Ghana's emergency care system is at a defining moment. For years, the phrase "no bed syndrome" has echoed across the country, symbolising the frustration of families who watch critically ill patients being turned away from multiple hospitals. But the deeper truth is this: the crisis is not simply about the number of beds. It is about how the system functions.

As an emergency physician working on the frontlines, I have seen firsthand that "no bed syndrome" is not a shortage problem — it is a coordination problem. It is a flow problem. It is a systems problem.

And systems problems require modern, proactive, system wide solutions.

Ghana now has a clear opportunity to redesign emergency care through practical, affordable, and globally aligned approaches.

The Real Issue: A System Under Strain, not a Lack of Beds or Mattresses.

The public often imagines "no bed syndrome" as a physical shortage of beds. The root causes are structural:

There are;

• No unified emergency triage system
• No real-time visibility of bed availability
• Slow internal patient flow
• Weak ambulance-hospital coordination
• Lack of accountability for emergency refusals

These gaps create delays, diversions, and preventable deaths — even when beds exist. Ending this crisis requires a modern emergency care ecosystem, not just more infrastructure.

A Modern, Proactive Framework for Ending "No Bed Syndrome"

1. National Emergency Triage & Stabilisation Standards

Every emergency patient that reports to a medical facility in Ghana must be:

-I- Assessed immediately, -I- Stabilised, and

-I- Coordinated for transfer if needed, following established national referral pathways. This will replace the outdated practice of refusing patients at the gate.

A unified triage system, adapted from global best practices, ensures that the sickest patients receive urgent care without delay.

• Real-Time Bed Visibility Across Hospitals

A modern health system cannot operate on guesswork. Accra's major hospitals should be digitally interconnected, allowing ambulance teams to know — in real time — where capacity exists.

Ghana needs a simple, scalable bed-visibility system that works in both digital and low-resource settings.

This includes:

• Structured manual reporting for facilities with limited connectivity
• A digital dashboard for larger hospitals
• Integration with ambulance dispatch

This single reform eliminates unnecessary diversions and saves lives.

• Faster Internal Patient Flow

Beds are often unavailable at the entry points of major hospitals because patients stay longer than necessary due to slow processes.

Modern flow reforms include:

• Dedicated Bed Managers
• Early discharge planning
• Short-stay/observation units
• Daily "flow huddles" between ED and wards

These measures free up beds faster and reduce emergency department congestion.

• Strong Ambulance-Hospital Coordination

Ambulances must not roam from hospital to hospital. A modern system requires:

• Pre-arrival communication
• Acceptance-before-arrival rules
• Routing guided by real-time bed visibility

This protects patients from dangerous delays and ensures ambulances deliver patients to the right facility the first time.

• Data, Monitoring & Accountability

For the first time, "no bed" refusals must become a reportable event. Hospitals should track:

• Emergency refusals
• ED boarding time
• Bed occupancy
• Deaths in transit
• Ambulance diversions

Weekly dashboards and monthly reviews create transparency and drive improvement.

A Smarter, Scalable, Ghana-Ready Solution This modern approach is:

• Low-cost
• Scalable across all regions
• Compatible with both digital and low-resource facilities
• Aligned with global emergency care standards

It does not require massive new buildings. It requires coordination, visibility, and system design, including continuous monitoring and evaluation.

A New Era for Emergency Care in Ghana

If fully implemented nationwide, our country could see:

• A dramatic reduction in emergency refusals
• Faster treatment for critically ill patients
• Improved ambulance efficiency
• Better use of existing hospital capacity
• Fewer preventable deaths

Ending "no bed syndrome" is not only possible — it is achievable now, with the right systems in place.

Is Ghana ready for a modern emergency care system? Ghana must decide — now — whether we will continue to accept preventable deaths as routine, or whether we will build an emergency care system worthy of the people it serves.

Thank you.

Dr Godfred Takyi, Consultant Emergency Physician, gbostone2004@gmail.com

About the Author

Dr Godfred Takyi is a frontline emergency physician with extensive experience in acute care delivery, emergency systems design, and hospital flow optimisation. His work spans clinical leadership, health systems strengthening, and the development of practical, scalable solutions for resource-limited settings.

He is also an educational resource creator and advocate for evidence-based reforms in Ghana's healthcare system. His professional interests include trauma and injury prevention, emergency care innovation, patient-flow engineering, digital health coordination, and national health policy transformation.

Dr Godfred is committed to building a modern, efficient, and equitable emergency care system that ensures no Ghanaian is denied life-saving treatment due to preventable system failures.