KUALA LUMPUR, June 12 — The cardiology service at Raja Permaisuri Bainun Hospital (HRPB), the only cardiac centre in Perak, has undergone “drastic restructuring” since last May 25 to manage a shortage of doctors.
The restructuring exercise at the Ipoh general hospital involved its cardiology clinic, review of cardiology patients stranded in the emergency department, indications for inpatient coronary angiography for HRPB patients, and management of cardiac patients by the internal medicine department.
“The cardiology department is required to restructure its cardiology services for HRPB and the state of Perak in line with current workforce challenges.
“Cardiology services comprise four major interconnected components operating simultaneously: inpatient care (coronary care unit [CCU] and cardiology ward); invasive cardiac lab (ICL); cardiology clinic; and non-invasive cardiac lab (NICL),” wrote Dr Nor Hanim Mohd Amin, the head of HRPB’s cardiology department, in a May 25 internal memo titled “Notification of Drastic Restructuring of HRPB’s Cardiology Service”, as sighted by CodeBlue.
“This is the only cardiology department serving the entire state of Perak and receives referrals from all health care facilities in the state. Therefore, this temporary restructuring, which we hope to be temporary, is expected to affect both inpatient and outpatient services.”
Cardiology Clinic: One-Year Appointments Except Pregnant Patients
HRPB’s cardiology clinic operates from 8am until 7pm. Under the restructuring exercise, the number of general cardiology patients at the clinic will be limited.
“This measure is also intended to improve the quality of care and allow greater focus on clinic patients,” wrote the cardiology HOD.
Urgent referrals to the cardiology clinic will only be considered for pregnant patients with heart disease. Appointment dates for other patients will be scheduled within one year.
Examples of such cases include pre-operative assessment for non-cardiac surgeries and routine cardiac evaluations (for example, chest pain requiring investigation).
“Under this new restructuring, patients experiencing recurrent chest pain are advised to proceed directly to the nearest emergency department. Telephone consultations for specialist cardiology opinions will continue as usual.”
Review Of Cardiology Patients Stranded In HRPB’s Emergency Department
Cardiology team rounds will only be conducted for pregnant patients with heart disease who are stranded in the emergency department.
“For stranded patients who are suitable for discharge, the on-call cardiology medical officer (MO) and cardiology fellow will reassess the patient before discharge is carried out.
“Telephone consultations with the on-call cardiologist will continue as usual,” said Dr Nor Hanim.
Indications For Inpatient Coronary Angiogram For HRPB Patients
To expedite discharge from the cardiology ward/CCU and reduce the number of patients stranded in the emergency department, the new indications for inpatient coronary angiogram (Coros) referrals from HRPB wards are:
- All acute STEMI cases within <48 hours
- NSTEMI with TIMI score ≥5
- Wellens syndrome
- Self-reperfused STEMI
- De Winter syndrome
- Acute coronary syndrome (ACS) with ongoing ischemia
- Ventricular tachycardia/ventricular fibrillation (VT/VF)
- ACS with cardiogenic shock (unable to be weaned off inotropic support)
- Intradialytic angina or unexplained intradialytic hypotension
Management Of Cardiac Patients By Internal Medicine Department
Patients diagnosed with unstable angina, NSTEMI with TIMI score <5, and heart failure shall be managed by the internal medicine department. Suitable patients may subsequently be referred to the cardiology clinic as outpatients.
Patients with cardiac syncope or presyncope should also be managed and investigated by the internal medicine department before referral to the cardiology clinic where indicated.
Referral of patients with atrial fibrillation (AF) or supraventricular tachycardia (SVT) to the cardiology clinic is recommended only if the patient agrees to undergo invasive treatment. Telephone consultation with the on-call cardiologist will continue as usual.
“This restructuring is expected to be temporary until workforce conditions become more stable,” wrote the cardiology HOD.
CodeBlue has requested comments from HRPB.
HRPB’s cardiology service is the third reported case within a fortnight of service disruptions in public hospitals, following plans to close Segamat Hospital’s obstetrics & gynaecology (O&G) specialist clinic and disruptions of Lahad Datu Hospital’s anaesthesiology and critical treatment services.
