Some patients have to wait many hours before a bed can be found

Call it the mystery of the “missing” beds.

At first glance, the figures look reassuring.

The six public hospitals here, on average, say they have occupancy rates in the mid-80s.

This means that for every 100 beds, there should be about 15 empty ones, right? But the reality is different.

Patients are accommodated in beds placed in corridors until space is available in the ward, as has been reported in Tan Tock Seng Hospital (TTSH).

They might have to wait many hours in the Accident and Emergency (A&E) Department before a bed can be found. Or they are told that their non-urgent operation – for example, the removal of a cancer tumour or a hernia – may have to be deferred for weeks or even months.

Health Minister Khaw Boon Wan spoke about the bed crunch last week in Parliament.

He cited one example at TTSH, where 5 per cent of A&E patients waited for more than eight hours for a bed in January, though half got a bed within two hours. TTSH gets more A&E patients – more than 500
a day – than any other hospital in Singapore.

So where are the empty beds?

First, it must be said that hospitals must set aside some vacant beds at all times for emergency cases.

A hospital cannot turn away an ambulance that comes with someone suffering, say, a heart attack.

Said Mr T.K. Udairam, Changi General Hospital’s chief executive officer: “We need to have at least one to two intensive care unit (ICU) beds free every evening in case of bad trauma. We must have the beds available.”

Private hospitals, which need to maximise income, said the ideal occupancy rate is between 70 per cent and 80 per cent. Above that, and they start planning for contingencies.

An average occupancy rate in the 80s, as is the case for public hospitals, is tight by hospital standards.

The occupancy figures also do not tell the whole story. An annual average occupancy rate of 85 per cent means there are days when the hospital is overflowing with patients.

At other times – such as during the recent long Chinese New Year weekend – it may have more empty beds. People understandably do not opt for non-major surgery during the festive period. Which was why, in the second week of February, in the run-up to Chinese New Year, TTSH had an occupancy rate of 75 per cent. This was a far cry from its Januaryaverage of 89 per cent.

Another fact is that occupancy figures are taken at midnight. Patients are discharged the previous afternoon or evening. New ones admitted for treatment come in the following morning. Some are warded after morning operations.

At Changi General Hospital (CGH), for example, patients can be discharged any time up to 10pm.

TTSH’s 89 per cent occupancy rate at midnight includes beds that have been booked by patients who will be admitted the following morning.

But what if these beds are taken up after midnight by emergency cases? It means that those who turn up with surgical appointments the following day might have to have their operations put on hold.

“At 85 per cent occupancy, I begin to worry. I have very little leeway for emergencies,” said Mr Udairam.

CGH gets about 450 patients a day at its A&E department. Fortunately, not all will need to be warded. But even if just one in 10 has to be hospitalised, that is 45 beds needed a day – about 18 per cent of beds at the 790-bed hospital.

If the hospital was 85 per cent full – that is, only 15 per cent of beds are empty – it would not be able to cater to even 10 per cent of its A&E patients.

In reality, about one in five who turn up at the A&E needs to be warded.

Of course, patients come through the A&E at all times of the day or night. So occupancy rates are very fluid and can fluctuate from hour to hour.

In the last week of February, CGH’s occupancy rate was 91 per cent, Mr Khaw said.

CGH sends some of its more stable and less ill patients to the adjoining St Andrew’s Community Hospital on days when it faces very tight bed situations.

The National University Hospital too said that on weekdays, “it is not uncommon for our bed occupancy rate to be above 90 per cent and demand for both private and subsidised beds is high”.

So is Singapore facing a bed crunch? Obviously, the answer is yes.

Does patient care suffer? Patients are not dying because of the shortage, but if delays in treatment are considered poorer service, then the answer is, again, yes.

Will things get better? At least here, the answer is more positive.

When the 555-bed Khoo Teck Puat Hospital opens its wards in September, the severe shortage of beds should ease. And the 700-bed Jurong General Hospital will be up by 2014.