Stretched but coping: How Singapore’s healthcare system has cranked up efforts to deal with COVID-19

This report delves into the measures that local public hospitals have adopted to cope with the surge in COVID-19 patient numbers, and precautionary measures for the approaching dengue season.
 
A/Prof Hsu Li Yang, programme lead of infectious diseases at SSHSPH commented that Singapore’s strategies were generally very effective up until mid-March, but the nation was unprepared for the explosion of confirmed diagnoses in the migrant worker population. However, he is confident the nation will be able to cope.
 
NTFGH saw a spike in cases at its emergency department and has had to rapidly re-purpose areas such as its Community Hub (at JCH) and six floors of wards, and extend its fever tent, to cater to the increasing load.
 
AH has turned two empty wards into isolation wards and increased its intensive care capabilities from 4 to 11 beds. It aims to have 20 ICU beds by this month.
 
NUH has been creating surge capacity since January by decreasing elective workloads, reconfiguring its facilities and has created family-friendly areas where parents and children with COVID-19 can be cared for together.
 
Hospitals have also ramped up training to equip nurses with skills needed in the current situation. At AH, Ms Doreen Heng, Assistant Director of Nursing, provides “express course training” to help former ICU nurses refresh their knowledge, and equip nurses from other backgrounds with ICU certification. 

Bouncing back from SARS with more love for nursing

​​Ms Noor Melati Ahmad (Nurse Clinician, NUH) and Ms Pauline Chong (Senior Nurse Clinician, AH) who contracted SARS in 2003. They share about their SARS experience and recovery journey, what it’s like fighting COVID-19 on the frontline, and how they combat stress and stay positive.

Satellite clinic for geriatric care to open at Queenstown Polyclinic

Elderly care will be more accessible by December 2019 when Alexandra Hospital opens its first satellite clinic for geriatrics at Queenstown Polyclinic. Visits to the satellite clinic, which is located between Queenstown and Commonwealth MRT stations, will be on a referral basis. It will charge lower-than-specialist clinic rates and provide one-stop geriatric assessment and management for conditions such as dementia, frailty, malnutrition, and fall and fracture risk assessment.

亚力山大医院药剂师走入社区登门指导病患服药 (Alexandra Hospital pharmacists pay house visits to assist patients in medication compliance)

From January 2019, Alexandra Hospital (AH) rolled out an initiative where hospital pharmacists make house-visits to help elderly patients facing polypharmacy and issues with medication adherence.

AH Pharmacist, Joshua Low shared that the combination of polypharmacy, a lack of understanding and poor memory may cause elderly patients to be confused with their medication dosage and timing which is alarming. A scenario he gave was an elderly mistaking high blood pressure medication for painkillers, which could result in low blood pressure and subsequently a fall.

Studies have shown that 14.5% of the patients who face the issue of polypharmacy are 66 years and older.

Chang Wei Terk, Principal Clinical Pharmacist, Ng Teng Fong General Hospital (NTFGH), shared that for patients who see multiple doctors and are on a variety of medications, it can be challenging to trace the history and side effects of medications that were previously prescribed. This may constitute to the issue of polypharmacy in patients.

Apart from AH and NTFGH, the National University Hospital also has similar initiatives to help their patients cope with Polypharmacy.

调整生活未 烟绸缪 (Preparing for Haze)

Dr Liew Mei Fong, Consultant, Respiratory and Critical Care Medicine at Alexandra Hospital (AH) commented about how the haze may bring about cough chest discomfort and breathlessness for patients with pre-existing allergic rhinitis, asthma and chronic obstructive lung disease. She advised that patients with asthma to ensure they have their regular corticosteroids inhalers and consider a top-up if they feel unwell.
 
Dr Jonathan Ong, Consultant, Division of Neurology at National University Hospital (NUH) and at Ng Teng Fong General Hospital (NTFGH) commented about the effects of the haze on migraine sufferers, saying that weather changes is one of the most commonly reported triggers. He advised sufferers to manage their condition through adequate sleep, hydration, exercise and regular mealtimes.

