NRH moves to ease bed shortage by ordering 71 new beds

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The management of the National Referral Hospital (NRH) and the Ministry of Health today announced immediate measures including the creation of additional bed spaces at the hospital with plans in place for 71 potential additional beds.

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There was outrage after pictures of patients sleeping on the floor went viral on social media and the public is demanding answers for the problem.  

Today the top echelon of the NRH leadership and the Permanent Secretary of Health Pauline McNeil faced barrage of questions from the media as they outlined their plans to address the problem.

They acknowledged that bed shortage is a chronic problem that has not been dealt with over past years but they have vowed to take serious steps to address it though it will be a huge challenge.

CEO Dr George Malefoasi in his presentation admits that the currently the demand for hospital admittance has increased and though the level of basic resources has doubled over the years it is not enough to meet “our needs and we don’t have sophisticated resources to contain the depth or burden of the disease.”

“What is needed is innovation and change and this is something that we have been trying to encourage at the NRH and the ministry as a whole,” he told journalists.

The NRH currently has around 293 beds however the number of those demanding admittance has outnumbered the beds.

“We see sick people coming up in numbers at Outpatients. We also have seen persons who are not very sick who should be seen at the clinics. That’s where the difficulty comes.

“Emergency is overworked, overload and crowded. It is always worst during weekends and public holidays sometimes they reach 40, 60 and recently 86 patients,” Dr Malefoasi said.

Even with high numbers, the Outpatient has only 20 beds.

Dr Malefoasi said at least they can manage about 40 patients at one at the time but when it goes beyond that it is really difficult for his team.

“We always think that one of the reasons is HCC (Honiara City Council) clinics are closed during weekends and public holidays so it makes life really difficult for NRH and when patients come they remain in hospital for more than 24 hours because of the severity of their illness so it leads to access block.

“Access block is something that is blocking the flow of patients in the ward,” he said.

Dr Malefoasi says despite that – the Emergency Department (ED) has already made a target in the Triage and they ensure that they have 3 categories of patients that they needed to deal with before two hours to immediately less than 2 hours.

So what are they going to do?

A statement issued earlier today by the hospital detailed that for the first time, NRH now has a Bed and Patient Taskforce Committee established with the purpose of managing the bed and patient flow within the hospital to ensure minimal time as much as possible from initial examination at ED, to admittance to the wards and discharge. Their tasks involve obtaining overnight the number of patients that needs to be admitted and check all wards for the beds. They also help various departments within the hospital identify beds and help to ensure smooth and swift discharges from the hospital to allow movement and transfer of patients into the wards.

The NRH medical laboratory is now operating on 24 hours basis to enable the doctors to make the diagnosis early and make a plan for medical management of the patients. In that case, a patient can be discharged early, if fit to do so.

A customer patient care service is in place and ready for roll out at the AED. There will be additional staff both nursing and non- skilled staff to help coordinate patient and non- patient movements at the department. They will basically direct patients to their appropriate clinics, and ensure they are seen by their doctors in a timely manner and help with their comforts on wheel chairs and beds.

All departments are also requested to develop their inpatient protocol, which involves accepted length of stay at the hospital wards for a particular sickness in lines with the principles of managed care. Reasons for any extended stay at the hospital will be flagged to the doctors and nurses. Patient discharges will be done no later than 10am each day with clear discharge, medication and follow up plan. Reducing the length of stay of the patients will not only ensure bed availability but also ensure that there are less chances of hospital acquired infections which could further prolong the stay of the people.

Stringent measures to control overcrowding at the AED will be implemented to prevent people from just walking in as always is the case, making it difficult for doctors and nurses to manage patients with diligent and care with duress.

With discharged patients, there is also delays due to waiting on beds for take home medication and transport. This will soon change as two areas have been identified and will be secured and cordoned for patients straight after their discharge.

Other internal short term measures include, creation of additional bed spaces at the hospital with plans in place for 71 potential additional beds. In the long -run, a new hospital to be built as per the NRH business case which is also in progress.

With regards to external measures, the ministry will be consulting with the Honiara City Council (HCC) and Guadalcanal Province for HCC and Guadalcanal clinics to be opened at the weekends to prevent influx of people to the NRH emergency during the weekend which cause crowding in the hospital especially during the weekend.

As part of our efforts to restrict the patients coming into the NRH, they have strengthened Good Samaritan Hospital and X-Rays can now be done there, a laboratory will be functional very soon and talks are ongoing with the hospital to provide isolation beds at the GSH.

The patient flow has also increased because of closure of Kukum clinic and talks are ongoing with the HCC to identify alternate health facility to attend the patients after clinic hours. Work on Naha birthing centre is in progress.

With this, the Ministry is urging the public to minimize as much as possible visitors to the hospital including caregivers to care for the sick. Space is vital in the operations of the hospital especially with the discharge of duties of doctors and nurses. Whilst we work on sorting out waiting area for discharged patients, we kindly request that patients prepare well in advance transport after being notified of the time they will be discharged so beds can be freed up as soon as possible. The patients are also advised to seek medical care early to prevent hospitalization, adhere to other good habits to prevent disease and seek hospital care only if they need it.

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