Nearly 7,000 adults, who could have been seen by their doctor or at a health centre, headed instead to the Accident and Emergency Department in the first five months of this year, increasing waiting time, costs and staff burnout.

Nearly all – 97 per cent – of these patients were sent home after being seen, clinical chairperson at Mater Dei Hospital’s A&E Department Michael Spiteri told Times of Malta.

Dr Spiteri was contacted following a survey by an emergency medicine trainee that showed the need for increased awareness about where to seek medical assistance. Overburdening of the department leads to increased waiting time, detracting from truly needed emergency care. 

Through his survey among 500 randomly selected people, Kurt Apap identified gaps in patients’ knowledge about what classifies as a true emergency.

Among others it transpired that while people should seek assistance at the A&E for a sudden, worst-ever headache, 44 per cent would instead go to a family doctor or health centre.

Meanwhile, half of the respondents would go to the A&E or call an ambulance for a twisted ankle or a small laceration wound on the head, when they should instead seek primary health care. 

The survey also found that over the span of a year, more than a quarter had been to the A&E, compared to half who visited a local health centre.

Dr Apap noted that overcrowding at the A&E was a global phenomenon and demand is forecast to increase further in coming years. 

However, local data shows that in 2012 some 70 per cent (77,571) of patients who went to the A&E were registered as self-referrals. This is well beyond the 30 per cent registered in Western Europe. 

Dr Apap urged people in doubt about the seriousness of a medical complaint to start with their doctor or local health centres, which can refer patients to the A&E when necessary.

People who went to the A&E by ambulance were still seen to according to priority, and unfortunately this service was often misused as an easy access to transport or by those unaware that their medical complaint was not an emergency, he said.

Asked whether self-referrals caused a significant burden on waiting time at the A&E, Dr Spiteri, meanwhile, noted that the number of self-referrals amounted to some 70 per cent of all emergency patients. 

“Although we triage all our patients so that the most serious are given due priority, the staggering amount of non-referred patients – some 280 patients every 24 hours – undoubtedly contributes in a negative manner on all logistical aspects of our operations,” he said.

Apart from the obvious negative contributions in terms of direct increase in waiting times, overcrowding of emergency departments leads to increased staff burnout

“Apart from the obvious negative contributions in terms of direct increase in waiting times, overcrowding of emergency departments leads to increased staff burnout and a significant increase in costs.”

A substantial part of self-referrals are mis-referrals and could have been dealt with at a primary health or outpatients care setting, he said, noting that during the first five months of this year, 18,285 adult patients were triaged at the lowest three levels of a five-tier triage system. 

Three-quarters of these patients were discharged back to the community after being seen and investigated within the Emergency Department. 

At an average stay of four to five hours per patient, this translates into 400 extra patient hours per day.

Dr Spiteri, too, urged people to understand that the department and 112 ambulance service were solely geared to provide a high level of emergency medical treatment aimed at those patients who have a life or limb-threatening condition.   

“Contrary to public perception, those suffering from a chronic or mild ailment will end up having a much better service from a primary or outpatients health care service than from an Emergency Department,” he noted. 

“We can supply a vast quantity of emergency supplies within minutes in a major emergency but we struggle to find a simple off-the-shelf adhesive generic dressing on a day-to-day basis.”

Overcrowding at the Accident and Emergency Department is a global phenomenon and demand is forecast to further increase in coming years.

Where should you go?

A twisted ankle in a 40-year-old: Family doctor/health centre.
Survey answer: 28.2% would go to A&E and 15.7% would call an ambulance.

Thunderclap headache in a 50-year-old: A&E
Survey answer: 44% would go to family doctor/health centre, 33.5% to A&E and 19.5% call an ambulance. 

A small laceration wound/cut on head in a 60-year-old: Health centre.
Survey answer: 33.7% said that they would go to A&E and 14.9% would call an ambulance.

A second opinion on anxiety attacks in a 42-year-old: Family doctor/health centre, with specialist referral if needed.
Survey answer: 30.4% to A&E. 

Long standing worsening of vision in a 60-year-old: Family doctor/health centre with specialist referral if needed.
Survey answer: 6.8% would go to A&E. 

Chest discomfort in a 55-year-old: A&E.
Survey answer: 15.3% would go to family doctor/health centre, 37.1% to A&E and 46% call an ambulance. 

Gastroenteritis in a 28-year-old after eating takeaway food: Patients are encouraged to stay light and drink oral fluids. If symptoms persist, family doctor/health centres.
Survey answer: 26.9% say they would go to A&E.

Worsening depression with suicidal ideations in an 18-year old: Family doctor/health centre for initial assessment and subsequent management.
Survey answer: 83.1% would go to a family doctor/health centre and 11.3% would go to the A&E.