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TTSH and KTPH join hands to offer holistic care

The first of three regional clusters to be set up caters to people in central and northern areas

The Straits Times (23 October 2017) - People living in the central and northern parts of Singapore can expect more comprehensive healthcare services with the setting up of the regional cluster that brings together Tan Tock Seng Hospital (TTSH) and Khoo Teck Puat Hospital (KTPH).

In the past, hospitals looked after patients who came through their doors, but care stopped once they were discharged. In future, they will be expected to care for the community around them, with each cluster having a full range of services, from polyclinics providing primary care to hospitals offering acute care and community hospitals providing rehabilitation.

Professor Philip Choo, head of the new regional cluster – the first of three to be officially set up – said the two hospitals would make good partners as they care for different segments of the population. The move is part of a nationwide reorganisation of public healthcare services into three regional clusters, each with at least two acute hospitals, a medical school, several polyclinics as well as other facilities such as specialist centres and community hospitals.

The public sector has until January next year to consolidate them. TTSH and KTPH both have bed occupancies about 10 percentage points higher than at other public hospitals, but the similarity ends there.

Patients at TTSH tend to be older and the challenge for the hospital is to keep them fit so they do not return with the same problem.

KTPH, on the other hand, has a younger population in its catchment and its focus has been to go out to residents offering health screening and other programmes. As part of the same cluster, they can bring the full spectrum of care to the two million people within the central cluster’s catchment area, said Prof Choo. “We’re now a regional care system and I’m responsible for the population,” he said. In the past, hospitals looked after patients who came through their doors, but care stopped once they were discharged.

In future, they will be expected to care for the community around them, with each cluster having a full range of services, from polyclinics providing primary care to hospitals offering acute care and community hospitals providing rehabilitation.

Prof Choo expects government funding to change to mirror a more holistic approach. When that happens, it will be in the interest of clusters to invest in preventive and rehabilitative care, to keep people healthy and out of hospitals, the most expensive component in the healthcare system.

He said: “Whatever can be done outside the hospital, should be done outside.”

The focus will shift to keeping people healthier for longer, including those with chronic illnesses.

For those who need care, the central cluster will work with the bigger nursing homes in the area to offer “slow rehabilitation” to patients who need it.

Today, most rehabilitation is done at community hospitals, where patients would stay for about a month. But Prof Choo said some people would benefit from longer rehabilitation of up to three months.

Nursing homes, which now provide long-term stay to patients, could turn some of their attention to rehabilitation. This would free up community hospitals and benefit patients if they are able to live at home independently.

His hospital chiefs “must see the whole ecosystem: how to keep the population well, how to maintain those with illness and how to look after patients who are frail”.

They also need to provide alternatives to a hospital for the dying.

Nursing homes could provide end-of-life care, he said, or people could live at home until the very end with help from home care services, an option that most would prefer.

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.
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.



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