Emergency Room needs urgent treatment

The Accident and Emergency Department at Mater Dei Hospital is chronically flooded with patients, including quite a few – almost a third, figures show – who should not have been there. The vast majority of nurses working in this department have just written to Health Minister Joseph Cassar to complain that conditions in the unit remain unacceptable despite strenuous efforts by the hospital administration to remedy the situation.

This letter concludes with the exhortation that the Health Division needs “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”.

Official statistics show that 18,309 patients visited the Emergency Department in December and January, a 9.3 per cent increase over the same period a year earlier. Fewer than a fourth of such visitors – 23 per cent to be precise – needed admission to hospital and about 30 per cent were not classified as emergency cases. About 50 per cent of the patients required urgent care but did not need to be kept in hospital.

Crowding at Emergency not only occurs because of unnecessary attendances that could be dealt with in primary care by general practitioners or at health centres but also because of bed shortages in the hospital. This delays transfers of admitted patients from Emergency to the wards. Patients, therefore, pile up in the unit and these require medical care because they need hospitalisation.

Such treatment takes place in corridors, which are unsuitable, unsafe, unsanitary and dehumanising because they are totally devoid of privacy. It is evident that patients should not be examined in corridors for obvious reasons of respect and dignity. Moreover, this situation predisposes to cross infections because of too many patients and the use of corridors, a problem that can be dangerous to both patients and staff.

In their letter, the nurses also note that patients may have to sit in chairs for hours if beds are unavailable, exposing them to pressure sores.

The staff at Emergency are naturally stressed. This, in turn, results in trained and experienced staff asking to be transferred, not to mention reporting sick.

Hospital CEO Joseph Caruana admitted that there was more to do adding, optimistically, that the hospital was coping.

One of the strategies adopted consists in transferring patients from Mater Dei to Karin Grech Hospital for rehabilitation, thereby freeing bed space at the main hospital.

This highlights the problems that this newspaper has repeatedly raised.

In the first instance, the hospital has too few beds. It beggars belief that this country built a hospital with fewer beds than the old St Luke’s Hospital. This was done in the setting of an ageing population that will inevitably require more medical care. Such a decision – probably the result of political pique between the two major parties – was greeted with incredulity by the medical profession and the doctors’ union.

A formal and permanent extension of some kind evidently needs to be introduced to Mater Dei, onsite or elsewhere, in order to increase the hospital bed capacity.

Also, if health centres continue to be closed and general practitioners are unavailable, acutely sick patients will have nowhere to turn to except Mater Dei’s Accident and Emergency Department. Health centres should therefore be strengthened and GPs encouraged to be more available through group practices.

Emergency situations demand urgent action, which does not happen by accident.