AHA magazine Jul-Aug 2018: Care Integration in Action

aha

Issue 4: July-AUGUST 2018

Care Integration in Action

MCI (P) 101/04/2018

Yishun Health’s campus-wide efforts to refine healthcare delivery processes at every level for safe, seamless and timely patient care

Put Your Best Foot Forward

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Party with a Purpose

20

Climb every mountain

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ontents

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COVER STORY Care Integration in Action Yishun Health’s campus-wide efforts to refine healthcare delivery processes at every level for safe, seamless and timely patient care

4

HEALTH HIGHLIGHTS What is CareShield Life?

6

WHAT’S UP Community events, outreach efforts, and more

11 DAILY DOSE

Put your best foot forward

Helpful tips to prevent foot pain 12 EVERYDAY HEROES

In tribute

Remembering the late Clinical Associate Professor Sin Fai Lam

26 LIVE WELL

Climb every mountain

Be inspired by Ruth Koh’s zest for life

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28 MAKAN TIME Lontong

Spicy, hearty and surprisingly healthy 30 MIND & HEALTH

Spot the difference

Take a break — spot the differences!

26

20 SPOTLIGHT

Party with a purpose

Gathering for games, snacks and medical assessments

INTEGRATED CARE SERIES PART 2 OF 3

24 5 THINGS ABOUT…

Feet & your health

Take care of your feet; they take care of you

28

This three-part series focuses on Yishun Health’s care integration model, which is the delivery of holistic, right-sited care across the healthcare spectrum.

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W

e hope you are enjoying the recent revamp to aha.

In this issue, we continue our series on integrated care: what it means, why it matters, and how we at Yishun Health are transforming to enhance patient care. The cover story (page 14) explores the shifts that have taken place to reduce barriers to care, make access to care more timely, and improve outcomes for patients.

This theme of care around patients extends to other stories in this issue. One of these covers the opening of the Admiralty Medical Centre (page 6). Another is an article on the HOPE and CARE initiative (page 20), which is an innovative way for healthcare professionals from different medical disciplines to observe a group of patients.

We have also included a healthy Lontong recipe (page 28). Whip up a dish for the family that is surprisingly yummy yet nutritious!

Happy reading!

The Editorial Team

PUBLISHER Yishun Health is a network of Medical Institutions and health facilities in the north of Singapore, under the National Healthcare Group. It comprises Admiralty Medical Centre, Khoo Teck Puat Hospital and Yishun Community Hospital. It also includes community extensions such as Wellness Kampung.

EDITORIAL TEAM Hannah Wong Sabrina Ng Sharon Ng Albert Foo

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg M A N AG I N G D I R E C T O R

Christopher Tay

E D I TO R I A L D I R E C TO R

Chua Kim Beng

C O N T R I B U T I N G E D I TO R

Sheralyn Tay

aha

E D I TO R

Dang Hui Ling

Issue 4: July-AUGUST 2018

A R T D I R E C TO R

Regina Wong DESIGNER

Melissa Poon S E N I O R M A N AG E R , C L I E N T R E L AT I O N S H I P

Jessie Kek

MCI (P) 101/04/2018

C O N T R I B U TO R S

Care Integration in Action

Yishun Health’s campus-wide efforts to refine healthcare delivery processes at every level for safe, seamless and timely patient care

Put Your Best Foot Forward

11

Party with a Purpose

20

Climb every mountain

W

Ahmad Iskandar, Genie Lim, Justin Loh, Lee Lily

26

hy aha?

The name aha holds much significance for us at Yishun Health.

In part, it is a nod to our history; it also stands for ‘Advocates for Health in Action’.

Through these pages, we hope to empower you to take charge of your own health and discover those ‘aha!’ moments that lead to a healthier, happier you.

ktph.com.sg/aha aha@ktph.com.sg

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 101/04/2018

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ealth Highlights

Introducing

CareShield Life CareShield Life will replace the ElderShield scheme in 2020.

Here’s what you need to know.

To better provide financial aid to people with severe disability and provide better security for an ageing population, CareShield Life will replace ElderShield in 2020. It will enhance ElderShield (a basic long-term care insurance scheme for persons with severe disability, especially during old age) and reduce the uncertainty of long-term care costs. You will enjoy higher payouts that increase over time.

Best of all, there is no cap on the payout duration.

MORE COMPREHENSIVE COVERAGE If you are a Singaporean or a Permanent Resident (PR) born in or after 1980, you will be automatically enrolled into CareShield Life. If you already have ElderShield, you will continue to be protected by the existing plan. However, ElderShield policyholders may opt to switch to the new scheme in 2021 by topping up their premiums.

CareShield Life will start when you hit 30, as opposed to 40 under ElderShield, and provide coverage even if you have pre-existing and severe disabilities. Unlike ElderShield, which is run by private insurers, the Government will administer CareShield Life.

If you are severely disabled, you will receive payouts of at least $600 a month for the rest of your life under the lifetime coverage of CareShield Life. This potential payout will increase over time until you reach the age of 67 or make a successful claim.

