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New policy at Emergency Department

Patients with minor complaints sent to health centres

People with minor complaints who call at Mater Dei Hospital’s Emergency during the day without a doctor’s referral will be sent to a health centre in line with a new policy. The policy came into place last week through a Health Department circular signed by Mater Dei’s chief medical officer, Natasha Azzopardi Muscat.

With patients already experiencing long waiting times, the Accident and Emergency Department has witnessed increased “walk-ins” – patients who go there instead of to their GP or a health centre.

A “significant increase in daily attendances” was noted, the circular pointed out. Dr Azzopardi Muscat said some individuals referred themselves “inappropriately” to Emergency even when they had minor complaints that could be easily treated elsewhere.

A poster displayed at Emergency’s main waiting area informs patients that if they come without a medical referral and if, after medical triage, their condition is considered to be non-urgent, they will be re-directed to a health centre, according to Dr Azzopardi Muscat.

“This policy was implemented to give Emergency patients more timely care,” Dr Azzopardi Muscat said.

An estimated 9,160 patients went to emergency last month, a 13 per cent increase over February 2011. Of these, 61 per cent were high priority cases that almost all led to admission in hospital.

A total of 2,896 patients were referred by other health professionals or institutions and almost 6,250 were walk-ins.

Almost 1,850 of the self-referred patients were high priority, 1,074 were medium and 946 had conditions considered to be low priority. The remaining patients required treatment in other departments such as paediatrics, obstetrics, gynaecology, ophthalmic and dental, among others.

Of the patients who had a referral, 1,130 were high priority, 786 were medium and 372 were low priority while the rest required treatment in other departments.

While educating the public about the use of emergency would continue, Dr Azzopardi Muscat said other action had to be taken.

Between last Wednesday and Friday, 869 patients called at emergency, including 564 self-referrals.

“There were 41 redirections during those three days,” Dr Azzopardi Muscat said.

The redirected cases were patients who had the “same, non-urgent complaint” for months or years or who wanted an earlier outpatient appointment.

When asked to define “minor complaint”, Dr Azzopardi Muscat said that each one was “taken on a case by case basis” following a medical examination of the patient. “Generally speaking, complaints that would have been there for a period of time are not classified as emergencies,” she explained.

The policy is being implemented between Mondays and Fridays from 8 a.m. to 5 p.m. Only patients who can be treated at health centres are redirected and those with fractures and dislocations are treated at Emergency.

Although it was “possible” that people with minor complaints would start turning up after 5 p.m., Dr Azzopardi Muscat said the policy would have to be monitored for its effectiveness.

What happened if someone required an X-ray?

Dr Azzopardi Muscat said Mosta was the only health centre equipped with a digital X-ray machine linked to Mater Dei Hospital. The service at Mosta is offered between 7 a.m. and 7 p.m. “We are working to try and increase our digital X-ray facilities in health centres,” she said.

“The exercise will be monitored and results will be fed into an audit so appropriate guidelines may be drawn up. This policy will be evaluated and fine-tuned over time,” she added.

Patient safety remained a paramount consideration throughout, Dr Azzopardi Muscat insisted.

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