No bed! No bed! Na whose fault? It was in the year 2000 when I was the lone house officer on night call at the medical emergency in Korle Bu Teaching Hospital. I heard the siren of an ambulance cautiously treading towards Korle Bu. I could not be bothered much at the time because most of the ambulances ended up at the accident centre. I soon became worried as the siren noise ever nudged closer and closer to the medical emergency unit! As I went out to check on the patient in the ambulance my heart sank deep into my belly! The patient had a stroke and had been transported all the way from Wa to Korle Bu in Accra! As far as I can recall there was no prior contact with us the receiving team as to if we even had beds to receive the patient! It was a big stroke which the patient did not survive and died a day later! The family had to escort the body back to Wa at another exorbitant price. If the medical personnel had consulted with us over the phone, we could have advised not to transfer because there was nothing new we could have added to his management at Korle Bu at the time and could have spared the patient an unnecessary ambulance ride! Throughout my time at the medical emergency as a house officer, there were numerous occasions where patients were referred to the unit inappropriately!Cases such as ruptured ectopic pregnancy came to us and would have died were it not for the vigilance of an attentive nurse or doctor. A few months ago I was baffled by a video I saw on Whatsapp about lack of beds in Korlebu! What irked me the most was the blame on the government and how the government had not lived up to its promise of providing good healthcare to Ghanaians! This is not a new phenomenon in Ghana or to any other health facility because every tertiary facility has a limited number of beds and cannot accommodate every patient to transfer all the time. It happens even in developed countries, especially in winter when hospitals go on diversions! I believe the practice of patients squatting outside the wards of Korle Bu awaiting admission and subsequent medical therapy will diminish if we have a good strategy of appropriate referral to one Of the busiest hospitals in Africa! The solution to this is to develop a standard practice of transfer and referral to our tertiary centres! It is a travesty of justice that in this modern times, with easy access to communication and cell phones patients still get transferred from one hospital to another without communication between the referring physician and the accepting physician! It is my humble opinion that standard practices need to be developed nationwide to reduce patients risks during transfer and forestall the circumstances where patients arrive at the receiving facilities with no beds available! According to a paper by Isla Hains, Ph.D., as healthcare becomes more centralised and specialised transfer of patients for critical and non-emergent reasons will increase. An established standard for patient transfer, using guidelines or standard forms or checklists, and adequate information and communication between health care providers will reduce adverse events, communication errors and lack of beds at receiving facilities! Such a standard should entail the following 1.The direct physician to physician communication about the patient and need for transfer and if the receiving faculty is the right place for the patient medical diagnosis. 2. The patient be transported by the right mode of transportation and by the right personnel to the right place at the right time 3. The receiving facility will be furnished with the appropriate medical records in legibly written form so as not to compromise patient care 4. That the receiving hospital has beds available to accept the patients in transfer I, therefore, propose that tertiary and regional facilities need a centralised or dedicated transfer hotlines available to all the medical facilities in Ghana! Every department in the tertiary hospital should have a “medical officer on duty or MOD” who will take such calls and triage the patients into 3 categories: immediate, urgent and elective with immediate cases given first priority! It will be very helpful for all the government hospitals to have a common electronic health record so that clinical information and imaging studies will flow seamlessly from one health care facility to another! I believe that such actions if taken will go a long way to solve the easily avoidable situation of sending patients to hospitals with no beds, improve patient safety and clinical outcome as well as prognosis! Luckily the implementation of such standard practice does not require lots of money with the exception of electronic health record system! Adios! Source: Dr. Yaw Berko (yawberko2001@gmail.com) *Dr Yaw Berko graduated from University of Ghana in 2001. He then pursued his residency studies at Kalamazoo Centre for Medical Studies and was Chief Resident of his class! He worked with PREVEA from 2007 to 2015 and was its chief medical information officer from 2011-2013. He is currently self employed and works as a Hospitalist! His interests are writing, tennis and traveling. |
