To help put things in perspective, here are the facts
Please read the story beneath. So it turns out that, far from being inefficient, Mater Dei is actually supremely efficient, performing 19,000 surgical operations in just five months.
I’d like to see any one of the private hospitals coping with that caseload. The private hospitals are very good, but they are not really hospitals at all. They are clinics. We call them hospitals because of their size, but their business and performance model remains that of a clinic. I say this only because it is an important fact to bear in mind when we make odious comparisons between a state general hospital with an A & E department and a client base of 400,000+ people, and a large private clinic with a client base plucked from among a restricted group of persons in the upper income bracket or those with private medical insurance.
The Times, Tuesday, 1st July 2008
Nearly 19,000 operations at Mater Dei in its first six months
Cynthia Busuttil
A total of 18,824 surgical operations were carried out at the new Mater Dei Hospital between its opening last November and the end of May.
Only 18.5 per cent were emergency operations, with the rest considered as elective, statistics from the hospital’s Clinical Performance Unit show.
More than 36,500 patients were admitted to the hospital between November 12 – the day that the first inpatient was wheeled into the hospital – and the end of May. Almost a quarter of patients were day cases.
The figures show a staggering 153,577 outpatient appointments, with 44,311 of them considered as new cases. The figures show that almost 60,000 patients were seen by the Admission and Emergency Department between the time that this department moved to Mater Dei Hospital on November 19 and the end of May.
The highest number – over 13,500 – was deemed the lowest level of urgency according to the triage priority coding used by the department. This is more than double the 6,450 cases deemed of highest priority.
But the figures also listed more than 10,000 cases as “not specified” while another 12,102 bypassed triage. The latter include patients taken to the department by ambulance as well as those who were referred to Casualty from a ward or the Outpatients Department.
Around 4,400 paediatric cases were also seen at the emergency department.
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“Only 18.5 per cent were emergency operations, with the rest considered as elective, statistics from the hospital’s Clinical Performance Unit show.
More than 36,500 patients were admitted to the hospital between November 12 – the day that the first inpatient was wheeled into the hospital – and the end of May. Almost a quarter of patients were day cases.
The figures show a staggering 153,577 outpatient appointments, with 44,311 of them considered as new cases. The figures show that almost 60,000 patients were seen by the Admission and Emergency Department between the time that this department moved to Mater Dei Hospital on November 19 and the end of May.
The highest number – over 13,500 – was deemed the lowest level of urgency according to the triage priority coding used by the department. This is more than double the 6,450 cases deemed of highest priority.
But the figures also listed more than 10,000 cases as “not specified” while another 12,102 bypassed triage. The latter include patients taken to the department by ambulance as well as those who were referred to Casualty from a ward or the Outpatients Department”.
That just emphasises the need of a medical “gate-keeper” service at communal level, in other words, properly equipped and properly functioning health centres, which also care for speciality cases, as is possible and as is practicable.
there is a fundamental flaw in your logic here,
the efficiency of a hospital is not measured by the number of operations done, in fact it is normally quite the opposite, a hospital is more efficient if it obtains better patient outcomes by operating on LESS patients.
You can only measure hospital eficiency by the result, which is patient satisfaction,
and patient satisfaction is maximum when his complaint is dealt with quicker, more efficiently and in the most humane manner possible , and with the least complications and best outcome,and with the lowest mrobidity and lowest mortality.
If these criteria are used instead of numbers of operations, I am sure Mater Dei would not even measure up to third world hospitals.
It would be really interesting (and I say this out of sheer curiosity, rather than disdain or scepticism) to see how many of those 13,500 ‘low urgency’ patients seen by the A and E Department could have been treated just as well by our local polyclinics.
Having spent a good 15 minutes just last week watching a doctor and a treatment nurse patiently pulling out a piece of glass out of my foot, I can testify as to how efficient polyclinics are – at least in this respect.
I’d even say they’re underrated by most people, who seem to think that a grand entrance into A and E is the only way to get proper care. Which explains the impressively short wait before I was seen to at the polyclinic: 20 minutes.
Looks like a very sick country or people are abusing the system and taking it for granted because it’s free.
That is over 150 operations per day.
@All who complain abut Mater Dei
Please read this and see how lucky you are
http://edition.cnn.com/2008/US/07/01/hospital.death.ap/index.html?iref=mpstoryview
@ Leo Said:
The Medical Gatekeepers you mention are already here in the form of polyclinics, which should be seeing to many of those low priority cases listed in the break-down of cases quoted above.
