Recently, media reports have highlighted an influx of patients and longer waiting times in emergency departments (EDs) at hospitals across Singapore,
Recently, media reports have highlighted an influx of patients and longer waiting times in emergency departments (EDs) at hospitals across Singapore, leading to a shortage of available hospital beds. This issue was brought up by nine Members of Parliament (MPs) on Nov. 8, prompting Health Minister Ong Ye Kung to explain the underlying factors and the steps being taken to address the situation.
Shifting Pressures
Ong began by noting that the Omicron Covid-19 variant, which is less severe than the Delta variant, has shifted pressure from intensive care units (ICUs) to regular hospital wards and, by extension, the EDs. This change is also a result of Singapore’s population becoming more resilient to the virus through vaccination.
While many people may feel that the pandemic is nearly over, healthcare workers and hospitals continue to experience heavy workloads. Ong emphasized that, despite most people returning to pre-pandemic routines, healthcare workers are still bearing a significant burden.
To manage Covid-19 as an endemic disease, the government has implemented three main public health measures:
Safe management measures (SMMs) to reduce viral transmission.
Vaccination to prevent severe illness and deaths.
Reliance on the healthcare system to treat and care for infected patients.
As most SMMs have been lifted and the majority of the population is vaccinated, the burden of managing the disease has disproportionately fallen on the healthcare system.
Waiting Times at Emergency Departments
Ong explained that critically ill patients continue to receive priority care in EDs, while those with non-life-threatening emergencies experience a median waiting time of around 20 minutes, which he described as manageable. However, for patients requiring hospital admission, the median waiting time is around seven hours this year, a few hours longer than in 2019. During infection waves, waiting times have spiked to as long as 50 hours.
Ong acknowledged that the situation is unsustainable but difficult to resolve during ongoing waves of infections. Now that the Omicron XBB wave is subsiding, he said it is crucial to diagnose the operational bottlenecks in EDs.
Mismatch Between Bed Demand and Supply
According to Ong, the root of the issue lies in a mismatch between the demand for and supply of hospital beds. While the average monthly ED attendance has decreased by 16% since 2019, the proportion of patients with serious conditions requiring hospital admission has risen by 3%, translating to several hundred more patients per month. Additionally, during peak periods of Covid-19 waves, the demand for hospital beds increases by 30%.
Two key factors are constraining the supply of hospital beds: an aging population, which leads to longer hospital stays, and construction delays caused by the pandemic, which have pushed back the opening of new healthcare facilities like Woodlands Health Campus. Furthermore, hospitals are required to set aside beds for Covid-19 patients, limiting available capacity for other patients.
Ong used a traffic analogy to illustrate the issue: “We run a very high throughput hospital system. Even a small mismatch in bed availability, like a few hundred beds, can cause waiting times to spike significantly, much like how a small obstruction on an expressway can cause a massive traffic jam.”
Adjustments to Address the Issue
To address the problem, the Ministry of Health (MOH) is making two main structural adjustments:
Activating more transitional care facilities (TCF): These privately operated facilities admit medically stable patients from public hospitals who are awaiting transfer to intermediate or long-term care, freeing up acute beds in hospitals.
Moving away from ring-fencing beds for Covid-19 patients: As most people have either been vaccinated or recovered from Covid-19, hospitals will now triage patients based on clinical severity rather than automatically setting aside entire wards for Covid-19 cases.
Ong concluded by urging Singaporeans to exercise social responsibility, seek care from General Practitioners when possible, and keep their vaccinations up to date to reduce the strain on hospitals.
Responses from MPs
MP Yip Hon Weng questioned whether there are sufficient healthcare workers to staff TCFs given the current manpower shortage in hospitals. Ong responded that the issue is being addressed through active recruitment of overseas workers and collaboration with local institutions.
Workers’ Party MP Gerald Giam suggested providing more home support for patients and helping families care for those who are suitable for discharge. Ong agreed, noting that home discharge is an important initiative, although it is manpower-intensive, as nurses are required to visit patients at home.
Top photo from MCI and Zhangxin Zheng
COMMENTS