The holidays are over and the flu season is reaching its peak impact, exposing once again the serious overcrowding problems being faced by Mater Dei Hospital. Many are rightly asking if this overcrowding is rendering the hospital unsafe for more vulnerable patients.
Overcrowding in hospitals is not just a local phenomenon. In the peak of the flu season, most hospitals in Europe, even in the US, face increased demand for services in their emergency departments and in the wards that treat patients for the various complications of the virus. A lack of inpatient beds for emergency cases remains a major impediment to the delivery of good healthcare.
Hospitals usually aim to ensure no more than 85 per cent of beds are occupied, thus minimising the risk of infections and delays in treatment. This occupancy mark is an internationally-recognised level that hospitals are advised to stick to in order to help manage the risk of infections and to enable them to have spare capacity to deal with major on-the-day emergencies.
Reports that Mater Dei Hospital is at present operating “very close to full capacity”, partly as a result of the outbreak of various types of flu, is indeed worrying. A hospital spokeswoman tried to allay the fears of the public by saying the Accident and Emergency Department was facing a particularly high demand for inpatient treatment. She also confirmed that a small number of patients were kept for some hours at Emergency until a bed was made available in appropriate wards.
This reality of overcrowding at Mater Dei must be tackled with determination, also because it keeps recurring. Improvements in hospital sanitation and better compliance with hand hygiene recommendations are essential in controlling and reducing healthcare-associated infections. However, more fundamental changes are required. The health authorities have a serious obligation to ensure that the hospital has sufficient capacity to handle day-to-day emergencies at all times of the year as well as contingency plans to deal with any extraordinary demand for hospital facilities in case of a major calamity.
Making patients, especially the elderly and people with disability, wait on uncomfortable emergency trolleys in corridors, with sleep deprivation and minimal privacy, is inhumane. Staff shortages, insufficient care facilities for the elderly, funding constrictions, fewer hospital beds than required and increasing demand for new treatments and procedures are contributing to access block at Mater Dei. Two strategies need to be sharpened to reduce this block.
A major focus should be on diverting patients to health centres by providing more services in the community that traditionally occur in hospital. Such services could include hospital outreach programmes and improved after-hours general practice services at the regional health centres.
Another strategy is to optimise bed capacity. Improvements have been achieved to increase the efficiency of healthcare delivery. Initiatives with quick returns have already been taken but further significant improvements need major investment in infrastructure, especially IT and physical capacity to cater for more beds. Additional human resources and more flexible working practices may also be needed.
An overcrowded hospital has to be regarded as an unsafe facility. The health authorities have to decide whether they want a well-managed, adequately-resourced healthcare system where demand is matched to available resources or take the risk of tinkering with stopgap measures that only ease pressure temporarily.
This is a Times of Malta print editorial
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