"In Singapore, within half-an-hour, you would be in SGH (Singapore General Hospital), TTSH (Tan Tock Seng Hospital) and within one-and-a-half to two hours flat, you'd know what went wrong."
- Lee Kuan Yew, TODAY, November, 2003
Recently a friend of mine (we’ll call her ‘Esther’) was admitted to the Accident and Emergency (A&E) department of the Singapore General Hospital (SGH).
Esther had earlier seen her GP who recommended that she consulted doctors at SGH to determine the cause of her illness.
Registration – 8.40pm
The registration at the triage section of the A&E’s Isolation Ward (IW) was smooth and swift and went without a hitch. The triage nurse was courteous, friendly and apparently highly efficient. We thanked her and took our seats at the waiting area for Esther’s number to be called by the doctor on duty that night.
It was about 8.40pm.
The consultation with the doctor eventually took place at around 10pm – after some 1 hour 20 mins later. Esther was told that she had to be admitted for overnight observation so that more tests could be done to ascertain the cause of her illness.
So, we returned to the waiting area and waited for Esther to be assigned a ward and a bed. In the meantime, a nurse told us that they would find a bed in the IW for Esther to rest temporarily, instead of sitting on the chairs in the waiting area, which was an exercise in endurance for someone who is ill.
It turned out to be a frustrating, excruciating and a very long wait indeed.
At 12.20am, some 3 hours and 40 mins after Esther had registered at the A&E, I approached the triage nurse and asked if they were aware that Esther was waiting for a bed in the IW. (In all those 3 hours 40 mins, we were not informed or updated about when a bed might be available.)
The nurse was very understanding and explained that there were no beds available and that there was nothing they could do. And so the wait continued.
12.50am – 4 hours 10 mins
At 12.50am – 4 hours and 10mins after registration – we were finally informed that a bed was available in the IW's Fever Zone. The relief – and exhaustion - on Esther’s face was evident. She would be able to rest her tired self finally.
The “Fever Zone”, where the temporary beds were, is a small section within the Isolation Ward. It has two rooms – one for male patients and one for female patients. Each room could hold about 6 to 7 beds. The Fever Zone is the place where patients who have to be warded are temporarily placed while waiting to be admitted to the wards of their choice.
Esther had opted for a B2-plus ward (5 patients in an air-conditioned room).
We were hopeful that we wouldn’t have to wait just as long for Esther to be assigned a bed in the B2-plus ward. The IW ward has its television and lights on 24-hours and patients are wheeled out to the wards and new ones wheeled in, a situation which doesn’t really allow one to rest properly amidst the noise and the comings and goings.
Our hope was misplaced.
The long wait was to last till the next day.
9pm – 24 hours 20 mins
At about 9pm on Day Two – 24 hours 20 minutes after registration - Esther was informed that a B2 bed was available and the nurse asked if she wanted it. As a B2 ward is non-air conditioned, as opposed to a B2-plus ward, Esther declined. (See here)
The reason why she declined is because we suspected that Esther might have to stay quite a while in the hospital (as she already had 2 previous unsuccessful blood tests, one at a private hospital and the other with her GP) and because of her constitutional sensitivity to warm temperatures we decided to wait for a B2-plus bed.
Thus, we waited a further 3 hours.
12.50am – 28 hours 10 mins
At about 12 midnight, a nurse informed us that a B2-plus bed was available. Preparation was then made to transfer us to the ward. Esther was put on a wheelchair and wheeled to the corridor of the IW. We were so tired from all the hours of waiting. It was only 15 minutes later that we heard the nurse informing the ward, through a phone call, that Esther was ready to be transferred. A further 12 minutes later, a male nurse arrived to wheel Esther to the B2-plus area of the hospital. Esther had waited for about 30 minutes in the corridor.
It was 12.50am on Day Two before Esther finally managed to put her head down on a bed in a B2-plus ward.
All in all, from registration to being admitted to a B2-plus ward, it took 28 hours and 10 minutes.
Nurses were patient, courteous and professional
Now, before you think that my frustration is directed at the nurses on duty that night, let me say that they were very patient, courteous and professional in their duties. Although they could have done better in some areas – such as keeping us informed of the situation with the availability of the bed – it is understandable as the A&E is a very busy place to work in. The nurses also had to tend to many patients.
I would like to mention, particularly, the nurses at the IW's Fever Zone. They were compassionate and understanding. This is especially commendable when one considers that most of the patients in the IW that night were elderly and weak.
One of the nurses explained to Esther that the situation has been such since the Chinese New Year. She also said that the wards in Tan Tock Seng Hospital were fully occupied and patients were being directed to SGH. Hence the shortfall of beds there.
A serious problem
Esther was not the only one who had to wait so many hours for a bed. But perhaps she is luckier than others who had had to wait in wheelchairs in the waiting area for hours and hours on end that night we were there – for even the number of beds in the IW is limited.
While MM Lee may be right that “within one-and-a-half to two hours flat, you'd know what went wrong” (even though in Esher’s case the cause of her illness is still unknown 5 days after admission to SGH), the other important thing is the availability, or the squeeze, on the number of hospital beds.
According to the nurses there, this is not a sudden or a temporary hiccup. It has been like this since the Chinese New Year, as earlier mentioned.
While we trumpet the excellence of our clinical healthcare service (and I don’t disagree with this), it is what happens on the ground to each patient that needs to be looked at.
Waiting for more than 28 hours for a bed is simply unacceptable.
I hope that the Minister for Health, Mr Khaw Boon Wan, will put some effort into solving this problem – especially now that he has been called “the best Health Minister Singapore has ever had” by none other than SM Goh himself. (Straits Times)
When you are sick and weak, you shouldn’t be made to endure a frustrating and excruciating 28 hours just for a bed.
And I am sure that Esther is not the only one who has had this experience.
Perhaps the new Khoo Teck Puat hospital in Yishun, scheduled to open in 2010, will help to alleviate the situation. But that is left to be seen.
One can only hope that Singapore’s healthcare system will not become what MM Lee said of the system in the UK, where he experienced "restlessness and unhappiness" when waiting for 45 minutes for an ambulance:
“There's no connection between those in the system and the patients..”
- MM Lee, (TODAY)
From Esther’s experience, one could say the same for Singapore’s system as well.