MAR 2019ISSUE #4

A HEALTH INSIDER BY SENGKANG GENERAL HOSPITAL

1II

CONTENTS

Publisher

Sengkang General Hospital Pte. Ltd. skoop is published by Sengkang General Hospital Pte. Ltd.

Copyright © is held by the publisher. All articles in this publication are for information only and are not meant to substitute any advice provided by your own doctor or other medical professionals.

All information is correct at time of printing. Reproduction in part or whole without permission is prohibited. All rights reserved. MCI (P) 037/03/2019.

90700-004-0319

PG 2

PG 10

STAY ON TOP OF YOUR HEALTH

HELP! BUT IS IT AN EMERGENCY?

CARE IS A FAMILY AFFAIR

What do healthcare professionals do to stay well? Here’s a little insight into what the leaders from the Sengkang General and Community Hospitals do to keep themselves healthy and motivated.

TURNINGON THE MOTIVATION

PG 4

PG 8

We’ve all been there. We tell ourselves to eat healthily and exercise regularly but we stop short of taking action. So how do we switch on the motivation?

1

We value your feedback on how we can improve skoop. Please send in your comments and queries to skoop@skh.com.sg

We’ve officially opened!The SKH Campus family is glad to join the northeast community as we

journey towards better health. Let us accompany you on your healthcare journey, from hospital to home.

SKH Campus at a Glance

Editorial Team

Cecilia PangLoretta LeeRenee Seow

Editorial Committee

Bernard ChanDr Victor KwokMohamad Rizal Bin Mohd RazaliDr Tan Choon ChiehDoreen TanEvangeline TanLicia Tan

You would think an Emergency Department (ED) is a place to get medical care quickly, but ‘first-come, first-served’ does not apply here. Find out how SKH ED prioritises care of emergency cases.

Both families and healthcare teams want the same

thing: to help patients recover. Families of the

sick can certainly do more to participate in the care

process, be it at the ward or during rehabilitation.

YOU’LL NEVER WALK ALONE PG 14

Through close collaboration and follow-ups by post-discharge care teams, at-risk patients can continue their recovery outside of the wards with peace of mind.

8 floors ofSpecialist

Clinics

Equipped with the latest technology to handle elective and emergency surgeries

State-of-

Operatingtheatres

the-art

Serves up to 1,500 meals per meal period, with a variety of cuisines

PublicHospital

Kitchen

Large

• Simulated outdoor and indoor environments • Robotic walking system for stroke patients • Virtual reality treadmill

One-stopRehabilitation

Centre

Smart tracking system helps visitors locate vehicles from 1,170 parking lots

Your CarEasily

Find

• Accurate dispensing of medication• Medication Management Counters at every clinic

1,000 beds

General

Community

Sengkang

Sengkang400beds

National

Collaborationwith

CentresSpecialty

Specialist services from NCCS, NHCS, SNEC, NDCS, NNI and KKH1 Integrated

Campus

EmergencyDepartment

• Designed to prioritise medically urgent cases• Separate entrances for ambulances and walk-ins• Decontamination area for mass casualty situations• Separate isolation area with its own X-ray facility and lift to isolation wards

Hospital

Hospital

Outpatient

SystemPharmacy

Automated(OPAS):

CONNECTING THE DOTS

PG 18

Doctors are unanimous on this: healthcare should be a closed loop. That is, you should receive the right care at every stage of your healthcare journey – from the hospital to the GP clinic and back to your home.

Expert Sources

Dr Melvin ChuaKe Bing-RuLee Hui BingDr David NgDr Ng Tong YongQuek Siew HongTan Khee KheeMelissa TanPrabha Techna MitiDr Farhad Fakhrudin VasanwalaDr Xu Bang YuYeo Si SenDr Laurel Yip

CommunityHospital

GeneralHospital

Polyclinics & GPs

32

My friends and I took the advice of a spritely elderly professor to start exercising regularly. He would even check with us on how we were doing. Due to his support (and persistence), we established a weekly exercise regime where we would meet at West Coast Park for a jog. This was five years ago, and we are still going strong!

Knowing what to do to get good health is one thing – having the support to maintain it is crucial. That is why SKCH helps to build a network of health and social services so that patients can have support and peace of mind when they return home. By working with social partners and volunteers, we also help motivate patients to be active stewards of their own health.”

“For me, peer support provides great motivation towards good health. Having like-minded people pushing and encouraging me works wonders.

Ms Margaret Lee Chief Executive Officer SingHealth Community Hospitals

Park explorer

What do healthcare professionals do to stay well? Here’s a little insight into what the leaders from the Sengkang General and Community Hospitals do to keep

themselves healthy and motivated.

STAYONTOP

OF YOUR HEALTH

Associate Professor Wong Kok Seng Deputy Chief Executive Officer (Clinical Services) SingHealth Community Hospitals

Avid reader

Patients too can take charge of their health by finding peace within themselves and distancing their minds from what they cannot change. Very often, the stresses of being ill and the worry for their future will affect their mood and take them away from the task at hand, which is to get better.

When patients enter the SKCH wards, they are introduced to a change in mindset – that they are partners in their own health. The wards are designed to provide them with ample and familiar spaces to carry out their exercises – this familiarity empowers them to get up and start moving. Every step they take is one step closer to their ability to resume their lives back home.”

“I find it important to unwind after a day’s work by diving into my books. I read for fresh ideas and perspectives, and also to get away from the busy thoughts of a workday.

