Hospitals take action in the face of a bed shortage

PUBLIC hospitals are so short of beds that they are asking patients to leave earlier or to postpone their operations, just to ensure that they have space for urgent cases, hospital heads say.

Other measures taken include more reviews of patients daily to see if they are ready to be discharged. In the past, this was done once daily, but at most public hospitals, this is now done two or three times a day.

Increasingly, patients whose conditions are classified as non-urgent may need to wait weeks, sometimes months, for treatment.

Some who turn up for scheduled procedures are told their treatment has to be postponed because the hospital is filled to the brim with patients and cannot safely take them in.

The bed crunch is a result of several factors, including an older and larger population and the delay in building a new hospital.

In 2004, the Government decided to scrap a planned 650-bed hospital in Jurong - which was scheduled to open in 2006 - in favour of the Khoo Teck Puat Hospital (KTPH) in Yishun.

This delayed the addition of the much-needed beds. But a new hospital will now be built at a different location in Jurong, and is scheduled for completion in 2014.

Meanwhile, hospitals contacted said they are groaning under the weight of high occupancy rates.

The worst-hit is Tan Tock Seng Hospital (TTSH), with an average occupancy of 80 per cent in January. Last month, a record 624 patients turned up on one day at its accident and emergency department (A&E).

Due to patient numbers, it has had to close its A&E to non-critical cases periodically, and even then has had to park patients in beds along the corridors due to a lack of space. This is in spite of taking back premises from Ren Ci hospital to cope with Sars in 2003.

Professor Philip Choo, who chairs TTSH's medical board, said the hospital has also taken three wards from the new Ren Ci Community Hospital to provide bed space for up to 99 stable patients.

It has also created "express wards" for simple cases like appendicitis, where patients now stay an average of 2.3 days in stead of the previous four.

Changi General Hospital (CGH) too rents a ward from St Andrew's Community Hospital next door. But even this is not enough, said its chief executive officer T.K. Udairam.

He said: "We have experienced over 100 per cent occupancy when A&E was overflowing. In such instances, we put patients in the psychiatric ward where there are usually up to 10 spare beds."

He added that in just three years, the number of very sick emergency patients who are over 80 years old has risen from 20 per cent to more than 30 per cent.

As 85 per cent of CGH's patients come through its A&E, the very old form a significant proportion. On average, they stay 12 days, compared with six for younger patients.

Despite measures by hospitals to tackle the numbers coming through their doors, bed occupancy still hovers around 80 per cent.

At the National University Hospital, a spokesman said it is "not uncommon for our bed occupancy rate to be above 90 per cent" on weekdays.

She added: "Occasionally, for the safety of our patients, we may have to postpone a small number of non-urgent elective operations."

At the Singapore General Hospital, average occupancy last year was 87 per cent. Its acting chief operating officer Loh Yong Ho said it will also "cut the number of electives to ensure we have sufficient capacity for emergency cases".

Such high occupancy rates are untenable for hospitals, which must set aside beds in both the wards and intensive care units at all times for emergencies.

A spokesman for Parkway Holdings, which runs three private hospitals here, said the ideal occupancy rate is between 70 per cent and 80 per cent.

Some relief may come in September, when KTPH opens and adds 555 beds to the 6,000 in the public sector now.    
 
But the relief will only be temporary, predicts Mr Udairam, as the ageing population will put heavy pressure on the call for beds.

In a recent posting on the Health Ministry's Facebook page, Health Minister Khaw Boon Wan admitted that the delay in building a new hospital had a high cost.

"In hindsight, we should have started building KTPH two years earlier," he wrote. "But we cannot change the past. I am determined not to repeat this mistake in the west."