Nursing aspirations for the new ED

‘Sister Sanda’, as she is affectionately known, calls the Emergency Department (ED) her second home. She is happy to have been part of planning for the new ED which has begun operations. 

Sister Sanda (2nd from left) with some of her ED team mates

Looking forward

Sanda Thangarajoo has held a long-standing passion for Emergency Medicine since she was a young nurse.

"I love the excitement. Every day is different, the varied nature of patients we see, as well as opportunities to be deployed into the field.”

She is even more excited about the Emergency Department (ED) operating from new premises in January 2026 in the Singapore General Hospital Emergency/National Neuroscience Institute building on SGH Campus.

"I think the biggest change for me was the ED going from one level to three in the new building!” exclaims the Assistant Director of Nursing. “Did you know there are very few multi-storey EDs in the world?”

She goes on to explain that initially, an entire level was planned as a large observation ward. However, this was when lab results took a while to be ready. As this is no longer the case today, the space has been repurposed to a holding ward for patients who are first seen at the ED and need to be admitted to the main inpatient wards. While waiting for a bed there, their primary care team start treating them in this holding ward.

An initiative Sister Sanda is most passionate about is palliative care for patients in the new ED.  A focus group of doctors and nurses had looked into ways to improve their care.

“Many patients don’t want to stay in the hospital towards the end of their life, preferring to be with family members at home. Thus, the team works with family members to have these patients discharged home, with relevant support in the community. However, for those who are unable to be discharged because of their symptoms, they are transferred to the Community Hospital for continuity of care under the inpatient palliative team.”

Sister Sanda explains a new initiative for actively dying patients – a term used for patients who only have a few hours left before passing away. “In the new ED, we decided to allocate single rooms within the short stay observation ward called the Extended Diagnostic and Therapeutic Unit (EDTU), especially for actively dying patients. This way, family members can spend the last few hours with their loved ones in privacy while we keep them comfortable until they pass away. This will be an improvement over the previous arrangement where such patients were moved to a ward.”

Sister Sanda and the EDTU ward

“Besides these single rooms assigned for actively dying patients, the rest of the EDTU is run more like an inpatient ward where patients with stabilised conditions can be observed and monitored for short periods. The ED doctors start treatment but want to observe the patient for up to 24 hours as they may not need admission and could be discharged.   Like the other wards in SGH, the unit is equipped with bedside tablets for patients which enable us to provide content to better educate patients and their caregivers about how to manage their condition. Caregivers can stay with patients and participate in their care.” Sanda was very keen to have this new model of care in ED implemented. “I felt it would be very beneficial for patients to have their loved ones close to them in the ED, especially if they belong to a high-risk group like frail elderly patients with cognitive disabilities like dementia or Parkinson.”
 

Something is always happening

The ability to adapt quickly to changes is a key characteristic of ED personnel. Sanda’s career is a good example. She started out her nursing career with the General Surgery ward in 1985 and subsequently rotated to ED in 1989. She also worked in ward 63C before being assigned to oversee the then Obstetrics & Neonatal Unit, as her specialty was Midwifery. She was then rotated back to ED as a Senior Nurse Manager in 2013 where she has been, ever since.

In fact, to Sister Sanda, versatility is another hallmark trait of an ED team.

The work is fast-paced and patient types are unpredictable. Every day, the ED sees more than  300 patients with a wide range of conditions, from those with strokes, heart attacks, respiratory failure to those with trauma from accidents.  Sanda has even assisted with delivering babies in the resuscitation room of the ED as there was no time to rush the patient to the Labour Ward!

The ED team also does ‘field work’ which means they work onsite to provide medical coverage at major events like National Day Parade and Formula One (F1) races.

Unfortunately, ED staff also face increasing incidents of abuse by patients or family members, including physical assault. “In 2019, together with my team, we created Code Grey. It is a systematic workflow to manage abusive and aggressive patients. Right from orientation, we train the nurses on how to manage the abusive patients and apply relevant restrainers to them with assistance from Security, as well as when to get help from Security. As a result, fewer staff are getting injured this way – which is something I am really proud of!”

A ‘panic button’ was also introduced at ED last year. Worn by every nurse in ED, the button allows them to activate help quickly when faced with an abusive situation.
 

Over the horizon

The biggest change over the years that Sanda is happy with, is that ED nurses are taking more active roles in managing patients, such as dispensing medications for pain and fever at the triage area, ordering X-rays and starting treatment plans for some of the patients. Her fervent wish for the future of the Emergency Medicine is for nurses to do even more and practise at the top of their licence. She speaks about getting more Advance Practice Nurses (APNs) – one for each area of the ED, such as triaging, critical care and EDTU - as they can play an important role in taking care of some of the high acuity patients.

She reminds me that one thing will remain the same – the closeness of the ED team. “In the ED, we’re like a big, close-knit family. We work together, play together and support one another every day. This has never changed.”

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