Associate Professor Ong Biauw Chi Chairman Medical Board Sengkang General Hospital

Yoga enthusiast

“I always ask my patients, ‘What makes you happy? What’s important to you?’ If the answer is playing with their kids, I tell them to keep well so they can continue doing it. If they say they have a hobby, I tell them to enjoy doing it now and not wait till retirement.

We all deserve to enjoy every moment and it takes good health to do so. For me, I practise yoga whenever I can as it makes me happy while keeping me fit.

Health is a personal responsibility and we can all do better with community effort. So we’ve been organising different activities to encourage the community to be fit and healthy. For example, we hold a weekly Sporty Friday for residents to take part in fun workouts, teach the young healthy habits by giving obesity prevention talks in schools and run the Millennia Kids Programme. We also host arts performances to lift and renew those on the path of recovery.”

“One of the most important things in life is to learn how to train yourself to know your own limits and goals. Just like it takes discipline, focus and continuous practice to get better at competitive sports, having the awareness to exercise control of your lifestyle can help you achieve success when it comes to health.

I feel that opportunities to exercise are all around us, all the time. Walk up the stairs to your office instead of taking the lift. Walk instead of taking the bus. Stand at your desk instead of sitting all day. Make time, not excuses, when it comes to health.

Many health problems can be avoided. While the hospital is here to help heal the sick, the best cure is prevention. Start by picking a goal and work towards it. If you know you tend to give in to temptation, avoid situations where you might succumb.”

Professor Christopher Cheng Chief Executive Officer Sengkang General Hospital

Marathon runner/cycling aficionado

54

We’ve all been there. We tell ourselves to eat healthily and exercise regularly but we stop short of taking action. So how do we switch on the motivation?

IN CONSULTATION WITH:Dr Farhad Fakhrudin Vasanwala, Head and Senior Consultant,Department of Family Medicine

“Face the fear of discovering the unknown and take control. Don’t leave it to fate. With help from your doctor, family or friends, you can start making changes that ultimately result in better overall health.”

TAKE CONTROL EARLY If we are feeling well, Dr Farhad urges us to take the

“better late than never” approach to see a family

doctor about health screening.

BREAKING THE INERTIA Dr Farhad stresses that whatever the motivator, we need to break the inertia and choose where to make a change, e.g. with diet, exercise, health screening, smoking or drinking habits.

“A family physician can explore with patients what change to make. Taking a small step is more achievable for most of us. For example, starting some light exercise such as walking for 10 minutes versus no exercise is still beneficial.”

DO NOT IGNORE THE SIGNSSome of us are guilty of ignoring health symptoms,

hoping they will go away. We may have chest pains

but go for a general health screening in the hope

that test results show nothing is wrong.

“When patients feel unwell, general health screening

will not do. Only specific tests – depending on

symptoms and family medical history – will uncover

what conditions patients may have,” says Dr Farhad.

DO IT FOR YOUR FAMILY “Many patients are men who are dragged in by

their wives to find out if their symptoms, such as

breathlessness, are signs of illness. I cannot

stress enough how early detection can help in

treatment and recovery.”

Dr Farhad puts it succinctly, “Take ownership of your own health. If you don’t want to do it for yourself, do it for your family.”

Dr Farhad also stresses the importance of consulting

a family doctor on our health screening results.

“Family physicians are trained to look out for

multiple chronic conditions from patients’ health

screening results and family medical history. They

will recommend lifestyle changes if necessary.”

“It is also important for patients to take their

prescribed medication because one chronic

condition tends to lead to another. Patients should

never stop taking their medication on their own.”

For many of us, finding the motivation to take ownership of our health is the biggest challenge. Even after flipping the motivation switch, many of us give up when we find our goals too difficult to reach.

According to Dr Farhad Fakhrudin Vasanwala, who heads Family Medicine at Sengkang General Hospital (SKH), many people snap out of inertia only when ill health gets too close for comfort.

“Sadly, it’s usually the loss of a loved one or seeing someone close suffer from a devastating illness that results in a change of health behaviour. Perhaps a celebrity’s condition, or the patients themselves have a health scare, these scenarios can also get people to act.”

ONTURNING

THEMOTIVATION

• Start small (e.g. cutting sugar).• Don’t do ‘cheat days’. Pick a change you can live with and stick to it.• Raise the bar as you get used to the change. The body learns to adapt so it gets easier.• Never give up!

John’s tips

We all love a success story. John* shares how his decisive action to change his lifestyle has helped him get into the best shape of his life.

John had high readings of cholesterol, blood pressure and triglycerides. After his blood sugar reached pre-diabetic levels, he decided to turn his life around.

The first thing he did was to cut out sugar. He switched from sugary drinks to water and skipped desserts. The weight loss was encouraging.

John soon realised that he found exercise easier and more enjoyable. He has since made exercise a part of his life. In fact, the 60-year-old believes that he is in the best shape ever, having run two half-marathons in a year.

DO CHEAT DAYS

“I not only feel better, I move faster and think sharper. I no longer need medication for my chronic conditions. I’m so glad to be adding not only more ‘life to my years’, but also more ‘years to my life’.”

DON’T

*Not his real name

76

MAKING THE SWITCH, NATURALLY

Our comprehensive weight management programme, SWITCH (Sengkang Weight Improvement Therapy and Complete Health) offers obese patients help with weight loss.

Obesity is a medical condition that adversely affects health and increases a person’s risk for conditions like heart diseases. SWITCH helps patients with long-term weight loss and weight maintenance. Its multi-disciplinary services range from diet advice and behaviour modification to bariatric metabolic surgery.

