Driving up the usage of Same Day Admission for surgeries has proven to improve operating theatre timeliness, alleviate bed crunch, reduce patients’ bill size and cut the risk of infections.

When a patient is scheduled for surgery, the typical journey involves booking into the hospital a day before their surgery to be assessed and primed.

Thanks to the Same Day Admission (SDA) process, most elective surgery patients now enter the hospital just two hours before their surgery, and can get from the registration desk to the operating theatre (OT) within 30 minutes.

Led by Dr Jason Lim, Consultant at the Department of Colorectal Surgery, a task force has driven up the number of patients benefitting from SDA in just six months.

The case for SDA

Why is SDA so important? Simple answer: bed space.

"Every patient placed in the SDA process means one bed day saved. We do about 17,000 surgeries a year, so if every patient takes up SDA, we will be saving many thousands of bed days a year," says Dr Lim.

There are other compelling reasons. In the words of Dr Tan Hiang Khoon, Chairman, Division of Surgery, "SDA aims to achieve triple wins: safety, cost effectiveness and better patient experience."

SDA means a shorter length of stay, which reduces the risk of hospital-acquired infections and cross-contamination when the patient shifts from the bed to the OT and then to another bed after surgery.

The patient also incurs lower cost, and has a better experience because they are able to rest in the comfort of their own homes before surgery.

With such irrefutable advantages, Dr Lim and his team are hustling hard to bring up the SDA take-up rate even further. They are doing it with the help of the SingHealth Office for Service Transformation, which is exploring the optimisation of SDA in other institutions.

Paving the way for higher take-up rates

While most patients are suitable to undergo SDA surgery, the road to increasing take-up was an uphill one due to bottlenecks in workflow.

"At the start, we thought it was due to operational and logistical issues within SDA Centre, but it turned out to be  a whole supply chain issue," says Dr Lim. For example, the SDA Centre can process the paperwork for a patient quickly, but the OT may not be able to receive the patient, or a bed in the ward is not yet available.

The task force pored over historical data of surgeries across 16 departments and worked with different teams to iron out issues in processes, speeding up and improving the patient's experience from his first step into the hospital till post-surgery.

Among various measures implemented include a station-based triage system to process patients en masse, improvements in training of nurses and doctors posted to the SDA Centre, getting OT nurses to pick up and escort patients from the Centre, and working with the Bed Management Unit to ensure that patients can get to their ward speedily after surgery.

To help patients reach SGH by 6.30am to be on time for the first scheduled surgery of the day, the team worked with various transport providers, including ride hailing company Grab, to facilitate ease of obtaining transport options in the early morning peak hour traffic. SDA Centre now has its own destination pin on the Grab app.

Numbers don't lie

Claire Wong, Senior Executive, Division of Surgery, shares the results so far. "The increase in SDA take-up has translated to a savings of 95 bed days per month in SGH. Timeliness of surgeries has also improved from before, and is now consistently at about 80 per cent."

These numbers have dispelled some surgeons' worries that SDA would cause delays and leave some patients without a bed. 

"The fact that so many of these patients can successfully go through SDA tells us that traditionally perceived difficulties and hurdles can be overcome," says Dr Lim who adds, "SDA is meant to ultimately benefit patients, and that should always be our priority."

This article was first published by Tomorrow’s Medicine, a news network of the SingHealth Duke-NUS Academic Medical Centre.

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