qed immoru l emergenza ghalxejn u hemm in nurses ikollom alternattiva li mit triage jistaw jigwidaw nies f dawn ic centri biex jiehdu servizz tajjeb, efficjenti u fi ftit hin.
Jiena ma niblejmjax ic cittadin ghax dan huwa scenario li gieli jigri u naf li gara.
Bniedem mar ic centru tas sahha tar Rabat ghax weggha idu, rightly so it tabib tar rabat bghat il pazjent ghal x ray il Mosta, mil mosta min hadlu l xray rega baghtu lura ir rabat, hemmek it tabib saghblu ksur zghir u bghatu l mater dei ghal gibs fejn ghamel 6 sighat ohra jistenna. So in all spicca ghamel madwar 8-9 sieghat jigri l hemm u l hawn biex jiehu servizz dicenti...minkejj ali dan l individwu ghadda mic channels kollha kif suppost. So let's face it....sur CEO tahseb li dan jekk darb ohra jweggha ha jmur ic centru tas sahha???? Nahseb risposta ovvja hux...imur dirett l emergenza halli at least flok 9 sighat jahli 6!!
Dak li jigri meta nies inkompetenti jintefaw jimmangijaw sptar meta ghanqas biss ghandhom ideja kif jimxi sptar u kif timxi kura primarja...sempliciment ghax bil habib ximkien li jista jmexxijhom il fuq.
Barra min hekk let's face it.....HAFNA tobba fic centri tas sahha huma KOMDI li kollox jibqa hekk....u b wicci mil quddiem nghid li gieli certi TOBBA 'ANZJANI' kif jaraw tabib gdid li qed jipprova jaghmel xi haga gdida go centru tas sahha malajr jiklulu wiccu u jghidulu "EJJJ HEMMM DAN MA NAGHMLUHX HAWN TIVVINTAX MODI GODDHA!! IRREFERI GHAL EMERGENZA!!!"
u dan li ghedt huwa kollu stat ta fatt!!! jekk irid xi hadd jiccelingjani fuqu nicalingjah! sur CEO....pero ghal pozi l ewwel niehdu!!!
Ms Maria Vella
Feb 3rd, 12:15
I have, in the past two years, been admitted twice in A&E for fairly serious cases and I honestly can't find fault or complain about the waiting time. Cases are prioritised properly in my opinion and given their due importance. If one goes to A&E for a sprained ankle does that person honestly think they are going to get priority over someone involved in a traffic accident? Let's get real.
I am not saying all is rosy and having patients sitting in a chair for hours is not the ideal situation but do you think this happens only in Malta? well think again because it doesn't.
Instead of complaining perhaps it would be better if we start educating ourselves on how to prevent some accidents and what 'accidents' truly merit a visit to the A&E rather than a polyclinic or a GP
Joseph Goerge Borg
Feb 3rd, 11:26
@ Noel Gatt To be honest I agree with your point. While studying at one of the very advanced northern countries I had to visit the OP Dept of the university hospital after being referred to by the college doctor and I was seen to after four hours.
Moreover my sister used to work at one of London's hospitals and at the emergency had a sign which read: " Minimum waiting time is three hours"
Emergency is an emergency and not to check your blood pressure or because you pricked your finger.
M. Bezzina
Feb 3rd, 10:23
Hemmek inxejjru il bandiera gonz.........l State of d art Hospital
Ms Maria Vella
Feb 3rd, 11:09
Well at least you have a free hospital to go to when you start snivveling with a pathetic cold as quite a few cases do
M. Bezzina
Feb 3rd, 12:46
Mandux x jaqsam ma li qeda tghid sinjura!!!Ghalija jista jamlu bl insurance basta ninqeda ahjar.
C Muscat
Feb 3rd, 09:44
The solution for the health situation is to have 24hour 7day a week service at the health centres.
maria aquilina
Feb 3rd, 09:19
I tried to fix an appointment with an ophthalmologist at Most Health centre.the appointment will be in two years time because there is a very long waiting list.Obviously
It is impossible to wait for so long for a check up.The reason they also gave me is that the ophthalmologist
visits only a morning once a week. Mosta health centre caters for the north of Malta so the clinic is very popular.Is the minister happy with this situation.?Or does he know about the situation?Before starting e-health it is better to have the basics working well.That is why the hospital emergency department is always full.
p he know about this pitiful situation?
