Healthcare 'pilots' taking off nationwide

Left: CGH senior staff nurse Lee Sze Wen showing how a bed transporter is used. Piloted at CGH last year, the device will be in use at several public hospitals by mid-next year. Above: CGH deputy director of nursing Wong Kok Cheong said the transport
Above: CGH senior staff nurse Lee Sze Wen showing how a bed transporter is used. Piloted at CGH last year, the device will be in use at several public hospitals by mid-next year. ST PHOTOS: SEAH KWANG PENG
Left: CGH senior staff nurse Lee Sze Wen showing how a bed transporter is used. Piloted at CGH last year, the device will be in use at several public hospitals by mid-next year. Above: CGH deputy director of nursing Wong Kok Cheong said the transport
Above: CGH deputy director of nursing Wong Kok Cheong said the transporter frees up staff and makes the task less taxing.ST PHOTOS: SEAH KWANG PENG

More institutions adopting innovations after projects put on trial at hospitals find success

The past few years have seen so many pilot projects being rolled out at healthcare institutions that the standard joke is the sector has more pilots than Singapore Airlines.

The good news is that some pilots have proven to be successful and will be scaled up nationwide.

Innovations in healthcare, while not new, had taken on a life of their own around 2012 to 2013, backed by more support and funding from the Government.

As healthcare agencies sought better ways of doing things, the number of pilot projects boomed, partly fuelled by the need to deliver good and sustainable care in the face of higher demand from an ageing population.

In an exclusive interview with The Straits Times, Senior Minister of State for Health Chee Hong Tat said: "Certainly, it's an exercise where we must be willing to accept some successes and some failures."

He added that no one should be penalised should a pilot not turn out as expected, and there are lessons to be learnt even in failures.

BED TRANSPORTER

One project that will find its way into several public hospitals by the middle of next year is the use of bed transporters.

The Health Ministry will buy 595 transporters for use in four public hospitals. They are projected to reduce manpower by 34 porters and 19 nurses in total.

Other public hospitals, including those coming on board in the next few years, will have the option to buy them at the same negotiated price. Piloted at Changi General Hospital (CGH) last year, the transporter works like an engine attached to a bed. It enables one person to easily move the bed, instead of two, as is the case now.

Even with two people, the task is strenuous, said Mr Wong Kok Cheong, the hospital's deputy director of nursing. "It is back-breaking work with the potential for injury."

That is because the bed, patient and any equipment like a ventilator or drip, would weigh between 260kg and 360 kg.

Typically, CGH needs to move about 120 patients and beds daily - to send patients for scans, for instance, or to move them to a different ward, said Mr Wong.

It is better to move a patient with the bed than to take him off the bed, transport him separately, and then place him back onto the bed, added Mr Wong.

Mr Chee said the transporters are useful as healthcare workers are getting older and the Health Ministry wants older workers to continue working, given the shortage of experienced manpower.

GP FIRST

Another pilot that will be scaled up nationally is CGH's "GP first" initiative, which encourages patients to see a general practitioner or GP, instead of heading straight to the hospital's emergency department.

At least several hundred of the more than 2,000 people who show up daily at public hospital emergency departments are not so seriously ill that they need hospital treatment.

But many patients do not see a GP first because if they were to need hospital care, it would mean paying twice and delaying the treatment they need.

So CGH worked with GPs in the vicinity and gave priority to patients sent there by a GP. The bills of such patients at the emergency department would also be $50 less to help offset the amount paid to the GP.

Ms Daphne Chan, an interior designer, fell and injured her leg in February. She visited her family doctor, who referred her to the emergency department at CGH.

"I was glad for the referral as I was not aware of the seriousness of the fall," said the 42-year-old.

Her family doctor charged her $20 for assessment and consultation and, at the emergency department, she was attended to within 30 minutes. She also received a $50 waiver at the hospital.

She now tells her friends to do it her way when they face non-life threatening problems.

Dr Lee Chien Earn, who heads CGH, said the scheme has resulted in a 10.5 per cent drop in walk-in patients since it began in 2013.

As healthcare agencies sought better ways of doing things, the number of pilot projects boomed, partly fuelled by the need to deliver good and sustainable care in the face of higher demand from an ageing population.

The hospital incurs some cost, said Mr Chee, but the results are worth it as, among other things, it frees up hospital staff to attend to more serious cases.

PREDICTING NO-SHOWS

Roughly one in four patients with appointments at public-sector clinics fail to show up.

These no-shows also do not inform the clinic, which could have given the slot to another patient.

This is especially critical in places like the National Dental Centre Singapore (NDCS), where patients can wait a year or more for treatment.

Ms Lee Chen Ee, the NDCS' chief operating officer, also noted that there is a waste of resources as the dentist would wait for the patient who fails to show up.

To tackle the problem, Integrated Health Information Systems, the Government's health IT company, piloted a predictive analytics software to try and identify patients who are likely to be no-shows.

For example, patients who were less than 30 minutes late for their previous appointment were more likely to show up for their next appointment.

The predictive model, which went on trial at the NDCS, was found to have a 77 per cent accuracy rate in identifying the likely no-shows.

The dental clinics would then call and remind these patients of their appointments. "Some would then inform us they would like to postpone the appointment," said Ms Lee. The slot would be given to another patient.

This predictive analytics model has been rolled out to all clinics at the NDCS since August, and will be adopted by other SingHealth institutes, such as its polyclinics and hospitals including Singapore General Hospital.


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A version of this article appeared in the print edition of The Straits Times on November 23, 2017, with the headline 'Healthcare 'pilots' taking off nationwide'. Print Edition | Subscribe