Tackling COVID-19 and resource challenges as a public hospital

As the main public hospital in Johor, Malaysia, Hospital Sultanah Aminah Johor Bahru bore the brunt of the Delta surge in 2021. Deputy Hospital Director Dr Sharath Chandran shares how the hospital has coped and its future plans for infrastructure improvement.

The surge in patient volume during the pandemic has been a challenge for hospitals worldwide, but more so for public hospitals which handle the bulk of these patients.

For Hospital Sultanah Aminah Johor Bahru (HSAJB), the main public hospital in the Malaysian state of Johor, the Delta surge in 2021 was a challenging period, recalled its Deputy Hospital Director Dr Sharath Chandran.

dr SharathThe 1,200-bed tertiary facility is one of the largest in Malaysia, and acts as a referral medical hub for the southern part of the country, with over 30 subspecialties offered. Serving a population of some 4 million people in the state alone, the hospital has always been busy, even before COVID-19 struck. Dr Sharath estimates that bed occupancy rate hovers around 90% pre-pandemic, and rose to a peak of 97% during the Delta surge.

“At the peak, two-thirds of our patients were COVID-19 patients. We set aside normal ward space to cohort COVID-positive patients, and converted operating theatres to ICUs. Clinics and elective surgeries were put on hold so we can pull manpower in to manage COVID-19 patients.”

Lessons from COVID-19

The shortage of skilled healthcare staff is an issue affecting countries across the world, and particularly in Southeast-Asia, where the World Health Organization estimates that 1.9 million more nurses and midwives are needed by 2030 to achieve ideal health outcomes.

Amidst the pandemic, manpower shortage has become one of the key challenges for the hospital, Dr Sharath noted. However, this is not a problem that can be resolved overnight. Even if new staff were recruited, time is needed to train them to reach the necessary competency.

As such, when manpower was critically short during the COVID surge, HSAJB had pooled staff from the operating theatres and clinic areas, as directed by the Ministry of Health.

After weathering the storm, Dr Sharath believes the hospital is now better prepared to deal with COVID-19 and any new variants that might emerge. For example, while medical equipment was in short supply at the start of the pandemic, HSAJB is now better equipped on this front.

“We now have more medical equipment in place to manage COVID-19, including portable ventilators and oxygen tanks. The situation right now is manageable as compared to the Delta surge last year, and we are in a better shape to manage Omicron.”

Plans to improve infrastructure

Beyond COVID-19 management, a chief work priority at the hospital would be to improve infrastructure that allows it to better manage high patient volume.

This includes digital infrastructure and systems. One example is a bed management system that the hospital has rolled out to track patient movements more easily.

An electronic health record (EHR) system would greatly help the hospital in its operations, said Dr Sharath. The government has plans to introduce an EHR system for public hospitals, as announced under the 12th Malaysia Plan.

“Currently, we have around 1.4 million paper records, which is causing a storage issue. It is also time-consuming to trace and track down the documents,” Dr Sharath explained. “An EHR system would help resolve these issues, and would allow information to be shared easily between hospitals. However, network and hardware infrastructure upgrades would be needed before such roll-outs.”

In terms of physical infrastructure, there are plans for upgrading works such as rewiring to be done at the main hospital building. A new ambulatory centre is also in the works, which would cater to day surgery and outpatient services. This would help relieve the pressure on inpatient capacity, and prioritise hospital beds for those who really need them.

Said Dr Sharath: “Ultimately, these plans are aimed at raising efficiency in our operations. Clinical management and quality standards will improve when these new and improved infrastructures are up.”

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