Colin Ong
Singapore 

Ng Teng Fong General Hospital in Singapore has rolled out an initiative which puts in place case management protocols to triage cases involving non-COVID positive seniors at its emergency department, so that the seniors receive timely and targeted intervention without hospital admission.  The hospital initiates right-siting case management protocol at emergency department to save beds while keeping seniors safe.

Called “CARED” for “Case Management for At-Risk patients at ED”, it targets seniors 65 years and above or frequent re-admitters with complex medical history, frailty and/or challenges with function.  A case manager at the emergency department provides comprehensive assessment, acute intervention at ED if necessary, and right sites the patient either to the hospital’s specialist outpatient medical, nursing or allied health clinics, arranges for home or centre-based care, or refers them to appropriate community care services.  The team led by Dr Colin Ong, a consultant at the E.D. of the hospital, rolled this case management protocol out in the peak of COVID, and since January 2021, their preliminary data showed that interventions have been able to facilitate and expedite the discharge of patients from the ED and avoid hospital admission in 51 out of 170 patients seen (30%), while providing value-added services for those being admitted or planned for discharge.

The ED Case Manager assesses eligible patients in the ED, and activates appropriate care for the patient before ED discharge. This includes allied health services such as the physio, occupational and speech therapists, pharmacists and medical social workers, who may review the patients in the ED itself or as an outpatient after discharge, as well as timely referrals to appropriate community based services and post-discharge phone support when needed. These interventions not only aim to provide holistic care for the patient but may also save hospital beds for those who might need them more urgently.

The post discharge referral pathways include:

1. General practice/Poly-clinic teamlet programme (For chronic disease management)
2. The Hospital’s transitional care programme (Hospital to Home)
3. Home based services: Home nursing, Home medical, Home Therapy etc.
4. Centre based services: Day Care, Day Rehab, etc.
5. Admission to Community Hospital for mid to long-term rehab