PREMIUMS AND SUBSIDIES If you are male, premiums start at $206; they start at $253 if you are female. Premiums will increase by 2% a year for the first five years; future increases will be determined later. These premiums can be paid via Medisave.

The Government will provide three types of subsidies: If you are Singaporean with a per capita family income of $2,600 or less, you will receive 20–30% subsidies; if you are a PR, you will receive half this discount If you are Singaporean, you will receive transitional subsidies amounting to $250 for the first five years You will receive additional support if you cannot afford the premiums despite subsidies

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CareShield Life Caring for you, for life

Many of us may need long-term care because of severe disability in old age

CareShield Life will provide better protection and assurance in 4 ways

1 3

Lifetime cash payouts for as long as you are severely disabled

Government subsidies make it affordable; you won’t lose coverage if you cannot pay the premiums

2 4

Payouts increase over time, starting at $600/month in 2020

Premiums can be fully paid by Medisave

What happens when CareShield Life is launched in 2020?

If you are born in

1979 or earlier

Your current ElderShield plan will continue to protect you You can choose to join the new scheme Your premiums, subsidies and support package will be recalculated

If you are born in

1980 or later You will automatically join the new scheme in 2020 or when you turn 30 Those with pre-existing conditions or disabilities will be included

For more information, visit www.careshieldlife.sg | 5

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hat’s Up

Admiralty Medical Centre: Healthcare Where You Are

PM Lee striking a gong to announce the opening of Kampung Admiralty. He was joined by (l–r): Mr Vikram Nair, Member of Parliament, Sembawang GRC (Admiralty); Mr Amrin Amin, Member of Parliament, Sembawang GRC (Woodlands); Mr Ong Ye Kung, Member of Parliament, Sembawang GRC (Gambas); Mr Khaw Boon Wan, Member of Parliament, Sembawang GRC (Sembawang); and Mr Lawrence Wong, Member of Parliament, Marsiling-Yew Tee GRC

K

ampung Admiralty, Singapore’s first integrated public housing development designed with an extensive range of elder-friendly features, was officially opened by Prime Minister Lee Hsien Loong on 12 May 2018. It comprises a hawker centre, supermarket, child care centre, as well as Yishun Health’s Admiralty Medical Centre (AdMC).

In his address, PM Lee noted how this project — the first of its kind — is aimed at helping Singaporeans lead active and meaningful lives, especially in their sunset years. He said that projects such as Kampung

Admiralty “promote strong social support and community bonding, and let people in their silver years stay socially engaged and live safely, healthily and happily”.

During his tour of the development, PM Lee also did a walk-through of AdMC. He was hosted by its Medical Director, A/Prof Yip Chee Chew. A/Prof Yip shared how the facilities — such as the Diabetes Centre and Eye Centre — will play a role in bringing convenient, quality and holistic care to patients and residents in the north.

One-stop care within the community Patients who have been referred to AdMC will be able to access a range of health services. These include outpatient consultations, day surgery procedures, endoscopies, diagnostic imaging services, rehabilitation therapy, as well as holistic diabetes management. They can also test their blood and fill their prescriptions at the pharmacy.

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ALL-ROUND DIABETES CARE AdMC’s Diabetes Centre encourages self-empowerment.

Here, patients are taught how to control their condition independently through Diet, Exercise, Support, and Monitoring — not just through Medication. The centre also provides specialised clinical services, complications screening programmes, and comprehensive educational programmes.

AdMC incorporates kampung living elements with modern architecture and health nudges.

The large central window symbolises doors that used to be kept open to neighbours; it fills the space with light and offers a view of a garden and the nearby HDB blocks.

The central staircase, with its eye-catching colours and prominent placement, also encourages visitors to literally take steps towards better health.

Ms Chelsea Law, Principal Podiatrist, KTPH, showing PM Lee her innovation: 2-in-1 shoes designed for persons with diabetes that can be used indoors and outdoors

AN EYE ON HEALTH

Mr Azman bin Kassim, an eye patient at AdMC, demonstrating to PM Lee how he uses the Macular Amsler Testing Application (MATA) to self-manage his eye conditions at home

Developed by AdMC’s Eye Centre, MATA is a userfriendly and low-cost smart phone app that replaces paper charts typically used for monitoring macular function. With the app, patients can do accurate self-monitoring of their central visual field. The app also contains step-by-step menus, with teaching videos and reminder notifications to undergo regular tests. The app drives timely disease management through better testing compliance and test accuracy.

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hat’s Up

May Day Awards: Strengthening the Workforce

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rs Chew Kwee Tiang, CEO, KTPH and Yishun Health, was conferred the Medal of Commendation during the NTUC May Day Awards Ceremony, which was held on 5 May 2018. Mrs Chew was one of 141 recipients who were acknowledged for strengthening labour management relations, upgrading the workforce, and being a partner to the Labour Movement.

