Emergency wards crowded out by non-urgent cases

The latest National Audit Report says patients at government hospitals generally have to wait a long time for treatment.

PETALING JAYA: For Dr James (not his real name), the look of frustration on the faces of patients who have been waiting for hours at the emergency ward of Hospital Kuala Lumpur (HKL) is nothing new.

According to the latest National Audit Report, patients at government hospitals generally wait a long time before receiving treatment.

The report spoke of congestion at such hospitals due to a spike in patients seeking emergency treatment, as well as a lack of medical equipment, limited space and poor information and communication technology systems.

But James also noted another factor aside from those mentioned in the report.

“There is an imbalance between the public’s expectations and what they need,” he told FMT.

At emergency wards, he said, there are typically three zones coded according to colour: red, yellow and green. At HKL, due to the volume of patients, there is also an amber zone which comes after the red zone.

Patients are grouped according to the severity of their condition. Typically, those in the green zone have a longer wait ahead than those in the red zone.

“The overcrowding at hospitals is mostly in the green and yellow areas,” James said.

“Hospitals will take anyone who walks in, but many who do are not really emergency cases.”

Often, the problem reaches the point where patients appear more concerned about the waiting period than their condition, he added.

A colleague who asked to be known as Dr Sarah said HKL has also been experiencing a drastic increase in number of patients, so much so that medical staff are struggling to cope.

Part of the problem is that many believe they will receive better treatment at major hospitals like HKL.

But there are also those who go to the hospital over problems that can be treated at normal clinics.

“There are those who come here even though they’ve only had a fever for a few hours,” Sarah said. “These are things that a klinik kesihatan can handle.”

Klink kesihatan or health clinics are public primary care clinics.

Sarah said awareness needs to be raised so that people understand what constitutes an emergency instead of using up resources which could be better used on others.

James agreed, saying government clinics could often be more efficient.

“For minor treatments or tests like for jaundice in babies, the klinik kesihatan can run blood samples in minutes, but for hospitals it can take hours because the machines we use run hundreds of samples at a time. We can’t do it one by one.”

However, he said the timing of visits might be problematic as many government clinics only operate during office hours. They do not open all day on Saturday and are usually closed on Sunday.

When contacted, Deputy Health Minister Dr Lee Boon Chye said about two-thirds of patients at emergency wards are non-urgent cases which can be handled at clinics.

“(But) our ‘no wrong door’ policy means that all these non-urgent cases will be seen at the emergency ward,” he added.

He said there are 73 health clinics across the country which operate on extended hours, from 8am until 9.30pm. Twelve of these are in Selangor.

“The fact is, despite these measures there is still congestion,” he said. “It means that additional measures are needed.”

Lee said the ministry would study its options, including the possibility of allocating more resources to emergency wards.

For James, one solution would be for all government clinics to open for longer hours and throughout the week.

He knows this would involve more public funds.

“But I think it would be worth it. A lot of patients or their caregivers now have to take time off work to bring their loved ones to a klinik kesihatan.

“The key, to me, is to increase their access to primary healthcare.” - FMT