An Emergency Department (ED) visit consists of the sum total of a series of processes that take place during an emergency care episode, all dedicated to the safe, efficient and timely care of the patient1. Unscheduled returns to an ED within a 72 hour period, or "re-attendance", is one of the quality indicators used internationally to benchmark the safety of ED in general to measure effective care - a core attribute of emergency care delivery2. While rates of return above 5% may reflect poor quality, rates below 1% may reflect excessive risk aversion3. CGH has performed at a mean of 2.31% (Jan – Dec 2017).
There are many reasons for re-attendance. A proportion of patients return to the ED because their health condition suddenly deteriorates. Others will return because they experienced an unrelated second health condition. In addition, patients with complex mental health needs may also tend to return to the ED more frequently4;
Development of appropriate clinical care pathways and communication strategies are key strategies that can help reduce unscheduled returns4. The Short Stay Unit (SSU) was established in CGH ED some years ago to manage patients with moderate symptoms. Patients who responded to therapy can be discharged, reducing the need for hospitalisation.
The SSU allows our patients to be monitored for stability as well as offers an opportunity for patients/care givers to receive counseling and education from our case managers. The session (e.g. teachings on correct techniques to using the multi-dose inhaler and proposed action plans) empowers patients to play a more active role in the management of their medical condition.
Over and above this, the CGH ED has also put in place a telephone-based system where a qualified nurse coordinator follows up with selected cases and checks on their condition and well-being within 72 hours after their discharge from the CGH ED. In addition to monitoring the patients, the 72 hours phone call serves a similar role for patient empowerment. With this partnership with our patients, we aim to drive down need for re attendance
1Wiler, J. L., Welch, S., Pines, J., Schuur, J., Jouriles, N., & Stone-Griffith, S. (2015). Emergency department performance measures updates: Proceedings of the 2014 emergency department Benchmarking alliance consensus summit. Academic Emergency Medicine, 22(5), 542–553.
2McClelland, M. S., Jones, K., Siegel, B., & Pines, J. M. (2012). A field test of time-based emergency department quality measures. Annals of Emergency Medicine, 59(1), 1–10.e2.
3Heyworth, J. (2011). Emergency medicine-quality indicators: The United Kingdom perspective. Academic Emergency Medicine, 18(12), 1239–1241.
4The royal college of emergency medicine: (2013, July 14). Retrieved September 8, 2016, from www.rcem.ac.uk/code/document.asp?ID=5832
2 Simei Street 3,
(65) 6788 8833
(65) 6788 0933
Changi General Hospital (CGH)