Yishun Health received the Innovative Breakthrough Award at the same ceremony as one of the

15 partners of the Kampung Admiralty Silver Community.

The inaugural award, received

by Dr Wong Sweet Fun, Chief Transformation Officer, KTPH and Yishun Health, recognises breakthrough initiatives that have impacted the lives of workers.

The May Day Awards is held in conjunction with Labour Day and recognises leaders and organisations for their contributions to workers in Singapore.

Left: Mr Chan Chun Sing, NTUC SecretaryGeneral, presented the award to Mrs Chew Kwee Tiang (CEO, KTPH and Yishun Health). She was one of 141 recipients acknowledged for their contribution to the Labour Movement Right: Dr Wong Sweet Fun (Chief Transformation Officer, KTPH and Yishun Health) represented Yishun Health in accepting the inaugural Innovative Breakthrough Award from Mr Chan

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Recognised for Better Care Delivery O

n 11 May 2018, 28 staff and five teams from Yishun Health were lauded at the 2018 NHG Awards Ceremony for their dedication and pursuit of excellence in patientcentred care. Two of the teams, the Hip Fracture Unit (HFU) and Acute Medical Unit (AMU), received Gold and Silver respectively. The HFU started in 2015 to provide an integrated pathway of care. Apart from lowering hospitalisation stays and rates of readmission and mortality, the initiative has also reduced the cost of care for treatment of surgical site infections.

Members of the HFU strike a pose.

They are joined by A/Prof Terence Tang (Deputy Chairman, Medical Board; Senior Consultant, Geriatric Medicine) on the far right

Turn to page 14 to read how the HFU and AMU are aligned with Yishun Health’s overall care integration transformation.

Inspiring award recipients who have shown outstanding contributions to better patient care

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hat’s Up

Maintaining Good Hand Hygiene for Our Patients

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o commemorate Global Hand Hygiene Day, Yishun Health’s Infection Control Team held an award ceremony on 18 May 2018 to recognise teams that have reflected outstanding hand hygiene compliance in their wards and departments. Dr Chris Willis, Chairman of the Infection Control Committee, and Senior Consultant, General Medicine, noted that hand hygiene compliance has improved over the years, and challenged healthcare workers to continue maintaining hand hygiene standards.

The team from Isolation Ward B46 has had the best hand hygiene compliance for three consecutive years

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put your best foot forward Over a lifetime, your feet would have walked more than 185,000km — that’s four times around the globe! Look after your feet so they can look after you.

In consultation with Ms Chelsea Law, Principal Podiatrist, KTPH

CHOOSE SHOES THAT HAVE: A supported heel collar for improved ankle stability A vamp that supports the foot (and has fastenings that keep the foot stable within the shoe)

A deep and wide toe box that leaves toes free to wiggle

T

he basics of good foot care are important to prevent problems such as ingrown toenails, corns, calluses and foot pain. Good foot care is particularly important for persons with diabetes and those with conditions such as peripheral vascular disease and arthritis (turn to page 24 to read about foot health). Apart from keeping feet clean and dry, and maintaining good nail care, it is also important to wear shoes that fit well.

CUT IT RIGHT Trim your toenails whenever they get long. Always trim your toenails straight across, not into the sides, to reduce the risk of ingrown toenails. When trimming, be sure to leave a little bit of the white part of the nail. Use an emery board or pumice stone to smooth the edges, but

only move it in one direction, not back and forth.

FUNCTION BEFORE FORM Shoes should be more than a fashion statement. Stylish but ill-fitting shoes are common culprits for not just foot pain, but also back pain.

Comfortable shoes can reduce the risk of developing corns, calluses and blisters as well as improve foot, leg and back pain. They may also play a role in preventing falls.

MAKE SURE THE SHOE FITS Always try on shoes before buying them. Do not assume they fit well just because they are ‘your size’. Your feet may expand throughout the day, so for the best fit, try shoes in the

A thin, firm, supportive shoe base and cushioned insole A low heel of 1 inch or less to reduce falls risk and strain on knees Breathable materials and a slipresistant outsole with good grip

midday and measure both of them for size. As it is common for one foot to be larger than the other, always accommodate the larger foot. Ensure that there is a finger’s width between your longest toe and the end of the shoe. Most importantly, put on both sides and test for comfort by walking around in them. Shoes should feel comfortable immediately and not require a ‘wearing-in’ period. | 11

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veryday Heroes

In Tribute Clinical Associate Professor Sin Fai Lam, who passed away in May 2018, dedicated a big part of his life in service to others — as a clinician, healer, mentor, leader and friend.

A

ssociate Professor (A/Prof) Sin Fai Lam was a familiar face to many. He contributed significantly to the growth of the Department of General Medicine at Alexandra Hospital (AH) and KTPH. He played an important role in the transition of AH to KTPH, imparting his insights, knowledge, patience and wisdom to the process.

