The relevance of the clinical decision observation unit in relieving overcrowding at the A&E department, Mater Dei Hospital, Malta

Abstract

In any given service provision, there exists the possibility of overcrowding, caused by the availability of the limited resources to deal with the relatively high level of demand. The emergency department at Mater Dei Hospital, Malta, is no exception to this. Given the fact that health provision is free for any Maltese citizen, or an EU nationals residing in Malta holding a European Health Insurance Card, together with the fact that Malta has an ageing population, the emergency department at Mater Dei is constantly put under pressure regarding long waiting times as a result of overcrowding. Although measures have been implemented in order to reduce patients’ waiting time, the question of sustainability is still very evident. Therefore reducing overcrowding within the Accident and Emergency department (A&E) at Mater Dei Hospital, Malta, has been considered as being of utmost importance. A possible solution for relieving the overcrowding problem is through the implementation of a Clinical Decision Observation Unit (CDOU). Patients who do not need urgent emergency medical attention are transferred from the emergency department to this unit, rather than occupying the scarce resources available in the A&E. In order to analyse this concept, data was collected using three methods; collection of secondary data highlighting each patient’s length of stay within the CDOU, observation of the core functions of this unit, and personal communication with the front line emergency department staff. This study reveals that through admitting patients who are deemed as “probable discharge” to the CDOU, the main benefit that the A&E will realise is the reduction of bottlenecks caused by these patients. Thus, the overall overcrowding will diminish. Other notable benefits include; having less patients reneging and self medicating, having a safer environment for patients since doctors can now focus on the more urgent patients, an increase in the overall patient satisfaction due to less anxiety and confusion, and a reduction of hospital costs. Since the A&E staff have the critical job of dealing with peoples’ lives on a daily basis, a high level of importance must be placed on improving their work environment. Therefore, recommendations that will contribute to the reduction of overcrowding are outlined. The primary recommendation is to re-instate the CDOU, since it was removed in February of 2017. Secondly, a better logistical flow of patients, meaning a smoother admission of patients from the A&E to the other wards within the hospital, will ensure that patients will spend the minimum amount of time in the department. However, this can only be done if there is an improvement in communication between wards. The final recommendation focuses on the long term care of people in Malta. Malta’s ageing population will only contribute to the unsustainable problem of overcrowding, thus adding more pressure on the department. Therefore, proper investment into the long term care in Malta is necessary.