A Helping Hand (Saturday Special Report)

November 13, 2010

DOCTORS from big acute-care hospitals here are spending more time and effort in helping shoring up quality of care in the long-term care sector. Both Changi General Hospital and Tan Tock Seng Hospital are active on this front.

Community hospitals - to which many acute-care patients who require longer term care are discharged - are a special area of focus. CGH, for instance, has been working closely with St Andrew's Community Hospital (Sach) since it moved next door in 2005.

Today, about 80 per cent of CGH patients who require step-down care are referred to Sach, says CGH chief executive TK Udairam. Such a transfer is convenient as the patients are wheeled over via a link bridge that connects the two hospitals. To ensure continuity of care, CGH doctors from the orthopaedics, geriatric medicine and psychological medicine visit Sach every week to see patients.

Working together, doctors from the two pairs of hospitals have also established 'formal care pathways' by charting the way that certain patients are to be treated. 'Doctors pre-determine the level of therapy and the treatment a patient should get, depending on the complexity of the case,' says Mr Udairam.

Stable hip fracture patients who need physiotherapy, for instance, can be transferred to Sach.

Those who have serious wounds or other conditions such as dementia, on the other hand, must be managed at CGH.

'When we discharge a patient to the community hospital, we can rest assured that there will be continuity of care,' says Mr Udairam. His hospital has also begun a programme to rope in general practitioners operating near the hospital to manage chronic patients who are discharged from its care. More than 60 GPs and 350 patients are on the programme, with the GPs diligently following up on the regular treatment of heart, diabetes and asthma patients. As a result, more than 90 per cent of the patients have not had any emergency hospital visits.

'We need to rope in as many community resources as we can to provide primary care,' says Mr Udairam. 'Only then will acute hospitals be treated as a last resort for the sick.'

At TTSH too, the link bridge allows easy transfer of both doctors and patients to the neighbouring hospital, pointed out Dr Tan Thai Lian, who heads the geriatric medicine department at TTSH. Earlier, when a Ren Ci patient developed a serious infection, he or she had to be taken by ambulance to TTSH and be re-admitted there.

'Now a specialist can simply walk through the link bridge to Ren Ci to treat the patient there,' said Dr Tan.

But the collaboration between the two hospitals is deeper than just a linking of physical infrastructure. Both institutions are increasing sharing patient information, services and medicines as well. Doctors from both hospitals can share x-ray reports of patients online, which is crucial, since many patients who require long-term care suffer from conditions like hip fracture, said Dr Tan.

Besides, Ren Ci no longer needs to stock certain costly antibiotics in case a patient needs it or face problems of the drug expiry should they remain unused. TTSH supplies the drugs to Ren Ci when necessary, thus eliminating wastage. A key aim of the collaboration is to 'improve cost effectiveness and operational efficiency'. 'But above all, it allows patients to get the right kind of care at the right place.'

radhab@sph.com.sg

~ The above article is taken from The Straits Times.

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