Graduating with a medical degree from the Queen’s University of Belfast in 1974, he was certified as a respiratory medicine specialist with the Specialist Accreditation Board. He later joined AH in 1983 and spent his entire 33-year career as a doctor dedicated to making the lives of patients better.

In 2001, A/Prof Sin Fai Lam was appointed Deputy Head of the Department of General Medicine.

He subsequently led as Head of Department until 2011. Under his leadership, A/Prof Sin Fai Lam built up the department, developed its subspecialty services, and recruited many specialists, including KTPH’s current Chairman of the Medical Board (CMB), A/ Prof Pek Wee Yang. The General Medicine Department is now the

largest clinical department in KTPH, providing round-the-clock care for acutely ill patients.

The department’s reputation for excellence in undergraduate and postgraduate training in general medicine in Singapore is thanks, in no small part, to A/Prof Sin Fai Lam, KTPH’s first Education Director at the Education Development Office.

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As a mentor, colleague and doctor, A/Prof Sin Fai Lam took the effort, despite his many responsibilities, to make himself available to junior doctors, staff, peers and patients. In particular, he truly cared for the well-being of the latter and it was not uncommon to find him running extra clinics on Saturdays to help reduce patient waiting times for new appointments.

A/Prof Wong Moh Sim, Deputy CMB (Clinical and Quality Manpower Development), and Head and Senior Consultant, Laboratory Medicine, shares, “A/Prof Sin Fai Lam was one of the most dedicated doctors I have known. He was very knowledgeable and wise, yet

humble. He was a pillar of support to me when I was a fledging Head of Department in AH. Despite his busy schedule, he always found time to listen to me and give me advice. He was a great boss and colleague.”

Mrs Chew Kwee Tiang, CEO, KTPH and Yishun Health, remembers him as “a wonderful boss, a magnanimous mentor, an astute clinician, a caring colleague, and a faithful friend”. She says, “The hospital is forever indebted to him. Though we mourn the loss of an icon, we want to celebrate his life dedicated to public service and his many achievements. His legacy shall live on in KTPH. He will be deeply missed.”

A/Prof Sin Fai Lam was a wonderful boss, a magnanimous mentor, an astute clinician, a caring colleague, and a faithful friend.

MRS CHEW KWEE TIANG CEO, KTPH AND YISHUN HEALTH

A HOSPITAL FOR ALL SEASONS

A/Prof Sin Fai Lam’s vision and hope for the hospital is encapsulated in a poem he adapted from Robert Bolt’s ‘A Man for All Seasons’.

A hospital through thick and thin A hospital with a sure purpose Not a ‘hail fellow well met friend’; A hospital of principle; Not going with the flow, Not a jellyfish floating with the fashion; But a hospital of its own destiny, A hospital with a true sense of its worth Before the might of God

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Cover Story

Care Integration

in Action

At Yishun Health, our goal is to simplify medical care and deliver a patient experience that is safe, seamless, timely and of high quality.

To do so, we are relooking and refining healthcare delivery processes at every level to better organise care around you.

Following her hip fracture surgery, Mdm K, 77, was able to stand up during her rehab session with Dr Mohamed Irshad Ahamed (Resident Physician, YCH) and Ms Joy Tan (Physiotherapist, KTPH)

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INTEGRATED CARE SERIES

W

hen seniors such as 77-yearold Mdm K are admitted to Khoo Teck Puat Hospital (KTPH) after sustaining a hip fracture, they usually worry about the long hospital stay, hefty bills and recovery period. In the case of Mdm K, the Yishun Health care team got her out of bed shortly after her surgery to practise taking small steps every day. Soon after, she was transferred to Yishun Community Hospital (YCH) to focus on rehabilitation. Have regained most of her mobility, she was discharged and is now on her way to full recovery.

For hip fracture patients, the timely care and holistic treatment plan help to alleviate potential inconvenience and additional financial burden. This efficient and seamless transfer from emergency care to surgery, ward and community hospital for hip fractures is part of Yishun Health’s Hip Fracture Service or HFS (see page 16). This service is part of a broader initiative to simplify and streamline healthcare across the Yishun Health campus.

ACUTE-TO-COMMUNITY HOSPITAL FLOW A/Prof Phoa Lee Lan, Deputy Chairman of the Medical Board (Care Integration and Clinical Standards), KTPH and Yishun Health, says pulling together traditional silos of care, refining conventional processes, and strengthening collaboration across different medical disciplines and care settings are the key success measures for the ongoing care integration effort.

“Care integration is about building a culture where, regardless of where the patient is within the campus, our doctors readily cross work boundaries to provide timely and coordinated care for the patient,” she says.

PART 2 OF 3

Traditionally, acute and community hospitals function as separate entities. However, under Yishun Health’s integrated care model, YCH is an extension of KTPH. “It acts like another ward,” A/Prof Phoa says.

“There may be different care units that cater to different medical needs, but we want a culture of a single multidisciplinary team caring for the patient.”

This unified vision means that the role of a community hospital and

and specialists if required to the community hospital to support patients with multiple active chronic conditions of high complexity or high care needs,” he adds.

