08 Feb 2011
HOSPITALS here are coming up with various ways to reduce the number of patients admitted through their emergency departments.
For example, they are setting up mini clinics or observation wards that assess whether those who show up at the Accident & Emergency (A&E) department need hospitalisation.
This way, they avoid a squeeze on the beds they have for inpatients, and lower patients’ medical bills since a hospital stay is not needed.
For instance, when construction superintendent Suherwan Jasmani, 31, went to the emergency department at the National University Hospital (NUH) last month with his blood pressure reading 190/110 – far higher than the accepted 120/80 – he was expecting to be hospitalised.
This would have been the case under normal circumstances. But to his surprise, he was asked to go home and to show up three days later at a “hot clinic”, where a specialist would decide if he needed to be warded.
NUH’s “hot clinics”, a new initiative by the hospital to cut patient admissions and thus medical bills, have saved the Department of Medicine 560 admissions a year since 2008.
As these mini clinics, set up within regular clinics and operating twice a week, have worked well, NUH is extending the concept across all its departments.
The push to cut hospital admissions comes amid a shortage of beds in public hospitals. Last year, it was reported that the occupancy rate for beds in public hospitals exceeded 80 per cent, and that in Tan Tock Seng Hospital (TTSH), patients were being put in beds along corridors.
As hospitals need to set aside some beds for emergency use, an average occupancy rate higher than 80 per cent is considered tight.
The push to cut admissions also comes against another backdrop: In the last three years, emergency rooms across hospitals here have handled a 4 to 5 per cent annual rise in attendances, said the Health Ministry.
The Singapore General Hospital places less urgent A&E cases in its 13-bed emergency observation ward, where a senior doctor decides whether these patients need to be hospitalised. With this ward in operation, patient admissions through the A&E department fell from 33 per cent of total admissions in 2007 to 30.8 per cent in 2008.
Admissions held steady between 30.8 per cent and 32.7 per cent last year – despite the A&E department handling 11 per cent more patients than in 2008, noted Dr Annitha Annathurai, a consultant in the emergency medicine department.
Changi General Hospital has an early clinic appointment system that allows those with fractures, for example, to be seen by specialists within a week; those with minor injuries are sent for day surgery instead of being admitted.
Associate Professor Mohan Tiru, who heads the A&E department there, said: “The measures help save costs for the patient, conserve hospital beds for the more critically ill, and improve care.”
To reduce unnecessary admissions, TTSH last month launched its Emergency Diagnostic and Therapeutic Centre, where certain patients are observed for up to 24 hours instead of being admitted immediately. Its admission rates dipped 11 per cent last year.
NUH has a similar concept in its Extended Diagnostic Treatment Unit, which it expanded in 2009 from eight to 16 beds.
And at the Khoo Teck Puat Hospital, patients who may need surgery are first put through further investigations. This has often meant a longer stay in A&E, but the practice has cut admissions by 20 per cent, said Dr Francis Lee, who heads the hospital’s Acute Care and Emergency Centre.
“This is because we may find that surgery can be done on an outpatient basis, without the need for admission,” he said.
Mr Suherwan said: “I was very happy when I didn’t have to be admitted because it will waste a lot of time. It affects my work because I have to be on site to oversee projects.”
He recalled that chest pains landed him in hospital for three days in 2008, and on medical leave for a week after that – only to find out that an innocuous muscle strain was probably the cause.
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Dept of A&E
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