SKH’S HELPING HAND FOR THE OBESE

“I had chest pains and would often feel breathless. I slept poorly and felt tired all the time.”

DIET• Cut out sugar from drinks,

reduce salt in food such as gravy or sauces.

• Make meals more wholesome and colourful by opting for brown rice or wholemeal bread.

• Follow HPB’s My Healthy Plate guidelines for meals – more fruits, vegetables and whole grains.

• Keep a journal. Pick a dietary change you want to achieve for the month, and keep to it through subsequent months.

SLEEP• Have seven to nine hours of

sleep for adults, more for children and teenagers.

EXERCISE• Aim for 150 minutes of exercise

a week.

• Daily activities can include walking, doing household chores, jogging or playing games.

• At work, walk with a friend at lunchtime, or with a family member after dinner.

MANAGING MEDICATIONS • Always ask your doctor or

pharmacist why you are taking certain medications and raise

concerns if any.

• Use smartphone apps or set alarms to remind you to take your medications on time.

• If you have a hard time keeping track of your medicines, put coloured stickers on medication labels (e.g. moon to indicate medicine to be taken before bedtime) or use a pill organiser.

QUITTING SMOKING• Gradually cut down on cigarettes

- instead of smoking a pack a day, cut it down to two or three cigarettes a day.

• Or go cold turkey by deciding to stop smoking on a particular day and sticking to it.

STAYING MOTIVATED • Set realistic goals - instead of

telling yourself no more junk food ever, gradually cut down amount or frequency.

• Pick a physical activity you enjoy - dancing, Zumba, cycling.

• Destroy excuses like “I am tired”. Instead, think of physical activity as an energiser.

• Be kind to yourself. Don’t get discouraged even if you are not making much progress.

6

MYTHS DEBUNKED

I should go for health

screening only when I feel

unwell.

I don’t need medical advice

if my test shows only mild abnormalities.

I should go for all available tests just to be

on the safe side.

Taking statins for my

cholesterol may damage my liver.

• Health screening may be too late when you feel unwell. Your doctor will recommend appropriate tests based on your symptoms.

• General health screening is recommended for those with no health symptoms.

• Follow up with your family doctor as the test results may indicate potential underlying health conditions that could turn serious.

• The family doctor will take into account your medical history and lifestyle when giving advice, and monitor medication side effects to ensure you take the right dosage.

• There is no need to go for all available tests as certain tests are only required for people with known conditions, e.g. blood tests for tumour markers if they suffer from known cancers.

• Unsure of which screening to go for? Use the www.screenforlife.sg health tool to find out if you have or might get diabetes, high blood pressure or high cholesterol.

• Research shows that statins prescribed for high blood cholesterol are mostly beneficial and safe, provided you take the tests prescribed by your doctor.

• Statins do not cure but help to control raised cholesterol levels. Prescribed dosages should not be stopped/reduced without doctor’s advice.

Our lifestyle may have a longer term effect than we think. Recent research suggests that parents’ lifestyle choices – diet, physical activity, smoking – can affect the health of their offspring as they cause modifications to their genetic composition, which is passed on.

So it is possible that what we eat, the stress we face, and toxins we are exposed to, can change the genetic legacy we pass on to our children, and perhaps even grandchildren.

With this finding, let us act early to take charge of our health!

DID YOU KNOW?

Here are some achievable goals you can work towards.

NO MORE EXCUSES!

Dr Farhad shares some common patient misconceptions. Do you have them too?

Yeah! Just enrolled in the SWITCH Programme today.

Hope I can stick to it and reach my health goals!

12 Aug 2018

Take morning walks

Exercise during breaks

Note my food intake

Evening run

Sleep early

Checklist

Worried she might develop heart disease and diabetes given her family history, Elizabethjoined the SWITCH programme where she was guided by her primary physician through an exercise regime and portions-control diet.

She made lifestyle changes which include daily morning and night walks, and takes the train instead of driving to work. Her sleeping schedule is adjusted. Making these changes wasn’t hard. “I found that journaling my exercise and food intake took effort at first but with time, it got easier.”

“Having lost 10kg, I now sleep and focus better. I can climb stairs or brisk walk without panting. And I intend to keep on doing better.”

• Start small with short-term goals.• Reaching those goals will spur one to set bigger, long-term goals. • Celebrate each success!

Elizabeth’s tips

Your lifestyle choices can

affect your kids!

98 98

A patient has just collapsed in the ward. Nurses rush to attend to him. A visiting relative of another patient rings the call-bell for water. Another calls for food to be cut up. The unanswered call-bells bring on frowns and complaints.

Senior Nurse Manager Quek Siew Hong remembers such moments of being rushed off her feet. In her 50 years of nursing experience, she has come across instances of visiting relatives who wait for nurses to do things that they themselves can easily do.

Other than offering comfort to their loved ones, how can family and visitors of patients do more as partners in care with the hospital?

Pillar of supportSNM Quek gives the example of Mdm Ang, an elderly patient who has dementia and was warded after a fall. Mdm Ang needed help

with basic needs such as eating, drinking, and going to the toilet.

With her family helping to refill her water jug and feed her, the nurses could better focus on preparing her medicine or tending to other patients.

SNM Quek shares, “I’ve seen what a difference it makes when family is more involved with caring for their loved ones. And we value such involvement because it takes some pressure off when we need to attend to more pressing needs, like patient falls.”

