Smarter emergency care at Saint James Hospitals

Saint James Hospital Group has invested €36m to transform care in Malta’s private health sector, and developed a superior Emergency service with experienced emergency specialists and essential equipment needed to manage most urgent medical conditions. Dr Neville Borg, lead consultant emergency physician at the Saint James Hospital’s ER Department, explains the advances the hospital has made in this crucial area.

Can you describe the advances Saint James has made in Emergency care, and what has been the main driver behind this change?

Over the past three years, one of the key developments has been to support the general doctors with the introduction of experienced specialist doctors within the emergency rooms.

We are now a team of five specialists, including four in Emergency Medicine and one in Family Medicine. Their addition, together with the experience of our existing medical colleagues, has significantly improved the quality of care we deliver.

In parallel, the Emergency Rooms have been restructured to accommodate a larger number of patients, while benefitting from investment in the latest equipment.

How is today’s ER model different? 

Previously, the Immediate Medical Care Unit (IMCU) operated much like a busy GP clinic or health centre, where patients registered and were seen in order of arrival, regardless of their condition.

We have now implemented a tailor-made triage system that prioritises acutely unwell patients, while also flagging high-risk patients to ensure prompt action and reduce the risk of serious issues being missed.

We strive to minimise waiting times, while prioritising those who are unwell, at risk, or in pain. Combined with specialist-led care, and the advanced procedures that have been introduced, this model aligns our department more closely with Emergency Department standards.

What are the services today’s ER can deliver?

Key additions include bedside (point-of-care) ultrasound, which enhances clinical reasoning and decision-making, as well as procedures performed under sedation — primarily orthopaedic operations that previously required formal anaesthesia.

Additionally, certain specialised procedures that were once exclusive to specific specialties are now provided by our ER consultants and specialists.

What is the biggest misunderstanding people in Malta have towards private emergency care?

In urgent care or emergency departments like ours, some patients understandably expect to be seen right away, regardless of the seriousness of their condition.

It is human nature to feel your issue is the most urgent, but our triage system ensures we see those in greatest need first. We work hard to keep waiting times short, but the hallmark of a safe, professional ER is that the sickest patient is seen first.

The Emergency Rooms have been restructured to accommodate a larger number of patients, while benefitting from investment in the latest equipment.

The mentality in the past has been, if it’s an emergency head to the State’s Mater Dei Hospital. What is your view on this?

Our ER is equipped to manage most urgent medical conditions, excluding major cardiac cases, strokes, poisoning, or severe trauma.

For other emergencies, we provide comprehensive care at our hospitals. We’re focused on delivering a full package of care within our hospitals.

With our specialist-led ER service, and experts across multiple medical specialties — complemented by the invaluable support of our skilled nurses and paramedics — we are set up to deliver high-quality care that does away with long waiting times.

What distinguishes Saint James from other private hospitals/clinics when it comes to emergency care?

The primary distinction of our Emergency Room service is the way specialist physicians and senior doctors lead to care for patients across the full age spectrum, from infants over one month of age to the elderly. 

We frequently handle complex cases, including patients with serious infections, such as sepsis, abnormal heart rhythms, and traumatic fractures or dislocations. The number of procedures we offer in ER has expanded significantly over the last few years.

How does the Emergency of Saint James Hospital fit into Malta’s wider emergency-care ecosystem alongside Mater Dei, health centres and the newer 1400 guidance model?

While I cannot speak for national decision-makers, collaboration between public health services and the private health sector has grown, and I’m sure will continue to develop in the coming years.

Significant steps have been taken over the past year, with Saint James Hospital's ER departments playing a pivotal role in this partnership.

We are hopeful that ongoing policy development and new care pathways will further alleviate pressure on Mater Dei Hospital's Emergency Department and offer the public reliable alternatives for urgent healthcare needs.