Freeing up beds without compromising care

To cope with high demand, Tan Tock Seng Hospital changed many of its routines, including having a senior doctor assess a patient early, followed by fast access to investigations and procedures.
To cope with high demand, Tan Tock Seng Hospital changed many of its routines, including having a senior doctor assess a patient early, followed by fast access to investigations and procedures.ST PHOTO: ALPHONSUS CHERN

Tan Tock Seng Hospital (TTSH) has faced such high demand in the past several years that it had to change many of its routines to free up beds without compromising patient outcomes.

Professor Philip Choo, head of the National Healthcare Group of which TTSH is a part, said it began some years ago to convert some elective surgery cases to day surgery, where the patient is admitted to hospital for the procedure and discharged on the same day.

Previously, patients would come in the day before and stay for up to three days. Going home after surgery worked out better, as patients were more relaxed knowing they could rest in their own beds.

Two years ago, he extended this to medical cases at the hospital's emergency department. He said: "Anything that needs one to three days' stay can be converted into one day's stay."

A major reason why these patients were in hospital for a few days previously was that senior doctors made their rounds in the mornings and evenings. A patient who came in during the day would stay to be seen by the senior doctor the next day.

The senior specialist might order some tests to be done, so it would be another day before the doctor saw the patient again with the test results.

The patient was in hospital for so many days, not because he needed to be, but because that was how long it took for his condition to be assessed and for him to get the proper treatment.

The hospital changed how such patients were cared for, which meant having a senior doctor assess their conditions early, followed by fast access to investigations and procedures. The senior doctors also do more frequent rounds.

Prof Choo said: "If the investigation report comes back in two hours, a decision can be made, instead of waiting for the traditional ward rounds in the mornings and evenings."

For common problems, the hospital has a strict protocol for care and discharge.

This means even junior doctors would know the tests to order for certain conditions and, depending on the results of those tests, whether the patient can be treated immediately and discharged or has to be hospitalised.

Prof Choo said patients staying for one to three days made up more than half of admissions. So it was in their best interest and that of the hospital to have them in and out within 24 hours.

 

Looking to the future, he said: "We need to build up a whole range of pre-hospital systems."

These will provide the care needed, including day wards, for patients who do not really need to be admitted for a hospital stay.

Part of this is his plan to set up a geriatric acute assessment unit for elderly patients with minor changes in their conditions, who might need reassessment of treatments and how they are managed.

They can be cared for in a day ward, so they know they will be going home soon, he said.

Salma Khalik

A version of this article appeared in the print edition of The Straits Times on October 23, 2017, with the headline 'Freeing up beds without compromising care'. Print Edition | Subscribe