At Yishun Health, doctors from KTPH and YCH hold joint

those of doctors in both the acute and intermediate settings need to evolve, adds Dr Lee Kok Keng, Medical Director, YCH. “Historically, it is assumed that all the acute medical issues have been resolved in the acute hospital once patients are transferred to the community hospital,” he says. “However the profile of patients has changed; today we are seeing more complex cases of higher acuity.”

For example, while someone recovering from a stroke or a broken bone may be warded for rehabilitation therapy in the community hospital, he or she may still have ongoing treatment — for sepsis, anaemia, or chronic ailments such as uncontrolled diabetes, active heart disease such as heart failure or acute exacerbations of chronic lung disease, to name a few. “We should allocate the right resources

consultations and ward rounds one to two times a week. This ensures that YCH patients and family physicians are adequately supported with specialist help, if required. This is also an opportunity for doctors from the acute team to gain a better appreciation of complexities faced by the community hospital care team and the environment they operate in.

To normalise this collaboration between the two settings, Dr Lee notes that it is less about the work process but rather the people. “The idea of care integration may seem very process-driven, but it requires a mindset change by all healthcare professionals who are involved in the direct care of the patient,” he emphasises. A/Prof Phoa echoes this sentiment: “It is not about being an acute hospital or community hospital’s patient, but being our Yishun Health patient.”

Care integration is about building a culture where, regardless of where the patient is within the campus, our doctors readily cross work boundaries to provide timely and coordinated care for the patient.

A/PROF PHOA LEE LAN, DEPUTY CMB (CARE INTEGRATION AND CLINICAL STANDARDS)

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Cover Story TOWARDS TRANSDISCIPLINARY CARE Another important piece of the care integration work is about moving away from episodic care to building an ecosystem of care around a patient that spans the entire ‘lifecycle of care’.

A/Prof Tan Kok Yang, Deputy Chairman of the Medical Board (Service Development), KTPH and Yishun Health, calls this transdisciplinary care. “This approach moves away from episodic ad hoc care, enhances the communication and collaboration between every medical professional, and builds a greater sense of ownership of every patient,” he explains.

It begins from a patient’s entry into the healthcare system, through acute and intermediate care, back to the home and the community.

Even when a patient is back in the community, the care continues so that the patient is able to manage long-term issues where he or she lives. This will reduce the chance of readmission into the hospital.

Hip Fracture Service (HFS) This service is one example of the ethos underpinning the transformation of healthcare delivery at Yishun Health. According to Dr Jagadish Ullal Mallya, Head of HFS, and Senior Consultant, Geriatric Medicine, KTPH, the transdisciplinary team of surgeons, doctors, nurses, physiotherapists and occupational therapists across both KTPH and YCH works together to streamline and improve processes. This collaborative effort has led to: • Faster admissions Doing away with sequential processes and allowing more parallel processes has shortened admissions. More than 60% of the patients are now admitted within four hours

The transdiciplinary team conducting a ‘huddle’, discussing Mdm K’s care plan LEFT TO RIGHT: Ms Hong Ai Ling (Senior Staff Nurse, KTPH), Dr Su Su (Consultant, Geriatric Medicine, KTPH), Dr Leon Tan Zhe Wei (Medical Officer), Dr Suresh Babu Loganathan (Consultant, Anaesthesia, KTPH), Ms Claudia Quek (Nurse Clinician, KTPH)

This approach moves away from episodic ad hoc care, enhances the communication and collaboration between every medical professional, and builds a greater sense of ownership of every patient.

A/PROF TAN KOK YANG, DEPUTY CMB (SERVICE DEVELOPMENT)

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of turning up at the Emergency Department (ED), up from 40%.

• Faster access to surgery While balancing the need for hip fracture surgeries with other surgical demands in the hospital, more than 60% of surgeries are performed within two days, up from below 40% previously.

• Early mobilisation Supported by anaesthesiologists and physiotherapists, patients are encouraged to get out of bed and get mobile the day after surgery. This accelerates functional

recovery and reduces the length of stay in the acute setting.

• Early transfer to community hospital Pain, lack of information on weight bearing, medical issues, and lack of coordinated care resulted in delayed mobilisation in the past. This increases the risk of complications such as functional decline, delirium and pressure sores. Transfer criteria and processes were reviewed and trimmed. From an average wait of three-and-a-half days, more than 80% of hip fracture patients are

now transferred to YCH on the same or next day.

• Lowering surgical site infections (SSIs) SSIs are preventable complications following surgery.

A comprehensive prevention programme has reduced incidences to 1.4%, compared to the international rate of 9%.

These improvements have raised the quality of care and enabled a more efficient use of hospital resources, says Dr Jagadish. The streamlined processes mean

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Cover Story

Mdm K being assessed by Dr Naidu Kanak (Consultant, Acute & Emergency Care, KTPH) and Ms Tan Yang Yee (Staff Nurse, KTPH)

doctors and nurses can spend more time on patient care rather than administrative work. The timelier transition of patients from the acute to rehabilitative settings helps their recovery and long-term management, saving time and money.