Singapore hospitals take steps to protect patients from haze; air quality forecast to improve

The National University Health System (NUHS) – which manages several hospitals, including National University Hospital, Ng Teng Fong General Hospital, Alexandra Hospital and Jurong Community Hospital – has implemented measures to maintain indoor air quality amidst the haze.

They include shutting windows in the naturally-ventilated patient areas, deploying portable air cooling and purifying units and installing filters to the air-conditioning systems in the buildings to minimise pollutants and smell in the air.

Senior security officer Haron Jasmin, 65, who is currently warded in Alexandra Hospital commented on how he found the air in the ward smells fresh and nice despite having the windows being closed.

Staff who are susceptible to the haze condition will be redeployed to work indoors. At Alexandra Hospital, security personnel wear masks when deployed outdoors for patrolling and the daily frequency for groundskeeping such as portering and landscaping has been reduced.

At NUHS polyclinics, the elderly, pregnant women, children and those with existing chronic respiratory and heart diseases will be given priority for consultations and treatment.

• The New Paper, 24 September 2019
  
• Channel News Asia Online, 24 September 2019
  
• Berita Harian Online, 24 September 2019
  

Air quality back at unhealthy levels, docs issue warning

​Dr Jonathan Ong, Consultant, Division of Neurology at National University Hospital (NUH) commented about the effects of the haze on migraine sufferers, saying that weather changes is one of the most commonly reported triggers. He advised sufferers to manage their condition through adequate sleep, hydration, exercise and regular mealtimes.

Dr Liew Mei Fong, Consultant, Respiratory and Critical Care Medicine at Alexandra Hospital (AH) commented about how the haze may bring about cough chest discomfort and breathlessness for patients with pre-existing allergic rhinitis, asthma and chronic obstructive lung disease. She advised patients with asthma to ensure they have their regular corticosteroids inhalers and consider a top-up if they feel unwell.

Special measures have been employed by entities under the National University Hospital System (NUHS) for patients – these include shutting windows, deploying portable air cooling and purifying units and having air-conditioning systems to be fitted with filters to minimise pollutants and smell brought about by the haze.

Non-urgent care the focus at Alexandra Hospital

Specialist and Surgical teams at Alexandra Hospital (AH) are focusing more on non-urgent yet high-volume cases to free up tertiary hospitals’ space to carry out acute, complex operations. Patients who feel medically unwell can visit AH’s Urgent care centre 24/7, where it’s new surgical wing will receive more elective cases which respond to the needs of an ageing population. These include cataract, hearing loss, total knee replacement.
 
The waiting time for the first appointment is reduced to 5 working days and procedures will be carried out as soon as apt. Normally, waiting times for the first appointment is 1 to 2 months. 
 
AH’s surgical facilities will also ramp up to 12 more theatres by 2026 and with the current capacity, AH is able to perform up to 600 electives per month. As part of AH’s model of care, there is no inter-institution transfer for rehabilitative care. Inpatient care is sited at the same bed, same hospital and by the same care team.

Facing Dementia Alone

Dr Tan Li Feng, associate consultant of the Healthy Ageing Programme at Alexandra Hospital, shares how some people with dementia will find themselves in the quandary of not being ill enough to have to go to a nursing home and yet not being able to live alone safely.
 
She added that that many who are in such situations are often discovered by social workers in the community to be living in increasingly unkempt and unsafe states, and eventually end up in nursing homes or in the care of the state.

New programme seeks to develop use of exoskeletons in patient rehab

About 36 patients who are unable to walk independently due to neurological diseases are part of a study looking at the effectiveness of using exoskeletons in the rehabilitation process.

The Temasek Foundation – Improving Mobility via Exoskeletons (iMOVE) programme will study patient outcomes and assess the viability and potential of scaling up the use of robotic exoskeletons in rehabilitation care, from the hospital to the community. It will seek to improve the mobility and independence of patients suffering from conditions like strokes and spinal cord injuries, said Professor John Wong Eu Li, chief executive of the National University Health System (NUHS).

