Health Commissioner finds accident and emergency at Mater Dei in deleterious state

Lack of ward rounds, patients left for hours even days on stretchers in wards devoid of privacy, dignity and general hygiene.

The newly-appointed health ombudsman Charles Messina has called for the introduction of a rapid assessment and treatment area inside Mater Dei's accident and emergency department, after finding limited space for the high turnover of patients presenting themselves at the A&E department.

Messina's own-initiative report, carried out in October 2012 and endorsed by Ombudsman Joseph Said Pullicino, said many patients were being left long hours, if not days, on stretchers awaiting admission in a restrictive space "devoid of privacy, dignity, general hygiene", increasing the risk of hospital infection.

Messina said many patients occupying most of the A&E floors waiting for a hospital bed, creating confusion that interfere with the concentration and service delivery of all staff.

The inquiry found that there were just 18 cubicles for the examination and treatment of some 300 patients admitted daily throughout 2012. 31% of patients were defined as very urgent, priority 1 patients; 21% were priority as urgent priority 2 patients while 17% were not urgent, priority 3 patients. The remaining 31% were referred to other departments.

Of these cubicles, 13 were reserved for priority 1 patients who are very sick and in some cases need prolonged medical management, while five cubicles are used for priority 2 patients. Since Area 2 was now being used as a holding bay for priority 1 patients awaiting a hospital bed, priority 2 patients had to be seen in Area 3 together with priority 3 patients.

Priority 3 patients however were deemed that they should not go to hospital in the first instance, and instead should be managed in a primary healthcare setting.

Messina found shortcomings in various areas of A&E:

  • repetition of work where junior doctors (housemen) have to wait for senior doctors to discharge patients, but not enough senior emergency doctors are on call so patients end up waiting longer for a high level assessment: "There were instances when patients were told they were fit to be discharged but had to wait for more than 24 hours for the doctor to go to the ward for his final decision."
  • long waits for ultrasound and CT scans;
  • the acute medical and surgical admission wards are being used as regular medical wards, instead of serving to decant A&E patients;
  • long waiting lists for patients needing a consultant at the outpatients department with the result that some patients go to A&E with the hope of having investigations done urgently.

Possible solutions

Messina said that since Mater Dei is an acute hospital, more beds are needed for patients requiring convalescence, rehab or admission to a home for the elderly. He said that consultants need to see their patients get discarged after the acute phase if over, but this meant that they should have their mind at rest that any after care needed is also being well taken care of.

He also said that surgical and medical acute admissions wards at the A&E had to be made available as they were originally intended, that is, to receive all daily acute admissions from A&E after a primary medical management plan.

Apart from better manned 24/7 health centres, Messina said that junior doctors should be replaced by basic or higher specialist trainees from medicine, surgery and orthopaedics and deployed routinely at A&E after their morning ward work. "They should be the doctors seeing the patients for the first time and they will be assisted by junior doctors, avoiding repetition of work and long waits for senior medical management."

The inquiry also demanded the setting-up of another triage room, increase cubicles and monitored beds, and re-establishing a short-term, high turnover Emergency Observation Ward manned by A&E specialists.

In a reply to the inquiry, health minister Godfrey Farrugia said he recognised A&E issues as a national healthcare priority, and that Messina's observations had also been highlighted by A&E staff and management.

"The ministry views this report as a constructive and positive feedback and proof of the great challenge it has inherited from the previous administration."

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Emmanuel Mallia
There are peoplewho openly said " do not expect our national health service to remain free". A newcommer to the health department said the same thing. Meditate Gente, meditate !
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Emmanuel Mallia
We mention many issues about this problem, except the way nurses are ordered to work by their union. The nurses are very good and dedicated, but is the way they work hampering the service given to patients ?
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Quick its 14:00 Hrs I need to go to the clinic my €50 per quarter hour is more important
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The A&E dept is the shop window of any hospital. Efficiency there means efficiency all over the hospital. Unless the matter is tackled urgently, things can only get worse, with a possibility of collapse of the whole system which is already in a very bad shape with endless waiting lists. The Directors and managers should wake up from their slumber or get down from their thrones and roll up their sleeves to the needs a of the citizens. No amount of letters behind their names can justify this chaos in the health system, which has been accumulating for years!
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Finally somebody is trying to assess the situation as it really is today and has been since this hospital opened its doors to the public where you are not allowed to film the chaos in the emergency department since all the staff members are not responsible. Now we need a full time hosptal which operates on a 24 hour basis not just half a day until 2 after which it resembles a cemetrary since there are no staff around. Well done for your effort now we need results.
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But . . . but . . . that's impossible. Godfrey Farrugia came on television weeks ago and assured that the problems had been solved and there were no queues. He said it with total conviction. Someone is not telling the truth.
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What are we waiting for? We needed more space from day one. It's no use not to admit that which we all knew all along! Get rid of all those spacious foyers where supposedly people may inquire and ask, but left unattended. One doesn't need to be an expert to see that large areas can be utilized for the benefit of patients.
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Naqbel. prosit
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Naqbel. prosit
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That was the state of the art hospital about which PN administration was boasting - why not sack the hospital administration who knew about this state of affairs all along but did NOTHING about it!
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Really ??? Oh boy , the service, cleanliness etc are optimal there. How about paying a visit to Mount Carmel Hospital for example ? If that doesn`t make him puke his guts out i dont know what would.