today • Wednesday 1 May 2013
16
health
Long-term assistive ventilation
Providing breathing support in the home The Home Ventilation Service enables patients dependent on ventilators to return home and not stay in hospital indefinitely Eveline Gan
eveline@mediacorp.com.sg SINGAPORE — Even with his hectic work schedule as a senior consultant anaesthesiologist at Tan Tock Seng Hospital (TTSH), Dr Chan Yeow found a way to care for patients who require long-term breathing support outside the hospital. Working with colleagues from other departments, Dr Chan spearheaded the Home Ventilation Service (HVS)
in 2009. The service trains caregivers to use respiratory machines so that patients who are dependent on ventilators can return home instead of staying in the hospital indefinitely. A multidisciplinary team comprising nurses, community physicians, respiratory therapists and other allied health staff conduct follow-up home visits and therapy. Dr Chan was one of 54 healthcare professionals who received the Healthcare Humanity Award yesterday. Now in its 10th year, the award is given out annually to outstanding healthcare workers who stand out for their efforts in improving patient care and going beyond the call of duty. To date, over 60 patients at TTSH have benefited from the HVS. The
It is possible to help ventilatordependent and ventilatorassisted patients live and thrive at home. For the correct patients, it works wonderfully. Dr Chan Yeow Director of Home Ventilation Service
Dr Chan Yeow on a home visit with Nurse Clinician Sun Tao to change the tracheotomy tube and make an assessment of ventilatory adequacy for a patient on the Home Ventilation Service. He and his team visit patients using this service about once a month. PHOTO: TAN TOCK SENG HOSPITAL
Ministry of Health came on board in 2011, approving a five-year project to study the benefits for patients who require long-term assistive ventilation. Dr Chan, who is Director of the HVS, said that the project was spurred on by patients he had encountered, many of whom “refuse to accept their fate” despite having severe respiratory failure. “Breathing support is available in hospitals. So why not in the home? Just like dialysis is available for kidney failure patients in the hospital and in the community. What we have learnt (through the service) is that it is possible to help ventilator-dependent and ventilator-assisted patients live and thrive at home. For the correct patients, it works wonderfully,” he said. One patient who has benefited from this service is 54-year-old Vincent Wan, who suffers from amyotrophic lateral sclerosis, an incurable, progressive brain disease that attacks nerve cells controlling muscle movement. As muscles gradually waste away, patients have problems breathing, speaking, eating and walking. Diagnosed in August 2011, Mr Wan
requires long-term breathing support. But trained by Dr Chan and his team to use the breathing equipment at home, Mr Wan’s wife, Elene, is able to care for him at home. “With his condition, many nursing homes won’t even take him. The team has been a big help. Without HVS, he’ll probably require long-term hospitalisation, which will run up huge bills,” said Elene, who pays about S$2,000 monthly for Mr Wan’s medical bills. The respiratory and monitoring equipment — which can exceed S$25,000, depending on each patient’s condition and needs — was funded by the TTSH Community Charity Fund. Dr Chan said long-term breathing assistance at home has been shown to be helpful in prolonging life. In certain groups of patients, it can also improve quality of life. Some patients on TTSH’s HVS are still doing well four years after hospital discharge, he noted. As long-term ventilation is expensive, most experts recommend that long-term mechanical ventilation is beneficial only if patients have retained their cognition, and can enjoy some quality of life, Dr Chan said.