“Most importantly, it enhances their quality of life,” he adds.

Integrated Care of Obesity and Diabetes (ICOD) The ICOD facility started in June 2018. ICOD co-locates a cross-disciplinary team of physicians, surgeons, psychologists as well as dietitians and physiotherapists in a single site to offer seamless

transdisciplinary care for the full spectrum of needs. This includes weight management, dietary advice, physiotherapy, internal medicine, and bariatric surgery.

“Obesity and diabetes do not occur in silos, but are often accompanied by other conditions,” explains Dr Tan Chun Hai, Head of ICOD, and Consultant, General Surgery, KTPH. “With ICOD, we can deliver effective treatments as an integrated team to provide bespoke, complex care for patients.”

This facility further extends what KTPH has already been doing for both obese and diabetic patients, as well as those who have gone

through bariatric surgery, but in a shared space. “An integrated facility gives us greater scope to plan clinical pathways to best secure good outcomes for our patients,” he adds.

Diagnoses, prognoses and medications that target all these conditions can now be done and prescribed within the same facility. Patients can be managed in the same place instead of having to travel to two different clinics.

Emergency Department (ED) The ED is historically one of the busiest places in a hospital. To reduce waiting times, improve access to more timely care, reduce

HFS IMPROVEMENTS ED TO WARD

WARD TO SURGERY

60%

60%

are admitted within 4 hours, up from 40%

undergo surgery within 2 days, up from 40%

REFERRAL WAIT

INFECTION RATE

waiting time for a transfer to YCH, down from 3.5 days

compared to global average of 9%

0.8 days

1.4%

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unnecessary hospital admissions, and enhance patient care, KTPH has rolled out several initiatives.

One of these is the Emergency Surgery and Trauma (ESAT) unit, where there is a dedicated team on call to perform emergency surgery.

Previously, emergency surgery was done by the surgeon on call, regardless of his or her surgical discipline. This meant surgeons would have to allocate 30–40% of working hours for emergency surgeries, putting a strain on resources. Elective surgeries were also sometimes postponed so that surgeons can attend to emergencies.

“The ESAT unit means KTPH’s ED can more effectively dedicate manpower to provide prompt and timely care for ED patients,” says Deputy CMB (Service Development), A/Prof Tan. Since its implementation, ESAT has halved the average waiting time from ED to operating theatre; reduced the average length of hospital stay from 4.7 days to 3.4 days; reduced the average length of ICU stay from 8.6 days to 4.9 days; decreased surgical complications; and overall mortality rate from 10.1 to 6.3.

Another initiative is the Acute Medical Unit (AMU), which provides high-quality, rapid assessment, close monitoring and treatment for patients with urgent medical needs.

Patients are located in a single ward instead of being scattered throughout the hospital. This allows the medical team to respond to them efficiently and deliver rapid diagnosis and treatment. Patients stay for a maximum of 72 hours.

During this time, consultants develop, review and communicate a care plan to the family. Patients who require further treatment are transferred to inpatient wards, and

DIRECT ACCESS TO CARE In the traditional model, patients warded in a community hospital had to go through the Emergency Department (ED) in order to be admitted back to an acute ward if their medical condition deteriorates.

Emergency Department

Acute Hospital

Community Hospital

At Yishun Health, medical teams at KTPH cross over to patients at YCH instead.

Emergency Department

Acute Hospital

Community Hospital

If a transfer to KTPH is necessary, patients will be U-turned back to the acute hospital, bypassing the ED, and can be treated as inpatients in specially designated wards.

those who are better are discharged.

This enhances patient safety and enables timely discharge.

Since its inception, KTPH’s AMU has saved more than 4,000 bed days a year. The AMU also admits patients directly from YCH, instead of conventionally via the ED. “This embodies the spirit and objectives of unified and seamless patient care, by providing rapid assessment and care for patients with acute medical conditions regardless of referring discipline or institution,” shares Dr Thofique Adamjee, Head of AMU, and Consultant, General Medicine, KTPH. In a related initiative, the ED also started an Extended Diagnostics and

Treatment Unit (EDTU), which is a 20-bed, 24-hour observation unit. At the EDTU, patients receive intensified therapy and extended diagnostic testing without being admitted.

They can then be discharged with follow-up advice or admitted for further treatment. Since it started operations, more than 2,000 patients have been treated, translating to savings in inpatient admissions.

Scan here to read Part 1 of the Integrated Care Series at Yishun Health

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potlight

PARTY WITH A PURPOSE

A multidisciplinary team of medical professionals is hosting what can only be described as parties for palliative patients. These gatherings allow them to better observe their patients in a relaxed atmosphere.

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INTEGRATED CARE SERIES PART 2 OF 3

T Because we come together as a group to assess patients, we can do co-consultations and highlight areas to take note of.

