At SGH, thanks to the Same Day Admission process, most elective surgery patients now enter the hospital just two hours before their surgery.
A team in SGH is driving up the usage of Same Day Admission for surgeries, which has been 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, getting assessed and primed, and staying overnight in the hospital while waiting for to be wheeled to the operating theatre (OT).
At Singapore General Hospital (SGH), thanks to the Same Day Admission process, most elective surgery patients now enter the hospital just two hours before their surgery, and can get from the registration desk to the OT within 30 minutes,.
Led by Dr Jason Lim, Consultant at the Department of Colorectal Surgery, a task force in SGH's Division of Surgery has driven up the number of patients benefitting from SDA from 60 percent to over 70 percent in just six months.
"SDA aims to achieve triple wins: safety, cost effectiveness and better patient experience."
- Dr Tan Hiang Khoon, Chairman of SGH's Division of Surgery
The case for SDA
Why is SDA so important? Simple answer: bed space.
"Every patient placed in the same day admission 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 as well. In the words of Dr Tan Hiang Khoon, Chairman of SGH's Division of Surgery, "SDA aims to achieve triple wins: safety, cost effectiveness and better patient experience."
Same day admission 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, on 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 now hustling hard to bring the SDA rate up to 90 per cent by the end of 2018. They are doing it with the help of the SingHealth Office for Service Transformation, which is exploring the optimisation of SDA in other institutions.
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
Paving the way for higher SDA rates
While most patients are suitable to undergo same day admission 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 Operating Theatre (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 processing patients en masse, improvements in training of nurses and doctors posted to the SDA Centre, getting nurses from Major Operating Theatre to pick up patients from the Centre and take them to the OT, 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 to SGH SDA Centre in the early morning peak hour traffic. SDA Centre now has its own destination pin on the Grab app.
"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."
- Claire Wong, Senior Executive, SGH's Division of Surgery
Numbers don't lie
Claire Wong, Senior Executive at SGH's Division of Surgery, said, "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. A forerunner is indisputably the Orthopaedics department with a 90 per cent SDA rate. They were also the first to practise SDA a decade ago.
"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."
Meet the SDA Work Group
|Dr Jason Lim||Consultant, Department of Colorectal Surgery||Clinician Champion|
|Ms Irene Goh||Nurse Clinician, Same Day Admission Centre||Quality Improvement Coach and Team Member|
|Mr Heng Yi Xiong||Senior Executive, Division of Surgery||Team Member|
|Ms Claire wong||Senior Executive, Division of Surgery||Team Member|
Assistant Manager, Division of Surgery
The project was done in collaboration with SingHealth Office for Service Transformation (OST). Special thanks goes out to:
- Ms Elena Binte Mohamed Ayob, Assistant Director Nursing, Division of Nursing
- Mr Franklin Tan, Deputy Director, SingHealth Office for Service Transformation
- Ms Karina Ng, Executive, SingHealth Office for Service Transformation
- All nurses and staff at SDA Centre and Major Operating Theatre