A survey by an emergency medicine trainee, Kurt Apap, has highlighted the need for increased public awareness about where people should go to seek medical assistance. Many people simply do not know what constitutes an ‘emergency’ (when they should go to Mater Dei’s Emergency Department) or something less serious when they should visit a doctor or health clinic.
This apparent public ignorance has serious consequences for the excellent service at Mater Dei’s Accident and Emergency Department leading to longer waiting times for genuine emergency patients, overcrowding of the emergency department, logistical strains, additional costs and increased staff burnout among nursing and medical personnel already working under severe pressure.
Nearly 7,000 adults, who could have been seen by the patient’s own doctor or at the first-class health clinics now available, have headed instead for the Accident and Emergency Department in the first five months of this year.
Nearly all these – 97 per cent – were sent home after being seen, the clinical chairperson at Mater Dei Hospital, Dr Michael Spiteri, said.
Dr Apap’s survey has exposed the huge gaps in patients’ knowledge about what should be classified as a true emergency.
Among different cases quoted, it transpired that while people would, rightly, seek assistance at A&E for a sudden, ‘worst-ever’ headache, 44 per cent would, however, still instead go to a family doctor or health centre.
On the other hand, half of the respondents to the survey would go to A&E, or call an ambulance, for a twisted ankle or a small laceration wound on their head, when they should instead have sought help from a doctor or health centre.
Local data shows that in 2012 some 70 per cent of patients who went to A&E at Mater Dei were registered as self-referrals – that is people who simply turned up without being referred there either by their doctor or a health clinic – a figure which is more than double the 30 per cent registered in Western Europe.
It was also established that people who went to A&E by ambulance were often misusing the service as an easy way of accessing transport to the hospital or, perhaps, by those who were unaware that their medical complaint was not an emergency in the accepted definition of the term.
The “staggering amount” of self-referrals – amounting to some 280 patients every 24 hours – undoubtedly contributed negatively to all logistical and medical aspects of the A&E Department’s operations, according to Dr Spiteri. The majority are ‘mis-referrals’ who could have been dealt with by their doctor or at a health clinic.
At an average stay at A&E of some four or five hours each, it is estimated that this amounts to 400 extra patient-hours per day.
It is clear that the public needs to become better informed about what constitutes an emergency requiring A&E treatment and what should be treated at primary care level by their own doctor or health clinic. Chest pains, bleeding that cannot be stopped, fever with convulsions and coughing or vomiting blood are obvious cases requiring A&E. But a cough, cold or sore throat, skin rash, flu-like symptoms, or earaches clearly are not.
Overburdening the A&E department inevitably leads to increased waiting times for most patients and detracts from truly needed emergency care.
It is important that the message gets through using all means necessary, from social media to news outlets. After all, A&E is a core service that often shapes people’s perceptions of the whole national health service.