HOSPITAL NIGHTMARE

20 beds, 60-100 patients per day at the Emergency

BY MAVIS NISHIMURA PODOKOLO

The Emergency Department (ED) at the national referral hospital (NRH) sees 60 to 100 patients per day. This is with only 20 beds.

And, this imbalance in service versus patients is doubling, says Dr George Malefoasi, chief executive officer of the NRH.

Mr Malefoasi also indicated that such overcrowding promotes more illness and death.

Dr George Malefoasi, chief executive officer of the NRH

In trying to address this problem, NRH is resorting to med-term solutions such as buying more mattresses for the ED, discharging patients in time at the inpatient wards, and bed-sharing among the in-patient wards.

Recently, concerns were raised on patients having to wait on the floor, or the benches at the nearby outpatient, along the corridor, any space one could lay or sit on.

Replying to enquiries via email on the matter last week, Malefoasi admits that “Bed shortage is an [on]going issue at our main referral hospital here, as it is everywhere in the world”.

“The gap between the demand for health care especial hospital beds is doubling whilst the number of beds are stagnant or reduced due to unforeseen changes,” he explains.

“The Emergency Department is the point of entry of most patients, once seen they are then referred for admission to the in-patient teams depending on severity of illness or given treatment and investigations ordered for follow up.

“The Emergency Department has 20 beds and sees from 60-100 patients in a day.

“The admission rate is 13.6 [percent] from the data in 2020, an increase from 12 [percent] from 2019.

“Admitted patients to the wards at times can spend from [less than] 24 hours to up to [seven] days in the Emergency Department waiting for a bed on the ward.

“This means that new patients presenting that day to the Emergency department may not have a bed as it is already occupied by those awaiting transfer to the ward.

“Studies such as that of Richardson. D (2006). MJA 184.4, have shown that overcrowding in the Emergency increases the chance of morbidity and mortality.”

Also contributing to the problem is what Malefoasi termed as ‘access block’, in which patients referred for admission by specialists in the in-patient wards cannot be provided any free bed there due to ‘no free beds in the wards’.

“This back flow then contributes to overcrowding due to no free beds in the ED and the wards.” Malefoasi explains.

Plans and measures undertaken

“Doctors, nurses along with the management are continuous engaging in monitoring, discussing and finding ways to manage the bed demand and shortage issues as a daily routine as well as longer strategic measures.

“The ideal situation is providing more beds which means building additional wards and so on but this is medium and long tern plan of the Solomon Islands Government.  

“First, at the ED, the management is buying additional mattresses for patients to used whilst proper beds are freed up. Communications among departments and ED will be strengthened, and bed management will be strengthened. Hence, a study on the patient flow in the hospital will be undertaken soon in the few days’ time. The objective is to identify local barriers to effective patient flow and provide recommendations of potential strategies that may more effectively support patient flow.

“Secondly at the moment, at clinical level (wards), nurses and doctors in-charge are ensuring patients are discharged on time. The clinicians ensure the discharge protocols are followed, and a diagnosis is reached quickly and right treatment prescribed as much as possible within their allowed days of stay in the hospital.

“Third, there is a ‘bed sharing measure’ which is activated so that patients from ED could be transferred for admissions on time and help free up beds at the ED. Bed sharing will happen in the wards to allow other department to accommodate other patients and secondly there is a ward space identified for 1-2 beds to accommodate spill over of ED patients without beds. This is short term and temporary measures whilst long term change happened.

“One of measures still at a negotiation and discussion stage with the Doctor at the Good Samaritan Hospital and the Health Director for Guadalcanal province is to relocate long stay patients from Guadalcanal Province there for completion of treatment and management e.g. TB patients and Diabetic patients, which are currently occupying beds.”