Partners in careAt the orthopaedic ward that SNM

Quek oversees, patients who have had bone surgery after serious falls usually need more time and manpower for their care.

Relatives who spend time in the ward can pick up useful tips on patient care from the nurses, such as simple cleaning of wounds or the right way to help those with walking or swallowing difficulties.

“We demonstrate to family members the safety measures for fall-prone patients. With them observing and practising under our guidance, it gives everyone the confidence to care for the patient after discharge,” explains SNM Quek.

In consultation with: Quek Siew Hong, Senior Nurse Manager and Ke Bing-Ru, Occupational Therapist

A therapist shares:Families know their loved ones best

A daughter’s experience

Occupational therapist Ke Bing-Ru recalls helping a stroke patient with visual neglect, who had difficulty paying attention to his left surroundings.

“He couldn’t focus on his left. But when I asked the caregiver to stand on his left and call his name, he was able to turn around to look at her. The session wouldn’t be as fruitful if she wasn’t taking part.”

“Patients usually improve faster when family members are involved,” says Ms Ke.

Although being a caregiver isn’t the easiest job, you do learn a lot and it can be rewarding, as the daughter of a patient recounts.

“My 85-year-old father was warded multiple times in 2017 after recurring falls. During my hospital visits, I shared with the dietitian and speech therapist my father’s picky food preferences and we worked together to ensure a balanced diet for him. I also learned to add thickeners to fluids to help him overcome his swallowing difficulties.

A more active role“We sometimes have visitors who, while taking care of their loved ones, also help the other patients. This helps to build a friendly environment which is great to see,” she adds.

But this is not common. SNM Quek has noticed a trend of more

family members leaving it entirely to nurses to do things for patients.

Reasons may range from the perception that hospital staff are paid to do everything to a squeamish fear of caring for the ill. Or perhaps because many families have domestic helpers

nowadays, we are no longer used to doing simple chores.

As we face a rapidly ageing population and projected shortfall of healthcare workers in the years to come, relatives can certainly do more to partner hospitals for better patient care.

“Therapy works best when they can share with us the patient’s goals because some patients are unable to communicate their day-to-day preferences.”

Besides tailoring treatments for patients with functional challenges, occupational therapists help patients cope with daily activities such as showering and going to the toilet. They also advise on the assistive equipment required at home, like ramps or hospital beds, to help patients resume daily activities safely. Together with nurses, they provide caregiver training when needed.

My father badly wanted to go home so I worked closely with the therapists to use that as his discharge goal, helping him gain the strength to negotiate the steps to my home. To prepare for discharge, the therapists referred me to rehabilitation partners to install grab bars in my flat.

I found the partnership with the hospital really helpful and comforting as these professionals understood the stress on the caregivers, and gave me useful tips on managing it.” - Mrs Foo

HOW CAN YOU HELP?Play a part in caring for your loved ones!

• Refill the water jug or make hot drinks for

your family member.

• Help your loved one to the toilet to ensure

that he/she does not fall.

• Help with cutting up food or feeding if

necessary.

• Be involved with the patient’s therapy so you

can help him/her keep it up at home.

1110

WHAT IS YOUR EMERGENCY?

You would think an Emergency Department (ED) is a place to get medical care quickly, but ‘first-come, first-served’ does not apply here. SKH ED has been carefully designed to ensure top priority is given to emergency cases.

ED nurses are specially trained to first determine the severity of a patient’s condition, that is, whether they need medical attention urgently. This process is called ‘triage’, which means ‘to sort’.

At SKH ED, the non-emergency cases are separated from the critical ones to provide better overall patient experience. A dedicated ambulance drop-off entrance allows quick access to the emergency area where medical attention can be given swiftly to critically ill patients. There is a separate drop-off entrance and waiting area for walk-ins.

ED Nurse Clinician Tan Khee Khee shares, “We made a conscious design decision to maintain separate areas so that we’re able to sustain a calm environment for non-critical cases. After all, those who’re already feeling unwell do not need to be exposed to the sight of trauma patients being given emergency treatment.”

Patients in the non-emergency group have their own waiting and treatment areas that are designed to end in a one-way flow with the pharmacy and exit.

“The pace can be frantic when we have critically ill patients or multiple trauma victims who need immediate attention. But these scenes are neither seen by the general public nor by the relatives of patients. Only authorised ED staff are allowed into the treatment areas to ensure patient privacy is maintained,” she adds.

BUT IS IT AN EMERGENCY?

Help!If you have ever been to the Emergency Department (ED) of Sengkang General Hospital (SKH) for non-critical conditions, you may find the scenario below familiar.

07:00am 08:30am 10:30am

P1 P2 P3 P4Major

EmergencyMinor

EmergencyNon-Emergency/

Non-Urgent/Minor ailments

Examples: Heart attack, stroke, severe bleeding or

injuries due to traffic accidents

Deadline:Immediate

Deadline:Within 30mins

Deadline:Within 3hrs

Deadline:No limit

Examples: Low blood

pressure, symptom of altered mental state (confusion,

amnesia)

Examples: Eye inflammation,

sprained ankle

Examples: Toothache,

common cold, small cuts, sore throat

Resuscitation& Critically Ill

You wake up with a splitting headache so you make your way to the Emergency Department.

Unknown to you, in another section of the ED, several traffic accident victims arrive by ambulance. Front-line ED staff rush to assess their conditions. Those who require resuscitation or whose conditions are life-threatening are given priority.

