Malta desperately needs ambulatory emergency care

I would like to draw the attention of our healthcare authorities to an article recently published in the Malta Medical Journal, Volume 34, Issue 2: ‘A prospective observational study on emergency medical admissions at Mater Dei Hospital, Malta.’

I co-authored this small study after having witnessed first-hand the benefits of having ambulatory healthcare services during part of my ongoing training in the United Kingdom.

The data analysis suggests that one in every 4.6 patients admitted to a medical bed in Mater Dei Hospital between January 2020 and March 2020 could very well have been managed in an ambulatory emergency setting.

Our burnt-out healthcare professionals need ambulatory care.Our burnt-out healthcare professionals need ambulatory care.

Ambulatory emergency care (or AEC) is a healthcare paradigm in which ‘a significant proportion of emergency department attendees are managed on the same or next day without being admitted to a hospital bed’.

Some variants of this model have already been trialled in Malta, however, a formal AEC unit has never been fully set up.

Our local clinicians have never been able to manage low-risk chest pains, low-risk pulmonary embolisms, non-septic cellulitis, deranged electrolytes or liver function tests, low CURB score pneumonias etc. in an ambulatory setting as the system does not allow for it yet.

In a post-pandemic world, finding novel methods of healthcare delivery will prove to be more important than ever. AEC could be the solution clinicians at the interface between primary and secondary care are looking for.

It would mean a reduction in the number of patients that are admitted to hospital for less than 24 hours, a reduction in bed occupancy leaving more room for the sickest of patients, improved patient flow with less crowding in the emergency department and an overall better patient experience. It is high time we acknowledge that there are better alternatives to the traditional healthcare model we currently deliver (that is, inpatient admission or discharge, with the former being the default option at any hint of risk aversiveness).

Our patients need ambulatory care.

Our burnt-out healthcare professionals need ambulatory care. Our stretched healthcare service now demands it.

Dr Martha Ann Dimech, dual trainee in emergency medicine and intensive care medicine, Health Education Thames Valley, England

The easy way out

From my own experience, professionally and personally, in Court District Sittings, a huge number of police cases deal with cases where there happens to be the alleged accused and his/her victim.

This includes persons who have suffered injuries of a slight nature when involved in a traffic accident, others who have been beaten up etc.

The accused’s lawyer takes on the responsibility to advise his client that, in order to attain the minimum sentence, the easiest way out is to admit to all or part of the offences (some prosecutors dare to drop part of the charges in court behind the victim’s back –happened to me – in order to appease that lawyer’s wish) whereupon the presiding magistrate pronounces judgment on the prosecution’s final declaration.

No wonder the victim will be astonished to hear that the offender has run off from court to celebrate. He/she never knows what is happening inside those four walls as the victims and witnesses are not allowed inside to watch proceedings of their own case.

Why is it that no time is given by the magistrate to hear the victim’s version of events even though a guilty plea has been filed?

And this is the one and only place where justice is supposedly meted out with care and honesty.

It is about time these intricacies are dealt with to save what good is left in our courts.

Anthony Saliba – St Paul’s Bay

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