Health Commissioner Charles Messina has called on the management of Mater Dei Hospital to urgently introduce a rapid assessment and treatment area in the Accident and Emergency Department and to re-establish the medical and surgical acute admission wards to cut waiting time.
In a report on an own-initiative investigation, Mr Messina also recommends the setting up of another triage room and substantially increasing the number of monitored beds and the number of examination cubicles.
He notes that, in 2012, almost 300 patients went daily to the A&E Department, where 91 (or 31 per cent) were defined as very urgent, 63 (21 per cent) urgent, 51 (17 per cent) not urgent and the remaining 91 (31 per cent) were not seen at the department but referred to other departments.
He says that those classified as very urgent were seen within a reasonable time and those who needed immediate care were attended to as soon as they arrived. However, those classified as urgent and not urgent often had to wait hours for medical assessment and treatment. Prolonged waiting times in this group of patients can be hazardous because they have a potential risk of deteriorating while waiting.
He recalls that the reason why such patients are being assessed in this area is that, at Mater Dei, a unilateral administrative decision was taken to use Area 2 as a holding bay for very urgent cases awaiting a hospital bed. Consequently, the patients classified as Priority 2 have to be seen in Area 3 instead of Area 2 as originally planned.
Mr Messina identifies the limited space which precludes the high turnover of patients as one of the main problems. There are 18 cubicles: 13 cubicles for very urgent cases and five for other patients.
There is a significant repetition of work because most of the A&E doctors are junior Foundation Year doctors, formerly known as housemen, who do not take decisions on their own and cannot discharge or admit a patient. Therefore, they have to wait for a senior emergency or senior ward doctor.
Sometimes, patients have to wait long for investigation results from the Medical Imaging Department and Laboratory, thus clogging the already limited space for the examination of patients. This problem is especially acute in respect of requests for ultrasound and CT scans in the night.
There is lack of functional acute medical and surgical admission wards at the A&E Department.
Many patients are being left for long hours on stretchers awaiting admission. Some patients were kept for three days on a stretcher before a bed became available. The restrictive space is devoid of privacy, dignity, general hygiene and this increases the risk of hospital infection.
Mr Messina says that, on average, there are about 50 patients every day waiting to be transferred from Mater Dei to a home for the elderly. There are patients who have been waiting for a year for such a transfer.
There are long waiting lists of patients who need to see a consultant at the outpatients department with the result that some patients go to the A&E with the hope of having investigations done urgently.
Mr Messina notes that, unless more space is created and practices changed, the problem will not be tackled in a sustainable and long-term manner.
Health Minister Godfrey Farrugia said that the public used the A&E department “as a walk-in primary clinic since no tangible or sustainable efforts to provide a good quality, 24/7 alternative primary healthcare system was available”.
“A road map is being planned to solve problems which had been building up within this department since its migration to MDH,” he said.