Hospital to Home | Singapore General Hospital

About

Eligibility

Process

What is Hospital to Home?

The Hospital to Home (H2H) program is a nationwide program that supports patients’ safe and timely transition back home, so that they can get well and stay well in the community after discharge from hospital.

It is targeted at patients with complex health, physical and social care needs, and at high risk of hospital readmissions.

Singapore General Hospital (SGH) H2H follows the ‘Place Based Care’ approach and supports patients living within the SGH’s catchment area: Bukit Merah, Chinatown, Kampong Glam-Kallang, Katong, Rochor, Telok Blangah, Tiong Bahru.

SGH H2H service is available to patients who:

Were recently discharged from an acute hospital , and
Reside within SGH’s catchment area, and
With frailty, complex health & social care needs, high utilisation of healthcare services, at risk of future readmission, and requires a multi-disciplinary team to manage sub-acute and chronic medical conditions post-discharge

Referrals will be sent to the SGH H2H team to ensure that suitable patients receive follow-up H2H care after their discharge.

How it works

During the patients’ stay in the hospital, a dedicated team of doctors, nurses, allied health professionals, patient navigators and medical social workers will work together to understand the patients’ post-discharge care needs and develop a personalized care plan for them.

After patients are discharged, our SGH H2H team will continue to support the patient’s medical, nursing, physical and social needs through home visits, phone calls or video consultations.

We also collaborate closely with the community health services to ensure patients receive all the support they need to recover and stay healthy in the community.