Audit: MOH Falls Short Of 50% Target For Priority 1 Ambulance Response Time

The AG’s report cited staff shortages and distance between emergency sites and hospitals as reasons for the ministry’s failure to meet its KPI for responding to Priority 1 cases.

KUALA LUMPUR, Mar 17 – A new national audit report revealed that the Ministry of Health (MOH) fell short of its 50 per cent target for responding to Priority 1 cases, achieving only 31.5 to 41.8 per cent between 2017 and 2021.

The Auditor-General’s (AG) 2021 report (Series 2) tabled in Parliament on February 16 revealed that out of the 1.06 million Priority 1 calls made to the MOH, only around 41.8 per cent (443,080 calls) were attended by an ambulance within the targeted 15-minute timeframe.

Priority 1 cases refer to emergency medical situations that are considered to be life-threatening and require immediate attention from medical professionals. Examples of Priority 1 cases included in the report were stroke, breathing difficulties, and accidents.

These cases are given the highest priority by emergency medical services and are typically responded to with the fastest possible ambulance dispatch time.

The ministry had set a key performance index (KPI) target of having 50 per cent of its ambulances reach their destination in under 15 minutes for Priority 1 emergency calls.

“Based on the priority one emergency case report, the audit department found that the MOH KPI achievement for reaching locations in under 15 minutes is between 31.5 to 41.8 per cent compared to the set 50 per cent. As a whole, MOH has yet to achieve the set KPI,” the audit concluded.

The audit analysis was carried out in hospitals that were visited to assess the KPI.

“The audit review found that only two hospitals, namely Tuanku Fauziah Hospital in Perlis and Sultanah Aminah Hospital in Johor, achieved the designated KPI of ambulance arrival at the location within 15 minutes, whereas four hospitals, namely the Tengku Ampuan Afzan Hospital in Pahang, Sarawak General Hospital, and Miri Hospital in Sarawak, did not achieve their set KPIs for the years 2017 to 2021,” stated the report.

Over the five-year period, the MOH received 2.07 million emergency calls. The majority of these calls, 51.2 per cent or 1.06 million calls, were Priority 1 calls, indicating the most urgent situations. Priority 2 calls, which are made when the patient feels their condition could become unstable or life-threatening, were the least common, representing just 10.6 per cent or 220,000 of the calls received.

The failure to achieve the 50 per cent target was attributed to two main reasons. The first reason was the failure of management to activate the response team at the hospital closest to the incident. The second reason was the significant distance between the emergency site and the nearest hospital, which ranged from 60km to 443km.

Tawau Hospital’s ambulance service is responsible for covering a one-way distance of over 450km, which includes multiple districts in Sabah, such as Tawau, Sandakan, Lahad Datu, Putatan, and Kota Kinabalu. The hospital’s achievement rate in meeting its targets was found to be between 14 and 44 per cent.

In September and October of last year, the MOH provided several responses to the AG, indicating that hospitals that did not achieve their KPIs were required to submit a “Shortfall in Quality” report. The purpose of this report is to identify the cause of the failure to meet the KPIs and outline steps that can be taken to improve performance.

“Future plans involve stationing ambulances in identified hotspot areas. The plan is to implement the hotspot concept by establishing the National Prehospital and Disaster Medical Services Institute under the MOH.

“A pilot project toward the establishment of this institute is planned to be carried out in a few selected areas in the Klang Valley in October 2022, after receiving clearance from the task force committee for the establishment of this institute,” stated the MOH in its response. 

According to the MOH, the pre-hospital treatment system requires 1,000 ambulances to run smoothly and compensate for the current shortage. As of September 7, 2022, the MOH Tender Board has approved 590 of the required ambulances, and the proposal is now awaiting approval from the Ministry of Finance.

While the MOH did not cite staff shortages as a reason for not meeting the KPI, the AG’s report indicates that the ratio of available staff to ambulances is only 0.7:1.

“Ratio of available staff compared to the number of ambulances in MOH is 0.7:1, and this shows a shortage of assistant medical officers assigned to the Emergency and Trauma Department (ETD),” reads the report. 

To comply with MOH guidelines for ETD services, one driver (H14, H11, R6, or R3) and one assistant medical officer (U29 to U44) with three responses are required.

Recently, Kuching MP Dr Kelvin Yii called upon the government to stop building new hospitals and focus its efforts on securing more manpower. 

This follows reports of staff shortages at various hospitals, including an anonymous statement from a health care worker at the newly opened Cyberjaya Hospital, who claimed that it is currently operating at just 20 per cent capacity due to severe understaffing, as reported in The Star.

High Job Satisfaction Among Emergency Medical and Rescue Staff in Malaysia

A survey was conducted on 310 emergency staff and medical officers in ETDs under the MOH, 102 Emergency Medical Rescue Services (EMRS) staff from the Fire and Rescue Department of Malaysia (JBPM), 75 permanent and voluntary operation members, Malaysia Civil Defence Force (APM) and drivers. 

Results showed that between 64.4 and 76.5 per cent of participants expressed satisfaction and agreement with their assigned duties.

“The audit analysis of the task-level assessment found that between 64.4 and 76.5 per cent of the respondents agreed and expressed satisfaction with their assigned tasks.

“The skill-level assessment for the MERS999 system and the use of GIRN (Government Integrated Radio Network) found that between 64 and 78.6 per cent of the emergency staff agreed with the training and skills provided,” the report noted.

The AG’s report held the percentages show a good staff efficiency level based on the skills acquired. 

In addition to the findings of staff satisfaction, the AG’s report also notes the suggestions for improvements that have been made which include the periodical conduction of ambulance courses, improvements to the equipment system, and adding more emergency staff. 

Survey Shows Mixed Satisfaction Levels Among Ambulance Patients in Waiting Time, High Confidence in Emergency Staff

Out of 30 respondents who received an ambulance within 15 minutes, 42.3 per cent expressed satisfaction with the waiting time. However, the satisfaction levels of the remaining 57.7 per cent were not specified. Among these, 38.5 per cent had to wait between 15 and 30 minutes, 15.4 per cent had to wait 30 to 60 minutes, and 3.8 per cent had to wait for more than 60 minutes.

While 3.4 per cent of the respondents expressed lack of confidence and 6.9 per cent were unsure, the majority of the respondents (89.7 per cent) had confidence in the emergency staff.

Additionally, 80 per cent of the respondents rated the service rendered as good, while 12 per cent found it unsatisfactory. The remaining 8 per cent were uncertain about the quality of service. 

The AG’s report surmised that the objective of providing fast service was not fully met. 

“The user satisfaction percentage levels when it comes to the ambulance service waiting time shows the service objective in providing fast service has not been fully achieved.” 

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