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Excerpted from |
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Ministry of Health Information
Paper by Phua Hwee Pin1 |
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Emergency Department services are provided round
the clock at public sector general hospitals viz. Alexandra Hospital (AH),
National University Hospital (NUH), Tan Tock Seng Hospital (TTSH), Singapore
General Hospital (SGH), Changi General Hospital (CGH)2. |
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At Emergency Departments, medical care is not always
provided on a first-come-first-served basis. Patients are prioritised based on
the severity of their medical conditions3. There are generally four
priority levels as shown in Table 1. |
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Table 1: |
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Definition of the 4
Priority Levels used at Emergency Departments |
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Priority Level 1
(P1) - Critically Ill and require resuscitation:
Patients are either in a state of cardiovascular collapse or in imminent
danger of collapse and require immediate medical attention. |
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Priority Level 2
(P2) – Major Emergency: Patients are
usually unable to walk and are in various forms of distress. Although
they appear stable on initial examination and are not in danger of
imminent collapse, the severity of their symptoms requires very early
attention, failing which early deterioration of their medical status may
occur. Examples: Limb fractures and joint dislocation,
persistent vomiting, severe back pain, renal colic. |
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Priority Level 3
(P3) – Minor Emergency: These patients are
able to walk. They have mild to moderate symptoms and require early
treatment. Examples: All
sprains, mild constant abdominal pain, fever with cough for several
days, insect stings or animal bites (patient is not in severe distress),
superficial injuries with or without mild bleeding, minor head injury
(alert, no vomiting), foreign bodies in ear, nose or throat, urinary
tract infections, headaches. |
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Priority Level 4
(P4) - Non Emergency: Example: Old
injury or condition that has been present for a long time. |
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P1 patients are attended to immediately and P2
patients will be seen ahead of P3 patients. P4 patients are attended to after
P1 – P3 cases are cleared. |
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VOLUME OF PATIENT VISITS |
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Total volume by hospital |
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Nearly 500,000 patient visits were recorded at the
five public sector general hospital Emergency Departments in 2004. TTSH’s
Emergency Department had the highest number of patient visits, more than 370
patients daily. AH’s Emergency Department had the lowest number of patient
visits (see Table 2). |
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Total volume by priority level |
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Overall, nearly two thirds of all patient visits
(62%) were P3 cases, while P2 cases made up about a third (31%). P1 cases
account for another 6% of patient visits and a small minority of the
attendances (less than 1%) were classified as P4 cases. |
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The profile of patient visits by priority level at
each hospital is presented in Figure 1a. More than half of TTSH’s patient
volume (52%) were P1 and P2 cases, well above the public sector average of
about 38%. It also has a higher proportion of P1 cases (9%) compared to the
public sector average of 6%. |
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In terms of absolute numbers, TTSH’s Emergency
Department also had the highest volume of P1 and P2 attendances (71,000)
followed by SGH (46,000). P1 and P2 patients require more resources and urgent
attention. CGH had the highest number of P3 patients (91,000), which is 36%
higher than the volume seen in SGH (67,000), which has the next highest P3
attendances. |
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PATIENT WAITING TIMES |
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Estimated Patient waiting time by priority
level |
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The waiting times were obtained from a survey of
patient attendances at each Emergency Department between 1st Nov 2004 and 7th
Nov 20044. |
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P1 Patients |
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P1 patients do not have to wait as they are
transferred directly upon arrival to the resuscitation room for immediate
attention. |
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P2 Patients |
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For P2 patients, following triage, preliminary
treatment (e.g. setting up a intravenous line) is started by experienced
nurses. They are then kept under observation while awaiting definitive
treatment by their doctor. |
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In most hospitals, the median (50th percentile)
and 95th percentile waiting times were less than 30 minutes and 90 minutes
respectively. |
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The exception was TTSH which had the longest
median and 95th percentile waiting time of 47 minutes and 125 minutes
respectively. |
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P3 Patients |
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The median (50th percentile) waiting times in all
hospitals were below 35 minutes, except for TTSH where it was 54 minutes. |
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The 95th percentile waiting times for P3 patients
in TTSH was slightly over 2 hours, while waiting times experienced in other
public general hospitals ranged from 49 to 109 minutes. |
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Conclusion |
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P1 patients need immediate medical attention and
all are attended to immediately upon arrival at the Emergency Department. |
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P2 patients are triaged, started on preliminary
treatment by experienced nurses and kept under observation while awaiting
definitive treatment by their doctor. The Nov 04 survey showed that median
waiting times for P2 patients were less than 30 minutes in all public sector
hospitals except for TTSH. |
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P3 patients’ median and 95th percentile waiting
times were longest at TTSH (54 and 127 minutes respectively) and shortest at
AH (16 and 49 minutes respectively). |
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P1 and P2 patients should seek treatment at the
nearest emergency department. P3 patients would also need medical attention
early but can choose to see their family physicians or attend an Emergency
Department. |
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If P3 patients opt to seek treatment at an
Emergency Department, they may find this paper useful, as they contemplate
which hospital’s Emergency Department to go to. An awareness of the waiting
times experienced by others would also help set their own service
expectations. |
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At the other end of the spectrum, P4 patients do
not require the services of the Emergency Department and should seek treatment
from their GPs or at polyclinics. By doing so, they avoid waiting
unnecessarily or tying up resources at Emergency Departments. |
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More..... (tables) |
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Source:
Ministry of Health Information Paper
2005/07 |
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1
Phua Hwee Pin is a Senior Statistician with the Health
Information Management Branch, MOH.
2
KKH’s emergency department sees only children. NUH also has
a dedicated children’s emergency department. However in this report, for
purposes of comparability, we have omitted these two children’s emergency
departments.
3
Classification is based on the assessment of the initial
complaints and initial provisional diagnoses. |
Waiting times at Public Sector Emergency Departments
