20 Jun 2011
By: SALMA KHALIK
AT A TIME when most of Singapore’s six public hospitals are experiencing a bed crunch, Changi General Hospital’s (CGH) drive to be more efficient has enabled it to not only treat more patients, but also reduce the number warded.
The 664-bed CGH has the highest bed occupancy here, averaging more than 90 per cent this month.
Its emergency department (ED) treats between 400 and 500 patients a day – more than any other public hospital.
From the start of this year up to the first week of June, its ED logged more than 70,000 patients. The figures at the 1,265-bed Tan Tock Seng Hospital and 1,250-bed Singapore General Hospital were more than 63,000 and more than 60,000 respectively.
Yet, patients at CGH’s ED had the shortest wait for a bed, with a median time of an hour or less most weeks this year, lower than the national norm of 11/2 to two hours.
In the latest week ending June 11, the median wait at CGH was less than an hour for five of the seven days, and less than 90 minutes for the other two days – a performance bettered only by Alexandra Hospital, whose bed occupancy is 60 per cent.
Not surprisingly, among all public hospitals, CGH’s ED scored highest in patient satisfaction, with 76 per cent giving it the thumbs-up.
“We worked very hard to achieve this,” said CGH chief executive T.K. Udairam of the changes he has implemented over the past year.
The biggest change was at its ED where, last year, one in three patients would be warded – still the norm at both TTSH and SGH. This has been cut to one in four at CGH, which now wards about 40 fewer patients a day.
“We’ve put in a fair bit of processes to try to reduce admissions,” he said, adding that the number of one-day stays is now very small compared with before.
It reviewed conditions for short-stay patients and found that giving immediate treatment could mean warding fewer of them.
The ED doctors, helmed by two senior consultants at all times, are now empowered to order non-standard investigations, such as CT scans.
Previously, patients who had suffered a fit for the first time were warded and monitored. They would go for a CT scan, which costs several hundred dollars, only if doctors were still unsure of the cause of the fit after a day or two.
With scans done earlier, Dr Lee Wee Yee, a senior consultant and deputy chief of ED, said patients with no tumours or bleeding in the head are discharged and given an early appointment to see a neurologist.
Patients, too, prefer this as they know immediately if there is something seriously wrong with them, she added.
The doctors also order ultrasound scans for the handful of young men who turn up with twisted testes. Once confirmed, they go for surgery as blood flow has to be restored fast.
Dr J. Raghuram, who heads respiratory medicine, said ED doctors were trained last year to insert a small tube into the chest of those with air in the chest but outside their lungs.
This happens to heavy smokers and surprisingly, young adults, when their air sacs burst, letting air out. This causes breathlessness and pain in the chest.
Previously, they would be warded since it takes two to three days to get the air out. Now, the doctors insert the tube and get them to return to see a specialist a few days later, after the air is drained.
Someone arriving with his hand wrapped in bloody rags because his fingers have been mangled or crushed will be sent straight to the operating theatre. Once treated, he is discharged.
As these are not life-threatening injuries, such patients would previously have been admitted and surgery slated within 24 hours.
People who turn up with back pain so severe that they are stretchered in are checked to ensure the pain is not due to something serious such as kidney problems.
If they come during clinic hours, they would be sent for therapy. After the treatment, those able to walk are sent home with an appointment to see a specialist in the next few days.
The hospital gets more than 1,000 cases of severe back pain each month.
With the population ageing, more patients are turning up with severe abdominal pain caused by the inability to urinate.
Instead of warding them, a catheter is inserted to release the urine, which eases the discomfort.
They are taught how to keep it clean and given an early appointment to see a specialist.
CGH also worked on how to free up beds faster. It found that even after a patient had been discharged, six in 10 remained in the ward for more than four hours before actually leaving.
Delays came from paperwork such as making follow-up appointments, providing medical leave of absence certificates, and getting the medicine for the patient to take home.
More than 100 patients are discharged every day, with most being discharged around late morning.
A colour-coded board now shows at a glance all work that has to be done for each patient, and indicating those likely to be discharged that day. Nurses can do the paperwork earlier.
A pharmacist now trails the doctor doing the rounds so he can alert the latter if his prescription clashes with other medicine the patient is on.
Previously, the pharmacist would have to track the doctor down for this – a process that could take more than an hour.
The doctor also has to fill up prescriptions electronically before moving from one ward to the next, so the pharmacy can react faster.
These steps have resulted in seven in 10 patients leaving within four hours – or almost double the previous number.
Even the way beds and the surrounding spaces are cleaned has been overhauled to cut the time from 30 to 20 minutes – by putting everything needed, such as bed sheets and pillow cases, on one trolley.
But given that demand for beds is climbing – in-patients at the six public hospitals rose by 3.8 per cent last year and 7.5 per cent in the first quarter this year – these measures alone will not be enough for the long term.
CGH is planning a nine-storey building in the empty space next door to add 200 beds. But even after the plan is approved, it will be three to four years before the new facility can be ready.
Meanwhile, it is expanding its ED to cope with the high patient load, and is trying to recruit more doctors.
Email: salma@sph.com.sg / www.facebook.com/ST.Salma
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