DR LAURENCE TAN MENTOR, HOPE AND CARE INITIATIVE

Top: Mr Clement Liew (Lead of HOPE and CARE; Physiotherapist, YCH), engaging his patients in activities alongside Mr Halim Zul Fahmi (Physiotherapist, YCH)

he tension builds as the elderly gentleman’s hands gingerly pull a wooden block from a precariously balanced tower. With a look of satisfaction, he places it atop the tower and grins at the man next to him: “Your turn.” Opposite the pair sits an elderly woman. Her eyes are closed in anticipated bliss as she brings a stick of ice cream towards her mouth.

Chatter, laughter and the clattering of Jenga blocks fill the room. Some days, they even break into song and hold impromptu performances. These moments of fun are not just your usual party for seniors, but a unique approach to multidisciplinary team assessments.

HOPE and CARE, or Holistic Patient Evaluation through Communal Activities and Rehabilitative Engagement, is an initiative at YCH. It is aimed at improving the quality of patient care in the palliative ward.

According to Dr Laurence Tan, Mentor for the HOPE and CARE initiative, and Consultant, Geriatric Medicine, KTPH, the multidisciplinary team typically meets weekly to share updates. “However, we wanted to do something more patient-centric.”

GETTING TO KNOW YOU Left: Dr Laurence Tan (Mentor, HOPE and CARE; Consultant, Geriatric Medicine, KTPH) ensures that patients are physically and mentally comfortable at the sessions

They have found that coming together with patients for a communal group exercise session followed by snacks and table games

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potlight

Above left: Ms Chan Sue Mei (Principal Dietitian, YCH) ensures that each patient eats adequately with enough nutrition Above right: Ms Lim Siao Ee (Senior Medical Social Worker, YCH) interacting with her patient to assess his psychological state and social health Right: Ms Chew Woon Ki (Speech Therapist, YCH) sharing her observations from the session with the multidisciplinary team

helps the team to learn more about their patients. “We can obtain real-time information about their mood, pain, tiredness and function,” notes Dr Tan. Compared with individual bedside assessments followed by weekly conferences, each member of the team can now see for themselves how patients are doing.

“Because we come together as a group to assess patients, we can do co-consultations and highlight areas to take note of. By the end of the session, the multidisciplinary report is filled out,” says Dr Tan. This saves time, increases engagement with patients, and strengthens the dynamics within the team.

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ASSESSING THROUGH OBSERVATION

With this initiative, check-ups are no longer confined to the patient’s bed. Instead, everyday activities are used to assess important wellness factors.

PALLIATIVE PHYSICIAN Role: Assesses pain, tiredness, mood and overall function Observes: How patients interact, their levels of energy and alertness, as well as their physical and mental functions OCCUPATIONAL THERAPIST Role: Assesses cognitive function, executive function, dexterity, mobility and the ability to perform activities of daily living Observes: How one holds a cup or piece of biscuit, moves around and interacts with the environment PHYSIOTHERAPIST Role: Evaluates mobility, range of motion, pain and other physical movements Observes: The range of motion and ability to move, and whether they exhibit signs of pain or stiffness

Mr Clement Liew, Lead of HOPE and CARE, and Physiotherapist, Rehab Services, YCH, appreciates the ability to co-consult with his colleagues in real-time. “There is less repetition and we can determine appropriate care on the spot.”

He adds that, because the assessment is less formal, patients also feel less stressed. There are many touch points, and many opportunities for interaction between patients, caregivers and members of the healthcare team. Caregivers and family members are also encouraged to join these fortnightly sessions. “They can raise questions, or we can do some simple caregiver training,” Clement elaborates.

Importantly, Dr Tan says that HOPE and CARE puts the patient back into the equation. “We want to view patients as people, not cases.”

Ms Ong Yock King (Assistant Nurse, YCH) and Ms Joyce Woon (Therapy Assistant, YCH) participating in simple games with their patient

DIETITIAN Role: Looks at appetite, weight and nutrition before designing nutrition plans based on patient needs Observes: Whether someone is eating well.

The dietitian works together with the speech therapist to manage eating difficulties SPEECH THERAPIST Role: Checks for swallowing and communication deficits and does rehabilitation Observes: Patients’ swallowing and risk of aspiration, their communication deficits and coping strategies MEDICAL SOCIAL WORKER Role: Assesses psychological states and social health of patients Observes: Patients’ interaction with family and other patients; their mood and how engaged they are with activities NURSE Role: Assesses patient’s symptoms, ability for self-care, and the competence of caregivers Observes: Patient’s symptoms and ability to self-care, and the competence level of caregivers

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ive Well

CLIMB EVERY MOUNTAIN At 69, Ruth Koh is going strong, keeping active and embracing all that life has to offer. She works, treks and volunteers — and doesn’t plan to stop!

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T

he phrase ‘you’re only as old as you feel’ is particularly appropriate when it comes to Ruth.