Your pounding headache has gotten worse but still no one has attended to you. You glance again at the TV monitor which shows that the estimated waiting time to see a doctor is 110 minutes. You fume and think: What? I’ve been waiting for an hour – when will it be my turn? The waiting area’s hardly crowded, what are the staff doing?

Finally you are given medication for your migraine. The attending physician explains that patients requiring urgent medical attention have to be treated first but you do not see such patients around. Where are they?

Meanwhile, the accident victims that require critical attention are being sent to the operating room for urgent surgery. Others are being treated and monitored closely in the ED observation area or Intensive Care Unit (ICU).

WHY ED WAITS ARE LONGOur ED has dedicated doctors and nurses, but similar to a busy restaurant, if it is packed, there will be long wait times. If a life-threatening case (P1) comes in, it will be pushed to the front of the line.

• ED doctors attend to critically ill (P1/P2) patients first.

• Each P1/P2 patient requires minimally half an hour each

54%46%are P3 and P4 cases

are P1 and P2 cases

This layout is unlike older hospitals where both emergency and non-emergency vehicles share the same entrance, and patients and relatives also share the same waiting area. As a result, everyone can witness the arrival of trauma cases requiring critical care and the frenetic action that one typically sees in any medical TV show.

READY FOR EMERGENCIES For seamless medical action, the ED is interconnected closely with essential critical care services required by the ED. Patients needing immediate attention will be sent quickly to operating theatres and diagnostic services.

“Our ED layout was planned such that there is a trauma lift that takes patients directly to the

operating theatre on level 2, the intensive care unit on level 3, and diagnostic services such as computed tomography (CT) scans,” explains NC Tan.

The ED is also connected to a separate isolation facility with its own X-ray room and lift to the isolation wards. To prevent infection and ensure patient safety, the negatively pressured isolation zone is designed with two sets of doors so that airborne contaminants do not drift to other sections or corridors.

ED staff are divided into three teams: acute, critical and resuscitation. When many patients requiring urgent care arrive at the same time, manpower is redeployed between areas to cope with the surge.

Patients are triaged based on the severity of their conditions – P1, P2, P3 and P4.

• P3/P4 patients wait longer as priority is given to P1/P2 cases.

Pie chart data based on total ED attendances from Oct 2018 to Feb 2019

11

Peak times:10am to 2pm 8pm to 11pm

Daily average ED attendance

(from 15-21 Feb ‘19): 264

1312

IS IT AN EMERGENCY?

Examples of non-emergencies• Fever • Headaches• Nausea• Cough• Sprains

Examples of emergencies• Heart attacks• Strokes• Sudden/unexplained breathlessness• Severe bleeding• Severe pain

COMMON MISCONCEPTIONS ABOUT THE ED

EMERGENCY 101: DOS AND DON’TS

DoN’Ts

• Don’t leave without returning the RTLS wrist tag that you are given to wear. The tag contains electronic information that cannot be used outside of the hospital. It is only used for contact tracing in the event of any infectious disease exposure.

If the tag is not returned or lost, additional charges will be incurred.

• Don’t bring along medications prescribed by polyclinics or public hospitals as information on such medications is accessible on national electronic health records.

• Be aware that the ED is not an appropriate place to visit if you are having non-emergency ailments like a cold or toothache.

• Bring photo identification, e.g. identity cards (ICs), work permits. In lieu of ICs, Pioneer Generation or EZ-link cards for the elderly will do.

• Appoint one relative as the main spokesperson to accompany the patient. • Ask all other relatives to wait at the waiting area.

• Attend a first-aid course to learn basic first-aid skills. Sometimes, first aid is often all that is needed to treat minor burns or cuts.

NC Tan reveals that, on an average day, the ED sees about 270 patients. This can exceed 300 on public holidays or during festive seasons. Waiting time for non-emergency cases can be more than four hours on busy days.

“About 54% are emergency cases while the remainder are minor to non-urgent cases. For the latter such as the common cold or small cuts, I would advise that patients visit their neighbourhood GP or the polyclinic first.”

NC Tan shares that many may not know how to determine when their conditions are severe enough to require urgent medical attention. Another reason is that access to polyclinics and clinics is limited after office hours.

PAEDIATRIC EMERGENCIESWhile there are no paediatric inpatient wards at SKH, the ED has a separate assessment and treatment area

for patients under the age of 16 years and a dedicated resuscitation cubicle. This is to cater to nearby towns like Sengkang and Punggol that have young families.

“Our ED was designed this way to separate the very young from the adults to expedite care and prevent anxiety amongst our young patients,” explains NC Tan.

For paediatric patients brought to the ED, SKH will stabilise them first or treat their conditions before sending them to KK Women’s and Children’s Hospital (KKH), if admission is required.

PARTNERS IN SPECIALIST CAREIn addition to KKH, SKH also works with other specialty centres like the National Cancer Centre, National Heart Centre Singapore, Singapore National Eye Centre, National Dental Centre and National Neuroscience Institute. ED patients can follow up with specialists at SKH Medical Centre instead of having to visit the specialist centres in Outram.

