SINGAPORE, Nov 9 — Health Minister Ong Ye Kung yesterday (November 8) announced measures to ease crowded hospital emergency departments, a situation he called “not sustainable”. One measure is that hospitals will no longer “cohort” or set aside whole wards for Covid-19 patients.
In another move to address the bed crunch, the Ministry of Health (MoH) will activate more transitional care facilities, which are step-down care facilities that admit medically stable patients from public hospitals while they wait to be discharged or transferred to intermediate, long-term care facilities.
Ong was speaking in Parliament in response to questions from Members of Parliament (MPs) about long waiting times at emergency departments.
He emphasised that critically ill patients who turned up at emergency departments were “attended to almost immediately due to the way we triage patients and priorities resources”, referring to the process of medical workers assessing and prioritising patients based on how urgent and serious their conditions are.
From January to September this year, the average waiting time for non-life threatening but emergency cases to be consulted was about 20 minutes across the emergency departments, he said.
Over that period, the average ward waiting time for emergency cases that required hospitalisation was about seven hours. This is “a few hours longer” compared to before the Covid-19 pandemic in 2019.
During infection waves, waiting times can rise sharply, even up to 50 hours.
Ong also said that the longer waiting times and crowdedness at emergency departments are a result of a mismatch of supply and demand of available hospital beds.
Some of the factors constraining the supply of available beds are a high number of older patients with longer stays, and delayed construction of more healthcare facilities due to the pandemic.
“Ring-fencing” or setting aside hospital beds for the care of Covid-19 patients for contingency purposes has also left fewer beds for emergency department patients.
To address the supply problem of available beds, MoH will activate more transitional care facilities to free up more beds for emergency department patients.
For now, three transitional care facilities are already in operation by private providers, with a total of about 400 beds.
Last August, Ong had said that in the event of an infection wave, a transitional care facility can also become a Covid-19 treatment facility for lower-risk patients.
During the recent infection wave caused by the XBB Covid-19 variant, the transitional care facilities were also used as a step-down care facilities for non-Covid-19 patients, including those who might be staying in the hospital and waiting for nursing home places.
Another measure is that hospitals will no longer reserve whole wards to house Covid-19 positive patients.
“We are now at the stage when most residents (in Singapore) have been vaccinated and boosted and recovered from Covid-19, and have good levels of hybrid immunity against severe illness.
“We should therefore allow hospitals to triage or assess their patients based on clinical severity and priority for treatment, and not manage Covid-19 patients to a different standard,” Ong said.
MP Lim Wee Kiak of the Sembawang Group Representation Constituency (GRC) then asked about the number of available beds if hospitals stop housing Covid-19 positive patients in dedicated wards.
To this, Ong said that typically, about 160 beds would be reserved during peak-infection periods, and around 200 to 300 beds during non-peak periods.
Ong added that steps will also be taken to resolve crowdedness at emergency departments.
Hospital clusters are working with MoH to reduce the crunch at emergency departments by providing primary care and alternative pre-hospital care options such as urgent care centres.
Other measures include educating the public to use these departments only for emergencies, and working with the Singapore Civil Defence Force to divert less serious cases to nearby primary care clinics.
In a supplementary question from MP Gerald Giam of Aljunied GRC, he asked whether the ministry could look into providing home care facilities since some patients are not discharged because the downstream care facilities are not available to accommodate them.
Ong replied that MoH was looking into home discharge as a way to free up bed spaces in hospitals.
However, he said that providing home care is manpower-intensive, such as having nurses to visit patients at home regularly for health check-ups, which adds to nurses' workload.
While MoH continues to take structural measures, Ong said that the public should also exercise individual responsibility, such as staying home and self-testing when unwell, and using emergency departments for emergencies only.
He noted that emergency department attendances had fallen compared to 2019, but non-urgent patients still make up about 40 per cent of cases at such units. ― TODAY
