Consulting a doctor does not mean having to wait for hours. With video consultation services now being offered at more than half of Singapore General Hospital (SGH) departments, it is possible to be "in the clinic" just minutes after getting out of bed.

This means patients no longer have to take the day off to travel to the hospital, queue at stations to register, have their vital signs monitored, wait to see the doctor, collect medication, and make payments.

"It is actually a win-win situation. With patients opting for video consultation, those who really need physical consultation do not have to wait for a long time," said Associate Professor Goh Su-Yen, Senior Consultant, Department of Endocrinology, SGH. She is also Clinical Director, Department of Future Health System, SGH.

<<Associate Professor Goh Su-Yen, Senior Consultant, Department of Endocrinology, SGH. She is also Clinical Director, Department of Future Health System, SGH.>>

Having video consultations for more services took on greater urgency with the COVID-19 pandemic. "The goal was to facilitate safe distancing, and we wanted to prevent overcrowding and reduce our patients’ dwell time in the hospital," said Dr Amanda Lam, Consultant, Department of Endocrinology, SGH.

The department was selected to pilot the service in March 2020, together with the Department of Orthopaedic Surgery. To date, the service has been launched in 27 departments across the hospital, with many more in the pipeline.

Patients in a stable condition can video-consult their doctors at their three-to-six monthly reviews. Most of them also should not need physical examinations, and are able to monitor their vital signs at home.

Patients only visit the hospital if they have to undergo periodic lab tests or radiological scans. To review their results, they can opt for video consultation, saving them a second trip to the hospital. A physical consultation with their doctor is still a must at least once a year.

"The hospital is looking to achieve at least 10 per cent of all follow-up consults on video, while keeping patient safety in mind," said Prof Goh.

To help patients benefit from new technology, Dr Lam and her team organised step-by-step demo sessions at the clinic. "Our doctors even ran a practice session with the patient in another room so that they can get familiar with the idea," said Dr Lam.

At the end of a video consultation, patient service associates help patients book their next appointment, and provide them with billing details, much like a regular consultation. Additionally, they also arrange for medication and documents to be delivered to the patient.

Aside from cost and time savings for the patient, the service allows loved ones to call in from their homes, offices, or anywhere else.

"So far, patients who have used the service are very happy. Around 94 to 96 per cent of them have expressed interest to continue," said Prof Goh.

She plans to expand the service to SGH’s multidisciplinary clinics. When it happens, a patient will be able to meet the doctor, a nurse educator, medical social worker, dietician, and pharmacist all at the same time via video.

"We want patients to have access to care wherever they are. If they need to visit the hospital, we try to make it as smooth and painless as possible; but if they do not, we want to make sure we get the healthcare to them," said Prof Goh.

<<In staged photo above,  Ms Nancy Ang, SGH Senior Patient Service Associate, explains to a colleague playing the role of a patient in a clinic waiting area how to use her smart device for video consultations.>>

With the COVID-19 pandemic showing little sign of waning anytime soon, SGH community nurses are engaging residents in the southeast region of Singapore on the use of new technology.

When residents are able to use the hospital’s video call or telehealth services, they can avoid travelling to SGH Specialist Outpatient Clinics (SOCs) or SingHealth Polyclinics (SHP). Even as safe distancing measures are imposed, telehealth services allow residents to receive appropriate healthcare and advice without interruption.

"Last year’s Circuit Breaker and ongoing safe distancing measures made it difficult for residents to meet community nurses, who were previously readily available as they were stationed near their homes," said SGH Senior Staff Nurse Suhaila Binte Samsudin, who is stationed at the Katong Community Nursing Post (CNP).

<<Community Nurse Suhaila Binte Samsudin and Montfort Care’s Marine Parade Family Service Centre social worker, Mr Damian Chong, demonstrate the use of video consultations at a resident’s home.>>

Community nurses play an increasingly important role in keeping residents fit and well since they were introduced in 2018. Stationed at neighbourhood care centres, they provide simple healthcare to elderly residents. They make sure residents take their medicines appropriately, check their general health, and respond to their queries on minor medical complaints under their regular "Ask Missy" meet-the-nurses sessions.

At the CNPs, community nurses and senior care coordinator associates teach residents the intricacies of using their smartphones and other devices for video calls, such as Zoom conferences. For those who do not own such devices, residents can go to their neighbourhood family care or senior activity centres, where such devices are set up for their use.

According to Nurse Clinician Nasrifudin Najumudin, word has spread as residents picked up the skills. "The use of video consultations gained momentum among residents who found it a more convenient and feasible alternative to face-to-face meetings," said Mr Nasrifudin, who is also from Katong CNP.

Using their smart devices not only allows residents to chat with their community nurses, it also enables them to undergo consults with their doctors. Video calls can also include multiple parties. For instance, a video consultation can involve a doctor, a community nurse and a resident at home. Having all of them on the same call means better integrated care, as all parties understand and agree with the treatment plan and follow-up care.

 <<Mr Nasrifudin Najumudin, Nurse Clinician, Katong Community Nursing Post>>

Machines to measure weight and blood pressure, as well as fingertip pulse oximeters, are available at the care centres. When the video call begins, the nurse prompts the patient to take his blood pressure and other readings. The first such station, known as a Telehealth Kiosk, was set up at a Montfort Care centre in collaboration with SGH community nurses.

Limitations exist, however, as "patients who require thorough, close-up or immediate examinations or assessments would not be suitable for video consults", said Tiong Bahru CNP’s Senior Staff Nurse Clarissa Vashti Atchiah.

Healthcare education is a key component of community nursing service. With more patients adept at using their smartphones, educational talks need not be suspended when safe distancing measures are imposed.

A talk on influenza vaccination was held at the NTUC Health Senior Activity Centre (Lengkok Bahru), which was attended by small groups of residents at neighbourhood centres and some from home. After the talk, 40 residents signed up for free vaccinations organised by Mount Alvernia Outreach Medical Clinic, a mobile clinic service.

Today, 35 CNPs are stationed across the five Communities of Care framework led by registered nurses trained in specialties such as geriatrics, oncology and chronic disease management.

For more information on SGH’s video consultation service, go to www.sgh.com.sg/patientcare/visiting-specialist/Pages/Video-Consultation.aspx.

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