True

DOs

WhyFalseED nurses assess patients’ conditions and will order necessary tests before treatment

The ED sees all ages of patients

ED fee of $121 includes basic investigation (urine or blood sugar tests, ECG), doctor consultation, nursing care, basic treatment (e.g. simple suturing), and standard medication (maximum 1-week supply upon discharge)

Medical certificates are not issued for all patients

You get priority at ED if you arrive in an ambulance or that care is given on a “first-come, first-served” basis

The very young or very old will be seen first for non-acute conditions

ED fee of $121 includes immediate specialised consultation, all diagnostic tests including MRI/CT scans, and all medications (standard and non-standard) for more than a week

Hospitalisation leave will be issued if you are discharged

ED staff are trained to triage patients and assign priority, based on severity/potential severity of conditions that could worsen if not treated fast

All patients will be triaged and seen accordingly based on the severity of their conditions

Specialised emergency investigations and specialist services will involve extra charges over and above the ED fee of $121

Hospitalisation leave is given only when you are warded

1514

You rushed to the hospital after hearing your aunt had been hospitalised, only to be told that you need to wait your turn to see her. Worried and impatient, you wonder why visitor restrictions are necessary.

To a worried next-of-kin, the strict visiting times and quota limits may seem troublesome but they are in place to protect patients and visitors.

As patients tire easily, a peaceful environment will allow them to get adequate rest and not be disturbed by too many visitors. For visitors, it is to safeguard them from contracting any infections from those who are ill.

As a precaution, no more than two to four people are allowed at any one time in most wards. Visitor quotas also help to reduce disruption to the medical and nursing teams providing care.

Stay home if you are sick. Otherwise, cover your mouth with tissue or wear a mask if you have to visit.

Use soap and water or alcohol-based hand sanitisers before touching the patient. It’s so easy to do, but also easy to forget!

Ask healthcare staff if they have cleaned their hands before they examine the patient. It’s fine to ask!

Follow all safety instructions if you are visiting someone in the isolation ward.

Check with the nurse whether certain gifts are appropriate (such as fresh flowers) as these may harbour germs.

Be a good visitor!

Protecting patientsTo prevent patients from getting more ill, anyone who feels unwell should avoid visiting the hospital. For a patient with weakened immunity, contracting just a minor cough or cold may complicate or even worsen his or her condition.

“We have rules to maintain a high hygiene standard for the safety of our patients, staff and also visitors. We appeal to visitors to play their part in minimising the spread of infection,” explains Dr Ng Tong Yong, director of infection prevention and control at Sengkang General Hospital.

“Besides not visiting a patient when you are ill, please also observe hand hygiene when in the ward. Check with our trained nurses if you are unsure about what you can bring or do when visiting.”

How can you reduce infection risks to yourself and healthcare workers?

Types of transmissions Precautions to take When precautions mustbe taken

For infections, diseases, or germs that are spread by touching the patient or items in the room

• Clean your hand• Put on the gown provided by the nurse• Wear gloves

• Methicillin-resistant Staphylococcus Aureus

(MRSA)• Diarrheal illnesses• Open wounds

For diseases or germs spread in tiny droplets caused by coughing and sneezing

• Clean your hands• Wear surgical mask

• Influenza • Whooping cough

For diseases or very small germs that are spread through the air from one person to another

• Clean your hands• Wear N95 mask

• Tuberculosis• Measles• Chicken pox

CONT

ACT

DROP

LETS

AIRB

ORNE

Quick visitor info

Visiting Hours*12pm to 2pm

5pm to 8.30pm

Mondays to Sundays including public holidays

*Visitors of Dangerously Ill List (DIL) patients are not subjected to quota or visiting hours

Caregivers nominated by patient

Keeping visitors safeIn addition to ensuring the well-being of the patient, visitor safety is also essential. An automated visitor registration system helps to track the flow of visitors in and out of the wards. This enables contact tracing in the event of an epidemic.

In some cases, when patients have or are suspected of having a contagious illness, the hospital will isolate them and take special precautions to prevent the spread of infection.

Not limited by visiting hours

Maximum of two caregivers per patient

Applies to all visitors• Only four visitors per patient at any one time during visiting hours – those with more than four visitors will have to take turns. • Once a visiting slot is available, an SMS will be sent to the next person on the waitlist. • Registration is required using a photo ID before visitors are allowed into the ward. IDs are scanned at the gantry during entry and exit.

Don’t sit on the patient’s bed as this can spread germs (use the chair provided instead).

Don’t touch the patient’s wounds or medical equipment (e.g. drips, feeding tube and urine catheters) as this can cause infections.

Don’t put your feet on the patient’s bed.

Don’t use thepatient’s bathroom (use the hospital public toilets instead)

Keeping

safe forhospitals

healing

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Behind

the ScenesHelping patients heal in

our own way

Greeting patients with a smile is how I start my day!

To ensure patient

safety, I always check

that the medications

dispensed are correct.

I keep the hospital clean and hygienic.

Being able to help patients get back on their feet makes me happy

We feel proud when we can serve nourishing meals to help patients recover their health.

From the visitor registration counter to the kitchen, we are part of a team that works to keep the hospital running smoothly.

As a service volunteer at the hospital, I try to create a welcoming environment for visitors and patients.

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Sengkang General Hospital brings holistic healthcare and greater convenience to residents in the northeast with a comprehensive suite of clinical specialties and medical services, including those from SingHealth’s national specialty centres.

With the opening of SKH, residents of Sengkang and its surrounding neighbourhoods are enjoying convenient access to a comprehensive suite of clinical and medical services covering major healthcare disciplines. Residents are benefitting from the coordinated, team-based care provided by SKH’s team of clinicians, nurses, and allied health professionals.

The SKH Medical Centre which houses the specialist clinics also serves as a hub for national speciality centres in the northeast, complementing its suite of specialist care services.