Joe Cordina
Feb 3rd, 09:11
How true. One 80 year old relative of mine has just spent two nights on a stretcher / chair at Area 2 as there were no beds. He was not alone of couse, the ward was full to the brim and only one toilet to serve all.
Victor Rodenas
Feb 3rd, 08:49
Mater Dei is small and it will be smaller in 10-20 yrs. time,very old people sitting for hours on a chair instead of a bed is disgusting.Males and females in the same room is something that used to happen centuries ago,it`s unethical.Bad planning,issa rridu nraqqu l-pannu bil-qara hamra.
Mr Joseph Borg
Feb 3rd, 08:42
There is a very easy solution, go back to the time when I was a kid: No one is to be accepted at the emergency without being referred to by a doctor.
Noel Gatt
Feb 3rd, 10:28
Taf x qed tghid?...Din x tip t emergenza tkun!
Is soluzzjoni hija li l staff tal emergenza jkollu ddrit jirrifjuta dawk il kazi li jistghu jinqdew post iehor!
U r responsabilta tal gvern hija li jkun cert li dan il post iehor jezisti 24/7.
Tony Bishop
Feb 3rd, 08:40
I would like to ask the minister when is the eheath.com is going to start all you get when going to the web site is COMING SOON.It was suposed to start 31st Jan.
David Borg
Feb 3rd, 12:23
The web site started on 31st January 2012. The proper link is www.myhealth.gov.mt
Robert Henry Bugeja
Feb 3rd, 07:57
The solutions was there before but this government scrapped it...like he scrapped everything good done under Labour Governments. Open all local health clinics again and make them work properly....around the clock!
Alex Falzon
Feb 3rd, 09:15
Pero jrid ikollok nurisng staff bizejjed. Il-bini facli ttelaw imma nies ma tantx hawn
joseph john magro
Feb 3rd, 07:53
Dear Sir I read with interest the contents of the above article. The inappropiate use of the Accident and Emergency Dept is not solely a Maltese problem . There are solutions , some of which require long term education of the population at large together with the establishment of a robust reliable system of general practice both in and out of hours together with allied community services to include nurses health visitors and appropiately trained community care workers.Regrettably this will take a generation or two to achieve given the conservative stance of the Maltese psyche. Providing more and more hospital beds whilst laudible is not necessarily the correct approach. Several scottish health boards including our own in Tayside have reduced hospital beds and freed monies which have been spent on community services explicitly to try and manage people within own homes and communities.
Patients need to be able to access a reliable system of general practice especially out of hours..a system that is efficient reliable and friendly. This will no doubt eventually tackle the commonly held idea that one needs hospital assessment and treatment at ALL times especially out of hours and eventually dwindle the daily queue at the Mater Dei A/E Dept. Mr Blair's words come to mind Education;Education;Education
Jo Magro OOHS GP jmagro@nhs.net
carmel callus
Feb 3rd, 07:32
And what have they proposed as a possible solution? Nothing!
FRANS H SAID
Feb 3rd, 07:19
There should be a true and practical means test. Those with millions to spare on luxury goods can easily go to private hospitals. These should include the presidents, bishops, ministers et al.
carmel callus
Feb 3rd, 08:53
And also those who have served on government boards, Mr Said!
Justin Psaila
Feb 3rd, 07:08
Recently I had to go to emergency and through my experience people who grumble about long waits and lack of service are just out to complain as they have nothing better to do.
One particular case that I saw with my own eyes was a couple who came in after me and because they waited for 30 mins they for a change complained about the service and funnily enough they blamed the government. Very ridicules stupid in my opinion.
J Degabriele
Feb 3rd, 11:23
Well, you just said "one particular case". When my 92-year old incontinent mother was in the A & E dept. she had to wait for 9 hours before she was first seen by a doctor! And when we asked that she would at least be changed, nothing waqs done about it!!
Lawrence Fenech
Feb 3rd, 06:55
Kif hargu il-persentaggi. Il-persentagg tad-dejn tal-Enemalta mhux possibbli bl'staff kollu li ghandu CMB.
Ganni Macgoogle
Feb 3rd, 02:31
I am always impressed with these comments on health, clearly showing the public knows nothing of what happens in health.