The problem is that some people do not even deign to use the polyclinic service and rush to A & E with whatever it is that ails them, even when what ails them is of the least possible consequence.
When you’ve sat in Paediatric Casualty seeing cases of gastro-enteritis, tonsillitis and simple pharyngitis, you’ll know what I mean.
@ Tri:
And don’t forget the curiosity factor when it comes to Mater Dei. Everyone and his cat (and I should know with a nick like mine!) wants to see the place and get treated there, so that will explain the high rate of low priority cases presenting themselves at the hospital to be seen to.
@Tri – I agree with you about the polyclinics, or health centres. Many of the people I see in the A & E waiting-room should really be at a local health centre, or even at their GP (but that means forking out Lm2). The last time I was there (with my broken wrist), the vast majority had no visible sign of injury. In fact, I amused myself by speculating what might be wrong with them.
@ Moggy
“The Medical Gatekeepers you mention are already here in the form of polyclinics, which should be seeing to many of those low priority cases listed in the break-down of cases quoted above”.
In which case, the questions are whether there are enough “polyclinics” (I prefer “health centres” as a description), whether the health centres are evenly distributed over Malta, whether the health centres are properly equipped and whether specialist (consultant) service is available at health centre level.
Furthermore, it seems to me that patients, as well as the providers in the health service, should urgently improve and refurbish their individual mentality.
It is indeed funny to medically classify cases of gastro-enteritis, tonsillitis, simple pharyngitis in children as a “Paediatric Casualty”, when the respective cases could possibly be better regarded as emergencies.
A medical gatekeeper, the general practitioner, should have enough knowledge to filter respective cases and conditions.
The medical institutions in Malta should seriously consider what kind of medical qualification is necessary before a young doctor sets up private practice.
@ Lino Cert
Sorry to disappoint you dear doctor. Only the last paragraph of my first post came from me, namely:
“That just emphasises the need of a medical “gate-keeper” service at communal level, in other words, properly equipped and properly functioning health centres, which also care for speciality cases, as is possible and as is practicable”.
Hence, it is the only parameter through which you can judge my logic. Please be advised that I was/am aware of the criteria, which you mention with regard to excellence and efficiency in a hospital.
Leo, it’s not their GP who sends them to casualty; they just turn up. An advertising campaign on television would go a long way to sorting out this problem, which is largely due to sheer ignorance.
@ Leo Said:
Judging by the short wait one of the posters actually experienced, I would say the number of polyclinics was enough, don’t you? I can think of at least 4 major polyclinics, and at least 3 smaller ones which see patients during the day.
Polyclinics are well enough equipped to deal with what would be considered as low priority cases in the E & A.
Kindly note: I was not classifying pharyngitis, gastroenteritis and tonsillitis as paediatric casualties. Indeed, what I said is that they are too often seen to in Paediatric Casualty (E & A). Neither is the fact that they turn up at E & A the GP’s (any GP’s) fault. As Daphne has already told you, they just turn up, sometimes even at three in the morning with just a common cold, unreferred, unfiltered and totally under their own steam. That is the crux of the problem here.
What self-respecting GP would refer cases of tonsillitis, pharyngitis or gastro-enteritis to Casualty, Leo?
@ Daphne:
An advertising campaign is a smashing idea.
@ Daphne and @ Moggy
Yes, indeed, public education per audiovisual media. I had in mind to write that but I forgot it in my diligence to be short as possible in my reply.
Xarabank Live, Bondiplus, Realta, Dissett, ViceVersa etc. could start with a common campaign, which would be of benefit to the whole Maltese nation.
Flimkien Kollox Possibli.
@ Moggy
4 or 5 major, well-functioning health centres should eliminate the need for smaller health centres.
The College of Local Council Mayors should take up the idea and promote it accordingly.
Flimkien Kollox Possibli.
@Leo Said
my comment wasnt addressed at your own post but at the original article,
unfortunately my post was published below yours which gives that wrong impression, I’m sorry about that
maybe the moderator can fix this and move my post up to the top
@lino cert
Can you let us know the outcome of your conversation about the little girl with the tumour? Your conversation with the communicstion coordinator at the health department, I mean. I’m curious to hear what someone can say in defense of something like that.
Thks
M
Believe me I am hoping against hope that the whole set up at the Health Centres needs to be overhauled.
There are usually 2 doctors – one just to sign drug prescriptions. Even if he/she has nothing to do and the waiting room is packed the doctor just sits in his office with his arms folded doing nothing.
