As Singapore’s population ages, healthcare is facing an increase in the complexity of diseases. It is more apparent in the patients seen in the NHCS Cardiothoracic Intensive Care Unit (CTICU). In response, a multidisciplinary team who called themselves “ICU Avengers” launched a quality improvement initiative aimed at reducing ICU stays for chronically ill patients. This effort brings together the skills and expertise of various team members to address the intricate needs of these patients, improve communication with families, and ultimately enhance patient outcomes.
A holistic approach to managing new challenges
NHCS is the nation’s leading provider of Extracorporeal Membrane Oxygenation (ECMO) service, a heart and lung support system for critically ill patients. With an increasing number of patients requiring ECMO support, longer hospitalisation periods in the CTICU have become more common. These cases often present with complications like recurrent infections, multi-organ dysfunction, and prolonged reliance on life support. Such complexities not only lead to extended hospitalisation and higher medical costs but also place significant emotional and financial strain on caregivers.
Advanced Practice Nurse (APN) Gillian Wee from the Nursing Specialty Care Unit (NSCU), and team leader of the ICU Avengers, shared, “Patients in the ICU are critically ill and may face uncertain outcomes or even unfavourable prognosis. This often creates challenges for the healthcare team when deciding how and when to communicate sensitive information to families, especially when they wish to pursue aggressive treatment to improve their loved ones’ conditions. However, this can add stress to the families and the care team. A clearer approach and stronger support system are essential in these situations.”
(L-R): A multidisciplinary team review session in progress; Physiotherapy treatment as part
of the team care approach to
promote lung function, reduce
infection and facilitate faster
recovery.
To address these challenges, a dedicated multidisciplinary team was formed. The team comprises a cardiothoracic surgeon, palliative care doctor, advanced practice nurse, medical social worker, physiotherapist and CTICU nurses. Together, they provide comprehensive, patient-centred care designed to meet the complex needs of these patients.
A key part of their approach was the introduction of bi-weekly multidisciplinary reviews. During these sessions, the team assessed each patient’s condition, medical progress, and response to treatment. These regular reviews enabled timely interventions and allowed the team to adjust care plans as needed. This not only enhanced patient care but also improved communication with families, helping them to better understand their loved ones’ health condition and reducing unnecessary stress.
“Each specialist brings valuable expertise to the table during these reviews, allowing the team to make informed decisions. With earlier palliative care referrals, we ensure that important conversations take place at the right time,” explained Foo Lee Lian, Assistant Director of Nursing, who facilitated the initiative. “Thanks to these improvements, nurses now feel more confident when updating family members about their loved ones’ conditions.”
Profound impact on patients and their loved ones
Since the inception of the multidisciplinary team initiative in 2022, the ICU Avengers have conducted over 60 review sessions and tackled nearly 200 complex cases. These structured assessments have led to remarkable results, including a 39% reduction in the average length of stay for long-stay patients — from 44 days in 2021 to 28 days in 2023. The initiative demonstrated the critical role of multidisciplinary collaboration in managing complex patient cases. With coordinated efforts across various specialties, the team not only improved patient care but also optimised the use of resources, fostering stronger collaboration among healthcare staff.
The team’s dedication has had a profound impact on both patients and their families. Many expressed heartfelt gratitude for the compassionate and personalised care they received during their most difficult times. Families were particularly appreciative of the team’s thoughtful gestures such as ensuring patients were comfortable and looked their best. One memorable instance involved fulfilling a patient's last wish by organising a family tea ceremony at his bedside, which created a meaningful and unforgettable moment for the family. These examples highlight the team’s unwavering commitment to patient-centred care and the profound, lasting effect it has on patients and their loved ones.
For their remarkable efforts, the team earned the Gold Award at the Team Excellence Assessment (TEA) earlier this year, as well as the Merit Award at the Enterprise Risk Management Congress Singapore 2024 – A well-deserved recognition of their dedication to advancing patient care!
(L-R): Leader, APN Gillian Wee from NSCU and facilitator, AD Foo Lee Lian from Nursing Administration, receiving the award on behalf of their team; Proud team members with their winning poster (from left to right: APN Gillian Wee, AD Foo Lee Lian, ANC Hii Yaa Wen from Ward 56 and SNM Yeoh Lee Shien from CTICU. Not pictured are co-leader, Asst Prof Philip Pang from Cardiothoracic Surgery, Asst Prof Shirlyn Neo from Supportive and Palliative Care, National Cancer Centre Singapore, NC Liew Siok Moey from Nursing Administration, ANC Cheung Pui Leng and SSN Lee Ying Ying from CTICU, Jasmine Ku from Medical Social Services, and Chen Hebin from Cardiac Physiotherapy and Rehabilitation Services.