Patients who enter triage area and are tired of long hours of waiting? Are they included in the statistics? Is this a cheeky comment? There is a generalised implied ignorance in this. Triage is a priority assessment. So if you present with a problem in your finger nail, in a national emergency department, every individual that is more serious than you are will be admitted before you. He may come 12 hours later, and still be seen before you. Try faking an appendix and see what happens: will you feel very important when you are immediately shipped into triage and straight into casualty before all the others in the waiting room? I am sure some people would say "ara, dak jaf ir-receptionist!". Come on, get a grip on what really happens before you fire comments. Everyone reads these comments, and people laugh at them. So is it included in the statistics? The point of showing those statistics is to show that emergency department is grossly abused of, its not an occasion to complain about how long you wait to have your petty feelings attended to.
Seeing the doctor of your choice? So you have a free service, which is overextended and can collapse at any point, and you demand the luxury of seeing the doctor of your choice. These are LUXURIES mate, accept it. Free health is NOT your RIGHT, it is NOT your RIGHT. It is a service you get, an expensive one, which sees people who sacrifice time, and family, only to be paid irrelevantly (it may be a lot to you, but compared to other places it is a stupid pay they get). You are lucky to be seen by a doctor, most places in Europe do not even have doctors nowadays, they have advanced nurse practitioners, and you want to be seen by the "doctor of your choice", the "consultant of your choice" even. And what is the reason for this? Is it because "the patient come first"? Yes the patient does come first, and that is why you are getting what you are getting, an expensive service offered free. DO NOT COMPLAIN, because BEGGARS CANNOT BE CHOOSERS.
Joe Julian Farrugia
Feb 2nd, 20:07
Are patients who enter the Triage room but then leave because of the long hours waiting included in the statistics?
Adrian P. Cassar
Feb 2nd, 20:55
One can safely assume that these people didn't need to go to casualty in the first place! I can assure you that nobody who really needs medical attention in hospital would leave!
C Muscat
Feb 3rd, 09:42
Adrian Cassar I had 2 friends (39 years and around 50 years old) that went to emergency did not wait and within 24hours died at home....
Jay Oatmon
Feb 2nd, 18:59
What percentage of emergencies are as a result of drug problems I wonder, or is it unfair/unseemly to ask this question?
Victor Vella
Feb 2nd, 18:57
Recently a colleague of mine was admitted at M.D.H and he remained for five days on a chair at the emergency department without any privacy with other patients. I think the question comes easily. What do one prefers a state of the art hospital or a hospital where the patient is treated like a real human being and not bicca cittadin Malti?. Whenever there is the health of the human being it would be ridiculous to involve politics After all people are paying good taxes for such services..
joe borg
Feb 2nd, 18:56
kwazi zarmaw il health centres naqsu is sodod ta li sptar u llum 2012 johorgu b dawn li staqrrijiet .
in nies li wasluna f da l istat kolla jidru f dal filmat u flok jerfaw ir responsabilita u jwarrbu jinaghtaw il promotions . f dal l istat qeghdin llum . iddur kull fejn iddur !!!!!
C. Sammut
Feb 2nd, 18:22
Surely if one had to take into account growth in population, one can easily forecast a growth in the number of patients in the winter season??
Adrian P. Cassar
Feb 2nd, 20:53
So what?
Of course one can predict that with the increase in elderly population there will be an increase in medical needs. Is anyone in the article saying otherwise?
Ka Busuttil
Feb 3rd, 08:18
No that is not always possible as quite a few patients are "frequent attenders". Patient education is what is lacking - lots of people think the back pain/ cold/ lump on their elbow they've had for weeks is an emergency and visit A&E instead of their GP/ local health centre for this. People are very often unaware what services their GP can offer and what the Health Centres have to offer. But having said that - as long as Primary Health is partially privatised, then people will continue to seek out a free service in hospital. And in the end every maltese wants to be seen by "il profs" despite very good and qualified care being available at your local GP. Attitudes must change!!!
Joe Grech
Feb 2nd, 18:10
May treatment at our hospitals remain for free for ever....but I personally doubt if that's really possible.
On another note: why is it that patients who have an appointment with doctors at Mater Dei, are seen by different persons?
It is certainly not reassuring to see the consultant / doctor hurriedly reading the patient's file there and then and then - possibly - even stopping to ask the patient questions! Why not have the ''consultant of your choice'' - or, failing that the ''doctor of your choice'' at Mater Dei? Can we please reassure patients by having them meet the same doctor? Hopefully this suggestion will be discussed and, if at all possible, taken up.