Three exoskeletons will be shared by NUHS' five partner sites: Alexandra Hospital, NTUC Health, St Luke's ElderCare and St Luke's Hospital and the Stroke Support Station.

NUHS is the first national health system in Asia to study how advanced exoskeleton technology can improve mobility and rehabilitation outcomes across the care system. A national task force to advance the knowledge and the use of technology in rehabilitation was also formed on 6 May.

• Channel NewsAsia, 9 May 2019
• The Straits Times, 7 May 2019, Page B3
• Lianhe Zaobao, 7 May 2019, Page 4
• The New Paper, 7 May 2019, Page 9
• Berita Harian, 7 May 2019, Page 5
• Channel 8 News, 6 May 2019
• Tamil Murasu, 7 May 2019, Page 3
• Lianhe Wanbao, 6 May 2019, Page 3
• Shin Min Daily News, 6 May 2019, Page 6

NUHS leads study of using exoskeleton technology to improve rehabilitation from hospital to community

The benefits of napping – and how to snooze without affecting your sleep at night

This World Sleep Day, Alexandra Hospital’s Chairman Medical Board, Associate Professor Khoo See Meng, comments on sleep deprivation and how naps may be a better option to catch up on sleep compared to sleeping in on the weekends.
 
He adds that “weekend catch-up sleep may disrupt the circadian rhythm and lead to poor bed time sleep,” and recommends short naps of 15 – 20 minutes as long naps result in slow-wave sleep which is associated with drowsiness and disorientation upon waking.

New integrated care model for elderly patients under trial

A new model of care, being piloted in Singapore for the first time at Alexandra Hospital, will see patients cared for by the same team from admission to discharge and stay under the same hospital roof.

Called the integrated general hospital model, it aims to better meet the needs of a growing group of elderly patients, many of whom have multiple medical conditions.

Alexandra Hospital’s Chief Executive Officer, A/Prof Jason Phua comments that this new model can be a “game changer”.
​

• The Straits Times, 15 December 2018, Page A1
  
• The Straits Time Online, 14 December 2018
  
• Lianhe Zaobao, 15 December 2018, Page 2 and 8
  
• Lianhe Wanbao, 14 December 2018, Page 6
  
• Shin Min Daily News, 14 December 2018, Page 2
  
• Berita Harian, 15 December 2018, Page 1
  
• Tamil Murasu, 15 December 2018, Page 1
  

Alexandra Hospital to open new facilities increase number of beds

​Alexandra Hospital which was taken over by the National University Health System (NUHS) in June, plans to open new facilities and increase its 176 beds to around 300 by 2020 to cater to an expected growth in demand from the Queenstown area. Associate Professor Jason Phua, Chief Executive Officer, Alexandra Hospital, said that even before the team took over the hospital they had already surveyed the many residents in the Queenstown area to understand how they could better meet the needs of the healthcare needs of the community.

亚历山大医院医护人员与病患亲手制月饼度佳节（Team from Alexandra Hospital Makes Mooncakes with Inpatients to Celebrate Mid-Autumn Festival）

Alexandra Hospital celebrated Mid-Autum Festival and taught inpatients to make their own snowskin mooncakes.   Occupational Therapist, Max Lim explained, “Making mooncakes not only hones cognitive abilities, but also trains both upper limbs, to prevent muscle and cognitive loss and degeneration. Additionally, such group activities, also create opportunities for social interaction which drives away bed-bound boredom.”

Alexandra Hospital’s inpatients are mostly seniors in age and with a few being single-dwellers and may not have visitors. Max added, “Besides boosting patients’ physical confidence to get back on their feet and lead their normal lives and routine when discharged, we are also encouraging them in the emotional aspect, to help them feel more empowered.  When reaching out to them, our tone of voice and willingness and patience to listen to them are paramount.”