The other doctor has to
1. Fill up the form required for blood tests
2. Give the result of the tests
3. See to people needing a GP
4. Deal with emergencies
This means that if an emergency comes in he has to go to the treatment room , his room remains empty resulting in more patients accumulating (and still the other doctor sits with his arms folded doing nothing !)
I`m under the impression that at least one Private Hospital has an A & E Dept. Maybe more people who have Health Insurance could be made aware of this and start using it more.
the problem is not enough doctors & nurses to run efficiantly these health centres
@MikeC
“Can you let us know the outcome of your conversation about the little girl with the tumour? Your conversation with the communicstion coordinator at the health department, I mean. I’m curious to hear what someone can say in defense of something like that.”
the communication coordinator asked me accusingly , “X-interess ghandek f’dal-kas?” (whats your interest in this case?) , I said “none” , since I didnt know this girl from Adam, though the mum was obviously distressed, he then gave me a form which I had to get several consultants to sign, saying that this girl could not get her procedure done in St Luke’s, it took me a whole day to get all these signatures, then I went back to the co-ordintator, and after a lot of huffing and puffing and a one hour waiting in a queue outside his office he finally gave me the go -ahead to organise this procedure to be done in a private hospital, this girl had the procedure done next day and the Health Department eventually paid the private hospital for it ,
the next day I handed in my resignation.
@moggy
I dont think that polyclinics are the answer,
when my son was six months old he got a bad chest infection, it got quite bad on the second day, which was a Sunday, and we decided to take him to Gzira policlinic, there was a large queue of people and my son seemed to be getting worse so we decided to go straight to St Luke’s Casualty, as soon as we got into the Casualty my son got a cardiac arrest ( we found out leter this was because his blood electrolytes had gone all hay-wire) , the CPR team were down in seconds and revived my son, I have no doubt that had I joined the queue in the polyclinic my sone would not be alive today, although I am a doctor I am ashamed to say I did not recognise the signs that my baby son was getting very ill and I really think that policlinics are not the place for anything except for minor cuts and grazes.
I don’t think that a chest infection in a six month old baby sould have been seen in a polyclinic either. It was obviously a hospital case from the word go. I am sorry to hear of your ordeal, and glad that your son came out of it OK.
Polyclinics can cater for a bit more than minor cuts and grazes, believe me.
@ Lino Cert
Sadly, I win the impression that you have disqualified yourself to some extent.
Your last message indicates precisely what I wrote above, namely:
“The medical institutions in Malta should seriously consider what kind of medical qualification is necessary before a young doctor sets up private practice”.
Health centres, as centres for primary care/gatekeeper practice, are definitely a solution. It would be however essential that the health centre staff includes doctors with adequate experience. I am/was accustomed to health centres where at least a qualified surgeon, a qualified physician and a gynaecologist are available, even over the weekends.
I admit that the setup was in colloboration with the parent body of medical insurance companies.
The public and the Medical Associations in Malta, as well as the Government of Malta, still have enormous deficiencies with regard to innovative reform.
Health centre doctors are usually doctors who have worked for at least two years in the general hospital. Specialists do attend, but they see cases as per appointment, mornings only. At least that is how I think things stand.
@ Leo Said
my point was that with all the goodwill in the world, it would be impossible to have a policlinic cover all the possible eventualities , and it should not be up to the patient to decide how urgent his case is,
even minor cuts can have serious consequences, for example a badly sutured cut on a child’s face can leave long-term psychological consequences, there is no place for policlinics in a small country like ours, we are very lucky that we have a central hospital that is within half an hour of any place in the island, and it woudl therefore make sense to centralise ALL medical emergencies, however large or small, into one place and have dedicated and experienced staff dealing efficiently and effectively with all kinds of emergencies.
Just a thought!Nothing to do with this subject though.
I was thinking that nobody really knows from where the expression ‘Tal-pepè’ comes.Might have solved this enigma.
It surely comes from ‘pipi’ as some people living in that area have a habit of putting perfume instead of changing their panty?
lol
http://www.maltatoday.com.mt/2008/07/09/t2.html
“Peter Muscat” – (Re your last comment) Kemm waqajt fil-bassezzi u hamallagnijiet. Breeding always outs, doesn’t it?
the way i see it policlinics and mater dei are doing thier best so you go private. my mother whos 66 went to her appiontment (which by the way made the appiontment a year ago)waited for 4 hours just so the docter gave her a telephone number to phone mater dei to make an appiontment there. no wonder her blood pressure went up. what do they think they are?? playing with people. i don’t think they do that to their mother eh??? couldn’t they give her the phone number last year instead of waiting a year for nothing. now lets see how many months she have to wait for this appiontment.