We provide consultative support to other researchers and clinicians from question formulation to research analysis. Individual team members are also involved in primary research as co-investigators and seek to share the knowledge of research findings through scientific publications. Our key areas of research include: outcomes research, health economics, operations research, management analytics and health technology assessment.
Manpower Scheduling at A&E
A new junior doctor roster was derived based on a published study that demonstrated that matching manpower availability with demand was effective in reducing waiting time of Accident and Emergency (A&E) patients. The derivation entailed three steps. The first determined the ideal number of junior doctors at every hour of a day by apportioning the total available man-hours according to the hourly patient volume of A&E. The second step involved application of an integer linear programming (ILP) model to assign available junior doctors to existing and new shifts so that the hourly number of doctors matched their respective ideal numbers derived in the first step as closely as possible. The last step involved adaptation of an ILP solution to the operational preferences of A&E. The new roster included a new shift and its impact was evaluated by comparing the time to first consultant review (TTFC) performance of the pre-implementation period of weeks 10 to 26 of 2013 and post-implementation period of 11 weeks which started one week after implementation of the new roster. Our preliminary findings showed that the new roster was effective in reducing TTFC of P2 patients.
Effect of Menu Labelling on Food Choices among Individuals Who Dine Out
Obesity is closely related to food intake. In 2010, about 1 in 2 (45.1%) adult Singaporeans dining out at hawker centres/coffee shop stalls/food courts (for any meals of the day) six times a week or more, and 56.9% doing so for lunch and/or dinner. However, most research on food choices have been performed in Western countries and in the setting of fast food chains. This study examined how the presentation of nutritional information on a menu influences the choice of food during lunch among working adults. This was a cross-sectional observational study of healthy working adult Singaporeans and permanent residents. A total of 400 healthy volunteers were recruited from four sites of Singapore (with representation of North, South, East and West). Four food courts were chosen to represent all locations of Singapore. The participants were asked information on demographics, health behaviour, knowledge of good dietary intake practices, daily dietary practices and their food choices. Trained research assistants collected data through face-to-face interviews using a questionnaire. We then compared the food choices of participants based on information presented on four nutritional menus.
Risk Stratification of Heart failure Patients
As heart failure (HF) has a poor prognosis leading to frequent hospitalizations, it is important to customize interventions according to the needs of each individual HF patient. This study aimed to develop a model to identify patients with HF-related readmission within 30 days post discharge; and stratify readmission risks of HF patients into different risk category.
This was a retrospective cohort study using electronic medical records. All heart failure patients discharged from the Cardiology department, who were on the clinical care pathway and with principal diagnosis of congestive cardiac failure, were included for analysis. Patients who died at index admission, died without readmission, were discharged against doctor's advice, or were discharged to other health facilities were excluded. Risk stratification models were developed based on probabilities of 30-day readmission derived using patient characteristics, vital signs, and laboratory and diagnostic study results. Discriminatory power of the models developed was examined using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under curve (ROC).
Profiling of Heart Failure Patients
In Singapore, age-adjusted HF hospital admissions has increased significantly over the years, accounting for more than 5,000 admissions in 2011. This study aimed to profile HF patients admitted to the Cardiology department between 2010 and 2012 in terms of (i) risk of 30-day readmission; and (ii) predictors of 30-day readmission.
This was a retrospective cohort study using electronic medical records from 2010 to 2012. All discharged HF patients who were on the clinical care pathway and with principal diagnosis of congestive cardiac failure were included for analysis. Patients who died at index admission, died without readmission, were discharged against doctor's advice, or were discharged to other health facilities, were excluded. All patients were followed up for 30 days.
Fall Risk Assessment Tool
This study aimed to develop a new fall risk assessment tool as an alternative to the Morse Falls Scale for inpatients at CGH. The primary objective of the study was to validate the tool prospectively in the hospital setting. This study included both qualitative and quantitative methods to explore patient, hospital, medical and environment factors that related to inpatient falls, as well as to perform validity and reliability assessments of newly development tools for in-hospital use.
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Changi General Hospital (CGH)