The sprightly 69-year-old is full of energy and life. After a long career of secretarial and administrative work, Ruth regained her lost love for sports and other activities.

Ruth had always been active, but work and motherhood meant that she had to set these hobbies aside.

“I started my hobbies again when my son went overseas to study after National Service,” she shares. “I play tennis, squash, badminton, go trekking and marathon running.” At an age when many slow down, Ruth picked up speed. In fact, she clocks an average of 28,000 steps a day and regularly tops KTPH National Steps Challenge rankings.

She even decided to try her hand at a new career, joining KTPH as a Healthcare Assistant with the Ageing in Place Community Care Team (AIP-CCT). Her job involves home visits to patients who have been discharged from KTPH. She is part of a healthcare team that ensures that patients and their families are coping well and flags areas of concern. “I wanted a job where I could meet and help people.”

Most inspiringly, her zest for life has not been dampened despite a bad fall in December 2016. She fractured three ribs and aggravated a previous spine injury. It happened at home when she fell late one night from a stepladder while hanging laundry. The gutsy lady braved the excruciating pain for several hours in order to catch the first bus to the hospital. “It was a hard lesson learnt,

but also a warning to keep in mind about falls prevention,” says Ruth.

She recalls that, during her two weeks in hospital, she tried to be as active as she could even though the pain was bad. “I knew that even sitting up or walking to the bathroom would help.” This determination helped power her through her rehabilitation.

“If I think positive, the road to recovery is fast. I didn’t dwell on the pain but focused on getting better.”

By February 2017, Ruth was back at work. Today, she is ready to take on her next big adventure — her third medical mission to Nepal in November.

Once a week, she climbs up 40 flights of stairs six times, and she will ramp up the frequency of these weekly climbs closer to the trip. Her fall has taught her to be more careful. Ruth says, “I will be more patient and pace myself, but I will still continue to be active and live the life that I love!”

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akan Time

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cut & keep

LONTONG

Creamy, flavourful and chockful of fibre, lontong can be a surprisingly healthy, low-fat and meat-free dish.

In consultation with Nutrition & Dietetics department, KTPH, and Food Services, KTPH

INGREDIENTS

METHOD

Serves 2

1. Blend the spices and oil into a paste 2. Use a non-stick pan to sauté the spice paste until it is fragrant 3. Add the cabbage, tempeh, tau kwa, rice cake, low-fat milk and chilli paste 4. Pour in around 150ml of water — adjust to achieve your preferred gravy consistency 5. Season with salt and simmer until the vegetables are cooked through 6. Garnish each serving with hardboiled egg

• • • • • • • • •

150g (3 pieces) rice cake, cubed 15g cabbage, chopped 15g tempeh, cubed 20g tau kwa (tofu), quartered 50ml low-fat milk 1 hard-boiled egg 60g chilli paste Salt to taste Spice paste: • 25g dried chilli, soaked and drained • 3 cloves garlic • 5–6pcs shallots • 1 inch blue ginger, sliced • 1 inch turmeric root, sliced • 1 lemongrass stalk (white part only), sliced • 1tbsp soybean oil

NUTRITIONAL INFORMATION (1 SERVING) Energy Carbohydrates Protein Fat • Saturated fat • Polyunsaturated Fat • Monounsaturated Fat Cholesterol Fibre Sodium

386kcal 40g 18g 16g 3.4g 8g 4.2g 161mg 8g 221mg

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ind & Health

SPOT THE DIFFERENCE One way of practising mindfulness is to pay attention to details. Can you find the 5 differences between these two photos of the Admiralty Medical Centre? Answers soon on our Facebook page!Â

Turn to page 6 to read about the official opening of AdMC, which was graced by Prime Minister Lee Hsien Loong.

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Community Nurse Post

Wellness Kampung

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the north. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting.

Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)

115 Chong Pang

260 Nee Soon East

765 Nee Soon

Blk 115 Yishun Ring Road #01-495, Singapore 760115

Blk 260 Yishun Street 22 #01-87, Singapore 760260

Blk 765 Yishun Street 72 #01-366, Singapore 760765

6257 4702

6257 4802

6257 4842

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M

Y

CM

MY

CY

CMY

K

Admiralty Medical Centre (AdMC) AdMC is a one-stop medical centre for specialist outpatient consultation, day surgery, rehabilitation and diagnostic services, as well as community health outreach activities.

Khoo Teck Puat Hospital (KTPH)

KTPH is a 590-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore.

It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.

Yishun Community Hospital (YCH)

YCH provides intermediate care for recuperating patients who do not require the intensive services of an acute care hospital. Situated beside KTPH, the two hospitals provide an integrated care experience for patients.

676 Woodlands Drive 71, #03-01 Kampung Admiralty, Singapore 730676

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800

www.admiraltymedicalcentre.com.sg

www.ktph.com.sg

www.yishuncommunityhospital.com.sg

www.fb.com/admiraltymedicalcentre

www.fb.com/khooteckpuathospital

www.fb.com/yishuncommunityhospital