Triage system vital for any hospital to function effectively, says Health DG

PETALING JAYA: A triage system to determine which patient should be given treatment first is vital for any hospital’s emergency and trauma department to function effectively, says Datuk Dr Muhammad Radzi Abu Hassan.

The Health director-general said as triage services are the first point of contact for all patients at the emergency department, it is important that all protocols are followed.

He said that client charters on display at public hospitals state that critical cases will be seen immediately, semi-critical in 30 minutes and others in 90 minutes.

“These protocols are designed to sort out patients according to their degree of severity, to ensure that they are seen in a timely manner and allocated appropriate resources.

“Triage processes are conducted rapidly within a few minutes to determine priority, resources and treatment zones. This is vital to facilitate patient flow through the emergency department and avoid unnecessary congestion,” he said on Friday (Dec 15).

Dr Muhammad Radzi said that in April, all emergency departments have been instructed to use the newly revised Malaysian Triage Scale 2022.

He said the Health Ministry monitors all triaging under the Hospital Indicators for Accountability.

He also said a training app had been designed in line with the transition to the new scale.

“The app aims to provide some decision support to what a purely subjective clinical decision has previously been. Methods to catch errant personnel include regular surveillance to the primary triage, CCTVs, use of body cameras and monitoring through other platforms including public feedback, clinical audits, yearly appraisal, incidence reporting and others.”

To educate the public, they are continuously kept informed on the importance of utilising the emergency and trauma department correctly through the various mass media and social media channels and government programmes, Dr Muhammad Radzi said.

“The ministry also educates the public that non-emergency cases are redirected to government or private clinics via the extended hours service and the Madani medical scheme,” he added.

According to Teluk Intan Hospital emergency and trauma department head Dr Samsu Ambia Ismail, despite the five-level triage system in place, some smaller hospitals tend to still use the three-colour code system (red, yellow and green).

“The severity is gauged subjectively and objectively. The first look is to decide how critical the patient is – whether conscious or unconscious, able to walk, cardiac arrest, etc.

“The first level of emergency is resuscitation, which is immediate life-saving intervention; level two is for emergency; level three for urgent cases; level four is early care; and level five for routine treatment,” he explained.

Resuscitation would be for cases such as cardiac arrest; emergency for cases such as stroke or shock due to blood loss; urgent is for cases such as stable lower limb fractures and patients in severe pain; early care is for patients with, for instance, non-specific chest pains and vomiting; and routine treatment would be for those who come in for illnesses such as a cough and cold or rashes due to an allergy.

“I do tell the medical personnel in the secondary triage to try to minimise the questions and read the vital signs to be more focused in assessing the severity,” Dr Samsu Ambia said, adding that this is to save time.

Earlier on Friday, Health Minister Datuk Seri Dr Dzulkefly Ahmad said cases of patients dying after being made to wait hours should not happen.

He was referring to a case at the Sungai Petani Hospital in Kedah on Dec 7 where a patient allegedly died after not getting treatment immediately.

“We must better the service at the emergency department at the triage level for patients, and triage must be based on the ‘severity of illnesses’, and not on the way a patient is dressed.

“As for the fatal case at Sungai Petani Hospital after waiting for five hours for triage, it should not be repeated,” posted Dr Dzulkefly on X on Friday.

On Monday, a 72-year-old man was turned away by security at Seberang Jaya Hospital when his dressing was deemed to be inappropriate. The episode was later attributed to a miscommunication.