01 Jan 2011
Many improvements made in SingHealth hospitals are the result of enterprising staff spotting and addressing a problem.
These changes are often to the advantage of patients too, as these two projects show.
Sunday walk
It was Monday, just two days after surgery on his knee, and Mr Sreekumar Pillai was still in pain.
Yet, he was sent to the gym for a second day of walking and other exercises with a physiotherapist.
Mr Sreekumar, who was injured in a soccer game in his 30s, was taught exercises to improve breathing, circulation and mobility. As the diseased or damaged portion of his knee joint had been replaced with metal and plastic implants, the 52-year-old aircraft technician was also taught techniques to strengthen the knee and increase the range of movement.
“The first two days after surgery are crucial (for recovery),” said Ms Ong Peck Hoon, Principal Physiotherapist, Department of Physiotherapy, Singapore General Hospital (SGH).
Patients who receive knee replacements are mostly in their late 60s, suffering from severe osteoarthritis or a knee injury sustained when they were younger.
It is important they start physiotherapy as soon as possible to reduce swelling and pain, and post-surgery complications such as deep vein thrombosis and bedsores.
They also need to learn to walk again. “When the patient has been guided to walk a couple of times, he will feel more confident, and will then be more keen to walk on his own, for example, to the toilet with assistance (instead of using a bedside commode or wheelchair). This will help him recover faster,” she said.
Certainly, Mr Sreekumar was glad to do the exercises. “If you don’t see the therapist, you most probably wouldn’t move as you don’t know what you should do,” he said.
While the principle to get patients up and about quickly is well understood, it is not possible for some patients to start physiotherapy the day after surgery or for them to have uninterrupted daily sessions, as there are no regular physiotherapy services on Sunday.
Patients who undergo surgery on Friday or Saturday, thus, face a gap in this service. Mr Sreekumar, for instance, had surgery on Saturday and would have started physiotherapy only on Monday.
A challenge by the late Dr Wong Yue Sie, who was SGH Chief Operating Officer, to make services more accessible to patients, prompted physiotherapists with the Department of Orthopaedic Surgery to look into this issue.
In October 2009, the team started a four month Sunday physiotherapy pilot programme for patients who underwent total or partial knee replacement surgery on Friday or Saturday. Ms Ong led the team, which included fellow physiotherapists, Dr Pua Yong Hao and Ms Chong Hwei Chi, and Dr Lo Ngai Nung, Senior Consultant, Department of Orthopaedic Surgery, SGH.
The team compared the results of the programme with data from the same four months a year before, and from the four months before the pilot programme, and found that patients in the pilot programme who had the benefit of Sunday physiotherapy generally recovered faster and were discharged earlier (after four instead of five days).
Patients discharged a day earlier saved on charges for an additional day. Early discharge also increased bed availability.
The project received the best oral presentation award (Allied Health category) at this year’s SingHealth Duke-NUS Scientific Congress, which gathered some 2,000 scientific and medical professionals from SingHealth and overseas to exchange ideas, and learn best practices.
More importantly, patients who undergo knee replacement surgery on Friday or Saturday benefit from having access to a physiotherapist on a Sunday.
“We are seeing some spine surgery patients as well now. Plans are underway to eventually expand the service to include patients who are likely to benefit from early intervention, such as patients who have undergone hip surgery,” said Ms Ong.
Tasting right
People with swallowing difficulties often have to put up with unappetising, thickened fluids to maintain a healthy weight.
Not surprisingly, Changi General Hospital (CGH) found that more than 70 percent of these patients disliked the otherwise nutritious concoctions so much, they wouldn’t eat enough. As a result, they became malnourished or ended up back in hospital.
To tackle this problem, a team of dietitians and speech therapists cooked up some 60 recipes, using natural foods to thicken the special liquid diets. The recipes, such as fruity soy curd shake or thick spinach soup, are easy to prepare at home.
Families who buy commercial powders can save more than $100 a month if they use CGH recipes instead.
Since CGH introduced the recipes, more than 70 per cent of patients now eat enough. With patients eating better at home, repeat hospital visits are down and caregivers also feel more confident that they can look after them.
To further improve the care these patients receive, the two departments set up a joint clinic.
“We thought a combined approach of reviewing malnourished patients with swallowing difficulties would make it easier for patients, who would have to spend less time waiting (for two separate appointments), and for dieticians and speech therapists (who can make a joint assessment of their needs right here),” said Mr Alvin Wong, Dietitian, Department of Dietetic and Food Services, CGH.
In the pipeline is a DVD to train caregivers after patients are discharged, as well as a specialist clinic to attend to such patients.
Their efforts have won several awards, including the Asian Hospital Management Award for Departmental Service Improvement and a handful of awards from the CGH Quality Convention Forum.
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