These national specialty care services are being offered by National Cancer Centre Singapore, National Heart Centre Singapore, Singapore National Eye Centre, KK Women’s and Children’s Hospital, National Dental Centre Singapore, and National Neuroscience Institute, allowing residents in the northeast to gain access to these services nearer their homes.

With SKH’s collaboration with national specialty centres, patients continuing their consultations or treatments for eye and heart conditions, like cataracts and heart disease for instance, need not travel far for follow-up appointments. They can have their medical conditions reviewed and tests conducted at the same time at SKH.

SKH collaborates with these specialty centres to offer specialty services at our Medical Centre.• NCCS Oncology @ SKH• NHCS Cardiology @ SKH• SNEC Eye Clinic @ SKH• Obstetrics and Gynaecology by KKH• Paediatrics by KKH• Dental by NDCS• Neuroscience by NNI

Consistent level of expertise and care but closer to home

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DR DAVID NG, Clinic Director, SHP-Punggol

“As SKH and Punggol Polyclinic are new and opened within a year of each other, the communications between us have been good from the start. Referrals have been easy and our patients are more than happy to head to SKH because it’s nearby.

SKH has been tremendously helpful as we’ve been able to participate in multi-disciplinary discussions to better understand complicated cases, especially diabetes. Our patients also enjoy fast access to specialised services such as SKH’s multidisciplinary diabetic foot clinic services (DREAM*) to address diabetic foot conditions in a timely way.

We are off to a good start but it is a long journey to refine the process and get everyone – GPs, voluntary welfare organisations and family service centres included – to recognise what the community needs. An example of an unmet need we’ve identified is poorly controlled asthma, especially among the young and middle-aged.

We’re also aware of social issues that need to be tackled. It is crucial that we manage these issues early to prevent patients from ending up at the emergency department.”

*Diabetic Rapid Evaluation of lower extremity Amputation Management (DREAM)

Doctors are unanimous on this: healthcare should be a closed loop. That is, you should receive the right care at every stage of your healthcare journey – from the hospital to the GP clinic and back to your home.

To achieve this, it is crucial to take a tag team approach where the patient, healthcare provider and other care partners work together for the same goal. speaks to four doctors who share their experiences and hopes for well-connected patient care in different settings.

CONNECTING

“At SKCH, we focus on providing well-paced, person-centric care so patients can better understand their own health conditions and care needs – we place a lot of emphasis on improving health literacy so they can manage chronic conditions back at home.

What’s also important, however, is the collaborative effort of the general hospital, community hospital and family physician to ensure patients get the right care at the right place. For example, we work closely with SKH’s orthopaedics department to generate a streamlined process so patients can be smoothly transferred to SKCH for rehabilitation based on a consolidated care plan.

Eventually, we refer the patients to community partners such as family physicians in the polyclinics or rehabilitation centres to continue the care journey beyond the hospital.”

DR LAUREL YIP, General Practitioner, Panhealth Family Clinic

“There are inevitably times when we need to refer patients for emergency treatment or specialist consult. SKH is generally our first choice as it’s nearest to our clinic. The referral process has been easy and straightforward thanks to the dedicated GP hotline. Our patients have been able to get early appointments for most specialties so far – this minimises the need for them to be sent to the emergency department.

SKH specialists keep us updated on our patients’ treatment progress so we can maintain shared care – this is especially important when patients get discharged and return to see us. They inform us of any missed medical appointments so we can contact patients for rescheduling.

We are also involved in community health screenings where participants are referred to us for post-screening follow-up, and the first medical consultation for these patients is sponsored by the hospital. We help ensure that abnormal results are looked into, and provide these patients a point of care for issues that crop up later on if they don’t already have a regular family doctor.”

GENERAL PRACTITIONERS

Shared care made easy

SENGKANG COMMUNITY HOSPITAL

Right care at the right placeDR XU BANG YU, Associate Consultant, Post Acute and Continuing Care, Sengkang Community Hospital

• Fast referrals• GP Hotline

• Access to specialist services

Back to thecare of theDoctor (GP)

• Back to the community for follow-up care

CommunityHospital

GeneralHospital

Polyclinics & GPs

• One consolidated care plan

• Multi- disciplinary discussions

DR MELVIN CHUA, Head and Senior Consultant, Department of General Medicine, Sengkang General Hospital

“We’ve had a steady and ever increasing stream of referrals from the polyclinics and community partners such as nursing homes for all kinds of conditions. In particular for Geriatric Medicine, our polyclinic colleagues in primary care help assess the elderly for frailty and other conditions before directing the more complex cases to us. Once the cases are referred to us, our multi-disciplinary team of doctors and allied health professionals will ensure patients receive the right care and treatment.

Our close collaboration with national specialty centres means patients continuing their treatment for eye and heart conditions for instance, need not travel far for follow-up appointments and are able to have their conditions reviewed at SKH. At the same time, we work closely with Sengkang Community Hospital to ensure optimal, seamless transition to rehabilitative care for patients.

SKH also has a primary care network (PCN), a group of family doctors in the region who collaborate with us to keep patients well in the community. My hope for the near future is that all GPs will work together with us to provide seamless care for the northeast. A seamless process is where our hospital specialist sees a patient referred by a particular family doctor and the patient returns to the care of the same GP who knows him/her best. This is the best way for patients to achieve full recovery and to better manage their chronic conditions.”

