Getting patients back to the hospital for the care they need

With elective surgeries and procedures delayed during the pandemic over the past year, providing these patients with timely treatments is a key priority for 2022, says Hospital Raja Perempuan Zainab II director Dato Dr Hjh Selasawati Bt Hj Ghazali.

Fully occupied hospital beds and long queues at emergency departments are scenes that we are familiar with during the COVID-19 Delta surge last year.

Although the current dominant Omicron variant is causing less severe disease and lower hospitalisation rates, that doesn’t mean hospital workloads are returning to pre-pandemic levels.

One consequence of the long-drawn pandemic is the backlog of postponed or delayed surgeries and procedures, which were deemed less urgent when hospitals were overwhelmed with COVID patients.

Close management of these cases will be a key work priority for Hospital Raja Perempuan Zainab II (HRPZII), a public hospital in Kelantan Malaysia, said its director Dato Dr Hjh Selasawati Bt Hj Ghazali.

“During the Delta surge, we had around 75% of our resources focusing on COVID-19 and ICU patients. While we continued to treat acute and emergency cases, we had to postpone elective surgeries.”

Her concern is that the delay may worsen outcomes for patients, even if they had presented with mild symptoms previously. Delayed diagnostic tests, such as scopes to detect cancer, may have hindered timely diagnosis.

Ramping up capacity

The hospital has resumed elective services since last October, and capacity has been ramped up to ensure as many patients receive their care as quickly as possible.

For example, the hospital has added more surgery slots, after receiving approval from Malaysia’s Ministry of Health to increase the current operating theatre (OT) operational hours on Saturdays. It has also rented OTs at private hospitals for its specialists to perform surgeries.

“We are now looking at our data to study the impact of COVID on patient outcomes. We anticipate that patients returning for appointments may present with more severe disease,” said Dr Selasawati.

“With our services resuming and more capacity available, we would like to encourage our patients to come back for treatment, especially those who have been afraid to return to the hospital during the pandemic despite their worsening conditions.”

She added that the hospital is now working with non-governmental organisations to engage the community to return for check-ups and treatments.

“The message is for patients and their loved ones to take responsibility for their own health,” she emphasised.

The role of digital in efficiency

Besides surgery capacity, Dr Selasawati shared that the hospital has recently added 10 new ICU beds, which will cater to non-COVID cases, both adults and children.

“This is part of MOH’s project to boost ICU capacity in public hospitals across the country, through building modular ICU beds. Amidst the pandemic, this will help ensure we have sufficient ICU beds for both COVID and non-COVID patients,” she explained.

She shared that efficiency in managing high patient volumes has been aided by digital systems, such as the Sistem Pengurusan Pesakit (SPP), which translates to Patient Management System.

This allows patient information to be accessed and updated in real-time by staff across different departments. For example, doctors can view freshly processed lab results on their devices, when doing their ward rounds or consultations. This is especially critical with the rise of integrated, multidisciplinary care.

In addition, the hospital has numerous digital systems, ranging from Lab Information System, Radiology Archive System (for access to CT scans and ultrasounds), as well as systems that track blood bag levels and critical care capacity.

Looking ahead, Dr Selasawati believes a real-time data dashboard, connecting data from hospitals in its cluster, would help boost efficiency. As the lead referral hospital for a cluster of hospitals in the region, HRPZII receives and directs patients for step-up and step-down care.

“Having information on disease burden, patient volume and trends at each hospital will help us to better plan and optimise our operations. It could potentially remove the need for paper referral letters for inter-hospital transfer, smoothening the process for patients and clinicians.”

There are plans by MOH to roll out an integrated EMR system, which Dr Selasawati welcomes. However, a key challenge lies in how different facilities in the country are at different starting points on their digitalisation journey. Older facilities would need more help, for example upgrades to IT infrastructure, before being able to join the scheme.

Nevertheless, she believes that EMR is the way to go for healthcare. “An inter-hospital EMR would improve information sharing between hospitals, and ultimately ensure more seamless care for patients.”