KUALA LUMPUR, August 14 — Record numbers of patients are being admitted to Sultan Haji Ahmad Shah Hospital (HOSHAS) in Temerloh, Pahang, exacerbating a staffing crisis already strained by housemen relocations and a suspension of new placements this year.
The HOSHAS General Medicine Department’s Annual Report 2023, sighted by CodeBlue, revealed an 86 per cent surge in ward admissions to the medical department, rising from 8,621 in 2022 to 16,065 in 2023.
CodeBlue understands that this near doubling of cases is due to an expanding patient pool, driven by the hospital’s growth in services. Previously, the department offered only general medical, nephrology, and endocrinology services. Since 2023, new inpatient services have been added, including rheumatology, respiratory, and geriatric care.
Year-on-year, the HOSHAS general medicine department saw a rise of inpatient count in 2023, with carry forward patients (C/F PT) increasing by 87 per cent to 76,491.
A specialist at HOSHAS told CodeBlue that most admissions were due to infection-related issues like pneumonia and other infections, followed by cardiac-related conditions like heart failure and heart attacks, and then renal disorders and diabetes-related complications.
Inpatient deaths in HOSHAS’ medical unit wards nearly doubled to 1,488 last year from 758 in 2022. According to the specialist, the leading cause of death for these inpatient mortality cases was infection/ sepsis, followed by cardiac conditions.
The specialist noted that sepsis-related deaths are often due to infections acquired outside the hospital, rather than hospital-acquired infections.
When comparing the inpatient data between 2023 and pre-Covid pandemic in 2019, admissions increased 44 per cent while deaths spiked 125 per cent.
Bed Occupancy Rate Increased to 73% Last Year
HOSHAS general medicine department’s annual report also noted a rise in the bed occupancy rate (BOR) from 68.84 per cent in 2022 to 72.99 per cent in 2023, with the average length of stay increasing from 4.6 to 4.81 days. Monthly BOR ranged from 69.12 per cent to 79.27 per cent in 2023, and the average stay varied from 4.58 days to 5.20 days.
As Pahang’s second largest hospital and the lead facility in the Ministry of Health’s (MOH) Central Pahang cluster, HOSHAS serves as a referral centre for medical and subspecialist services to other public hospitals in Bentong, Bera, Jengka, Jerantut, Kuala Lipis, Raub, and Sultanah Hajjah Kalsom Hospital in Cameron Highlands.
Earlier this year, HOSHAS general medicine department head Dr See Chee Keong cited some of these data in a February 16 letter to the Pahang state health department (JKNP), urging that house officers be retained, as the halt in new placements of trainee doctors has “directly affected” the department’s services.
Dr See said for service continuity, the general medicine department needed at least 46 medical officers and 34 house officers. As of February 2024, it had 16 specialists (including subspecialists), 24 medical officers, and 20 house officers.
He wrote in another July 10 letter that as of last month, the general medicine department had even fewer medical officers at 20. This means that the medical department currently has less than half (43 per cent) of its required medical officer manpower and needs another 26 medical officers at least, barring any further resignations.
CodeBlue on Monday reported that the transfer of housemen from HOSHAS to Tengku Ampuan Afzan Hospital (HTAA), the Pahang state hospital in Kuantan, has led to a staffing crisis at HOSHAS, jeopardising patient safety with delayed blood tests and antibiotics not administered on time.
The general medicine department will have “zero” house officers by the end of this month, due to their relocation to HTAA and the suspension of new housemen placements at HOSHAS.
Since the beginning of the year, the MOH has limited housemen placements to state hospitals and Kuala Lumpur Hospital (HKL), due to a sharp fall of 47 per cent in house officer appointments from 2019 to 2023.
Neither JKNP nor MOH Putrajaya have issued a statement on CodeBlue’s report that has been widely shared on social media, with nearly 1,000 shares of two Facebook posts by CodeBlue of the story.
More Services, Less Manpower
HOSHAS’ general medicine department provides outpatient and inpatient care, referral services, rehabilitation treatment, health education, and consultation services.
It operates six medical wards: Kenanga 10, 11, 12, 14, the heart treatment unit, and Bunga Raya 2, with a total of 165 beds. The department also has specialist clinics, a diabetes resource centre, male and female medical wards, a haemodialysis unit, and a critical care unit (CCU).
By the end of 2022, the HOSHAS general medicine department provided in-house subspecialties in endocrinology and nephrology. In 2023, two new subspecialties were added: rheumatology in January and respiratory in March. This brings the total number of in-house subspecialties at the department to four.
The department’s specialist clinic reported a 27 per cent increase in patient visits, rising to 20,705 in 2023 from 16,340 in 2022. Of the total in 2023, 19,478 were repeat patients and 1,227 were new patients.
The medical clinic, managed by internal specialists who consult with experts at HTAA on specific issues, saw 1,939 cardiology patients in 2023, along with neuromedical (740), gastroenterology (627), haematology (204), dermatology (649), and infectious disease patients (457).
Meanwhile, its subspecialty clinics recorded 9,579 patient visits in total in 2023, including endocrinology (3,157), respiratory (1,431), rheumatology (1,449), and nephrology (3,542).
The general medicine department also offers 15 procedural services. The following procedures were performed in the outpatient clinic in 2023:
- Echocardiogram: 1,649
- Stress Test: 254
- Holter Monitor: 161
- Lung Function Test: 312
- Slit Skin Smear: 2
- Skin Biopsy: 26
- Skin Scraping/ Nail Clipping: 17
- Joint Ultrasound: 80
- Intra Articular Injection: 250
- Botox: 16
- Nerve Conduction Study: 24
- Electromyography (EMG): 8
- Electroencephalogram (EEG): 199
- Blood/ Specimen Collection: 5,378
- Ambulatory Blood Pressure Monitoring (ABPM): 4
