The Straits Times (1 June 2023)
Waiting times have improved and treatment is better coordinated with a model of care launched less than a year ago at the emergency department (ED) at Tan Tock Seng Hospital (TTSH).
The department there is the busiest in Singapore, handling about 132,000 cases a year.
Among the patients seeking help are those suffering pain from joints, bones and muscles as a result of sprains, degeneration, bruises or falls. These are generally nonemergency cases, and make up about 15 per cent of cases, or 19,000 cases, per year.
Such cases are on the rise as the population ages, and to cater to the growing demand, TTSH introduced a model where patients see a trained advanced practice physiotherapist (APP) instead of a doctor when they come to the ED.
The initiative to improve waiting time and provide timely treatment, which was rolled out in June 2022, is a collaboration by the physiotherapy, emergency, orthopaedic, hand and reconstructive microsurgery, and radiology departments at the hospital.
It is designed to improve patient outcomes, enhance patient workflows and add value to healthcare in the wake of workforce shortages and fiscal burden for TTSH.
Principal physiotherapist Ngo Xueting said: “The APPs are trained to independently manage patients with joint, muscle and bone issues, and see them directly after they register and are triaged by a nurse at the ED. For the first time, the APPs are able to order medical imaging instead of getting a doctor to do so.”
Since June 2022, the APPs have treated about 134 patients.
“A key benefit is it helps increase efficiency in the ED. As doctors, we are able to focus on treating lifethreatening emergencies,” said senior consultant in emergency medicine Terence See.
The model has so far reduced the waiting time for such patients by between 30 per cent and 50 per cent, and by 70 per cent for a patient to receive physiotherapy.
Businesswoman Sabrina Lau, 66, who went to the ED at TTSH in March when the pain in her right knee suddenly became unbearable, said the whole process took less time than she expected.
“After registering and seeing a triage nurse, I waited only 30 to 45 minutes before I was ushered into a room to see an APP. I was sent for an X-ray to ensure there was no fracture, and by the time I was told what the issue was, taught to do exercises and given my medication, I was out of the ED in just three hours,” she said.
When she took her mother to the same ED two months earlier after the older woman fainted, it was 12 hours before she was discharged, said Ms Lau.
Other Singapore restructured hospitals have also started initiatives to cut waiting times and reduce staff workload at their EDs.
Since January, the physiotherapy team at National University Hospital (NUH) has had same-day consultations on weekdays for patients referred by the ED. This is part of the National One-Rehab Framework to facilitate patients’ timely access to appropriate types of rehabilitation care.
Senior principal physiotherapist Ng Tze Siong of NUH’s Department of Rehabilitation said patients who benefit from a same-day consultation include those with pain resulting from muscle degeneration or acute pain that improves with painkillers; those able to walk who would benefit from physiotherapy; and those with difficulty walking but with less pain after medication given at the ED.
Ng Teng Fong General Hospital (NTFGH) started a care management scheme for frail, elderly people who frequently visit its ED in August 2020. Its goal was to “decongest the emergency department and save beds”.
Under the scheme, case managers intervene with all at-risk elderly people, and patients of any age who are functionally and socially challenged, said NTFGH head of physiotherapy Lee Chiew Lan.
Between May 2022 and April 2023, the ED at NTFGH had 34,225 patients aged 65 years and above coming in for treatment, and its team managed to intervene in almost 3 per cent, or 1,017, of them.