Patients with non-urgent conditions can wait hours to see an emergency medicine doctor. To avoid the long wait — three hours on average and up to seven on very busy days — Singapore General Hospital’s (SGH) Emergency Department (ED) has teamed up with Minmed Group to pilot a service to allow this group of patients to be seen promptly.

Called SWIFT (SGH-Wide Initiative for Telehealth) Care, the service offers eligible patients teleconsultation with the private healthcare group’s general practitioners (GPs). Registration and consultation are done almost immediately, and can be completed in 30–60 minutes, with the patient’s medicines delivered to his home within three hours.

<<The SWIFT Care Clinic, which has two booths for teleconsultation, is sited within SGH’s Emergency Department. Patients can undergo triage by nurses first, or proceed directly to the SWIFT clinic, where they speak to a GP via a video call.>>

“P3 (Priority 3) patients have very long wait times because we’re spending more of our efforts on the sicker P1 and P2 patients,” said Associate Professor Kenneth Tan (below), Head and Senior Consultant, Department of Emergency Medicine, SGH. “Our aim is to provide suitable P3 cases with an alternative to be seen by our care partners. This option will improve the patient experience for this group through a shorter wait time and prompt care. Doing so also allows us to deploy our resources appropriately for more critically ill patients.”

P3 refers to patients with mild to moderate medical issues that do not require immediate medical treatment. Patients may have symptoms of respiratory illnesses like COVID-19, minor sprains, stomach flu, or food poisoning. Priority to receive emergency care is given to P1 and P2 patients.

The highest priority P1 patients need immediate attention and are typically treated in the ED’s resuscitation area. P1 patients are usually critically ill, having suffered cardiac arrest, severe injuries, bleeding, shock, or a severe asthma attack. P2 patients also need prompt attention although they may be stable with no resuscitation required. They may have suffered major limb fractures or dislocation, have abdominal pain, or need surgical emergencies, and are usually unable to move on their own.

With an ageing population, hospitals’ EDs have been grappling with growing numbers of patients seeking emergency attention, some of whom may not actually require urgent care. For instance, some 320 patients visit SGH’s ED every day, but about 20 per cent of them do not require urgent care.

Associate Professor Goh Su-Yen, Clinical Director (Digitalisation and Technology), Department of Future Health System, SGH, described the partnership with Minmed as an excellent opportunity to deliver the best possible care for the right categories of patients. Minmed boasts an island-wide network of GPs, and expertise in the use of telemedicine.

“We chose to go digital first because we think our population is increasingly comfortable with the concept of digital health,” said Assoc Prof Goh. Located in SGH’s ED, the 24-hour SWIFT Care service was launched in June 2024. Patients assessed to be eligible can register at the SWIFT Care Clinic to be seen by a Minmed doctor via video. An assistant helps with registration and other administrative tasks, while a nurse is able to support the doctor in procedures such as basic wound care and administration of intramuscular injections if necessary.

<<Minmed staff are on hand to help patients with registration throughout the day, including a nurse to support the doctor during teleconsultation with patients>>

After the consultation, any medications prescribed will be delivered to patients’ homes within three hours. A flat fee for consultation and medicines is charged. Depending on their condition, patients may be referred to a specialist for further review, or sent back to the ED if found to need emergency care or an examination in person. Should the latter happen, the patient will not be charged the MinMed fee, said Dr Eric Chiam, Chief Executive Officer and Founder, Minmed Group. Patients may also opt for the SWIFT Care Clinic services directly, without having to be examined at the ED’s Nurse Triage station.

Who isn’t eligible for SWIFT

While the SWIFT Care service is ideal for non-emergency medical conditions that can be effectively managed through telehealth, patients with certain conditions will not be accepted into the SWIFT Care Clinic. These are:

• Serious emergencies like life-threatening conditions, severe abdominal pain,
• difficult breathing, stroke-like symptoms, chest pain, pregnancy-related conditions
• Chronic conditions that are not well managed
• Medical procedures such as dressing changes, stitches, or abscess drainage
• Conditions that are not improving despite multiple ED visits before