SENGKANG GENERAL HOSPITAL

Striving for a seamless loop

POLYCLINICSFast referrals for specialised care

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Through close collaboration and follow-ups by post-discharge care teams, at-risk patients can continue their recovery outside of the wards with peace of mind.

Mr Tan’s* family was sure nothing was going to go wrong. After all, they had lived with his Parkinson’s disease for years – surely they would be able to manage the caregiving at home despite his deterioration.

But a visit to Mr Tan’s home by a patient navigator told a different story.

The 60-year-old was found stuck in the bathroom, unable to get out on his own. His wife was in a panic, admitting that she didn’t know how to change her husband’s diaper or feed him via his feeding tube. The elderly pair counted on their daughter, who works flexi-hours, for these essential caregiving duties – an unsustainable arrangement in the long run.

That was a bleak moment but also a turning point for the Tan family. The healthcare team swiftly arranged interim care services for him while the family waited for a full-time helper to arrive. After the helper

In consultation with:Patient Navigators/Nurse Clinician Tan Quee Eng and Senior Staff Nurse Yeo Si Sen, Sengkang General Hospital Prabha Techna Miti, Senior Medical Social Worker, Sengkang Community Hospital

arrived, the patient navigator continued to follow up with the family to check on their progress. His condition steadily improved as a result.

RETURNING TO THE COMMUNITYMr Tan is just one of several patients, identified to have complex health needs with a high risk of hospital re-admissions, who have benefited from the care of a post-discharge team, comprising healthcare workers of different disciplines.

The team ensures that patients can ease back into their homes and stay well for as long as possible. More importantly, the team aims to reduce hospital readmissions and visits to the emergency department.

It takes a village to execute such transitions between hospital and home. Here at Sengkang, our teams at both the general hospital and community hospital help each patient move from one care setting to another based on their individual needs.

WHO’S INVOLVED All hands are on deck to provide the best level of care for you or your loved one.

Patient navigatorThis is usually a nurse and your primary point of contact and coordinator between you and the rest of the healthcare team. In Mr Tan’s case, the patient navigator also provided guidance on caregiver training such as tube feeding.

Family medicine doctorThe doctor reviews cases together with the patient navigator and allied health professionals, and offers support with phone consultations or house calls to stabilise your condition if needed.

WHAT TO EXPECTIf you, or a loved one, is identified as having a high risk of hospital re-admissions and need help managing your conditions at home, you are likely to benefit from these post-discharge care services:

At the hospital… This is where you or your loved one will be first assessed and rehabilitated. The team will find out who your caregivers are going to be or if there is insufficient help at home.

Counselling will be provided when necessary and coping skills will be taught to help you and your family cope in the hospital and at home.

Before discharge… Caregivers at home will be taught necessary skills such as tube feeding and be guided on medication dosages. An occupational therapist may survey your home to see if any mobility aids (such as ramps or rails) need to be installed.

You may also be referred to community resources such as day care, day rehabilitation or family service centres to help in the integration process.

Back at home… The patient navigator will make regular phone calls or home visits, usually for up to three months. On top of ensuring compliance to medication, the team shares tips on falls prevention and checks your blood pressure and other vital signs at each visit.

When needed, your primary physician or therapist may make house calls as well. And if a problem ever crops up, help from the team is always only a phone call away.

*Not his real name20

Community partnersOrganisations like NTUC Health, Thye Hua Kwan, Home Nursing Foundation and Ang Mo Kio Family Service Centre are just a handful of many partners that provide eldercare services or professional caregiving services.

Allied health professionalsThey may include physiotherapists, occupational therapists, speech therapists or medical social workers who are qualified to review your caregiving situation.

2019/2020 PROGRAMME

Levelyour knowledge

OUR SPEAKERS FROM SKH CAMPUS

30 Mar – 25 May 2019Module 1: Health and WellnessTopics include: Ageing & Falls, Cancer Screening, Lifestyle Habits (Smoking, Alcohol, Diet, Exercise), Travel & Vaccination

27 Jul – 9 Nov 2019Module 2: Common Medical ConditionsTopics include: Cancer, Chronic Cough & Asthma, Dementia, Diabetes, Depression, High Cholesterol, Skin Allergies and Infections

4 Jan – 14 Mar 2020Module 3: Life-threatening SituationsTopics include: Acute Breathlessness, Chest Pain & Heart Attack, Childhood Injury Prevention, First Aid (including seizures), Heartsaver & AED, Stroke

VENUE:Sengkang General HospitalSeminar Room, level 2 (near Community Hospital)1 Anchorvale Street Singapore 544835

TIME: Saturdays, 9am – 12noon

COURSE FEES You may choose to register for the whole programme consisting of 3 modules or choose any module to attend. Single workshop trial class is available at $10 nett. Light refreshments provided.

2 modules @ $75 All 3 modules @ $1001 module @ $50

A/Prof Derrick Aw Senior Consultant Dept of General

Medicine(SKH)

A/Prof Koo Wen Hsin Chairman Division of Medicine

(SKH)

Dr Nausheen Edwin Senior Consultant

Dept of Emergency Medicine

(SKH)

Dr Loh Jiashen Consultant

Dept of General Medicine

(SKH)

Dr Victor Kwok Head & Consultant Dept of Psychiatry

(SKH)

Dr Pooja Sachdeva Consultant

Dept of General Medicine

(SKH)

Dr Luke Low Consultant

Dept of Family Medicine(SKCH)

Join the Community Health Academy @ SKH Campus!

(education@skh.com.sg) REGISTER NOW!

For enquiries, please call 6930 2991/6930 2993