CLOSURE OF TAN TOCK SENG HOSPITAL'S A&E DEPARTMENT AND BED SITUATION IN PUBLIC HOSPITALS

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**CLOSURE OF TAN TOCK SENG HOSPITAL'S A &E DEPARTMENT AND BED SITUATION IN PUBLIC HOSPITALS **

8.

Dr Tan Sze Wee asked the Minister for Health with regard to the temporary closure of TTSH Accident and Emergency (A&E) services to ambulance cases, (a)

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how many times has TTSH A&E been closed in the period of January to July 2005; (b) what is the average period of such closures; and (c) what is the impact of these closures on the workload of A&E departments and waiting times for A&E physician consultation (excluding triage time) and beds of NUH, AH, SGH and CGH.

9.

Dr Tan Sze Wee asked the Minister for Health (a) what is the hospital average length of stay for TTSH, NUH, AH, SGH and CGH for 2000 to 2004, excluding 2003 for SARS; (b) what is the hospital average length of stay in 2005 for (i) all disciplines (ii) the discipline of geriatrics (iii) the discipline of rehabilitation medicine; (c) what is the number of patient admissions for each hospital from 2000 to 2005; and (d) why do some hospitals have a longer average length of stay than others, even for geriatrics and rehabilitation medicine when patients' demographical differences are probably not significant between hospitals.

10.

Dr Tan Sze Wee asked the Minister for Health (a) if the standard procedure of warding chickenpox patients in the Communicable Disease Centre (CDC) instead of Tan Tock Seng Hospital (TTSH) has been changed; (b) if so, what is the number of chickenpox patients admitted to CDC and TTSH for this year compared to last year; (c) whether the recent rise in dengue fever infections has consumed additional beds in CDC and TTSH; and (d) if so, what are the numbers for CDC and TTSH compared to the rest of the four general hospitals.

The Senior Minister of State for Health (Dr Balaji Sadasivan) (for the Minister for Health): Mr Deputy Speaker, Sir, with your permission, I will take the next three Questions together.

Mr Deputy Speaker: Yes.

Dr Balaji Sadasivan: Dr Tan Sze Wee asked a number of questions related to

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the bed situation in public hospitals, including admissions and length of stay, the closure of Tan Tock Seng Hospital's (TTSH) Emergency Department and the handling of chickenpox cases. Let me address these in turn.

Hospital Admissions

Although Singapore is a small city-state, there are demographic differences in the patients seen by the different public hospitals. Different hospitals see different types and ages of patients, have different medical departments, and treat different ratios of non-elective to elective cases. For example, in 2004, the median age of Tan Tock Seng Hospital's patients was 59 years, compared with 55 years in Singapore General Hospital (SGH), 52 years in Alexandra Hospital (AH) and 51 years in Changi General Hospital (CGH). The median age is 44 years for National University Hospital (NUH), partly due to its pediatric service. As another example, TTSH sees more rehabilitative medicine patients than other hospitals. In 2004, it treated 3,367 such patients, while CGH had the second highest volume of 510 such patients.

The average length of stay in a hospital is therefore determined by a range of supply and demand factors, such as the demographics of the surrounding population, the conditions treated by the hospital, and the availability of step-down or alternative care services.

Specifically, since 2000 when the average length of stay for public hospitals was 5.9 days, there has been a gradual decrease in this figure. The average length of stay in public hospitals for the period from January to June 2005, across all disciplines, was 5.6 days. NUH had the shortest average length of stay of 4.9 days, while TTSH had the longest length of 7.0 days. By discipline, the average lengths of stay for geriatric and rehabilitative medicine from January to

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June 2005 were 9.4 and 19.7 days respectively.

The total number of patient admissions in acute care public hospitals increased slightly over five years, from 297,000 in 2000 to 303,590 in 2004. The figure from January to June 2005 was 150,290. The number of admissions varies depending on each hospital's capacity. For the first half of 2005, AH with the fewest beds had 10,530 admissions, while SGH with the most beds had 34,870 admissions.

These statistics show the comparative situation in our hospitals. What is more important, however, is for each hospital to continue to ensure that their patients get appropriate medical treatment. If a patient needs to stay longer than the average length of stay in order to receive proper medical care, his doctor must ensure that he stays. While we monitor the length of stay in order to make hospital operations more efficient and more effective, we must also be careful not to make statistical data more important than the quality of care that patients receive.

Closure of TTSH's Emergency Department

The Emergency Department is one of several units in a hospital. The number of cases that can be treated by the Emergency Department varies, depending on the situation in the other units. For example, if there are a large number of dengue cases taking up many beds, then the Emergency Department's capacity to manage cases will be affected.

Between January and August 2005, TTSH's Emergency Department was closed about 9% of the total operating time. In 2004, similar closures at TTSH comprised 1% of total operating time. During such times, ambulance cases are

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sent to the nearest hospital which can confirm it has available capacity. However, the most critical cases are still admitted even if closure is declared.

The declaration of "full house" at TTSH's Emergency Department is not something that is done lightly, since it has a knock-on effect on the operations of other hospitals. We will continue to closely monitor the situation across hospitals.

Chickenpox and dengue fever

In the past, chickenpox patients were typically admitted to the Communicable Disease Centre (CDC). If a patient's choice of ward class was unavailable at CDC, he would be warded at TTSH. The number of chickenpox cases admitted to TTSH and CDC in the first half of 2005 was about 100 cases a month, while there were about 50 cases a month in 2004.

However, as chickenpox is a relatively mild disease that can be managed outside a hospital setting, TTSH and CDC have since July 2005 only admitted patients with chickenpox if there is a medical indication for hospitalisation. In August 2005, only eight such cases were admitted. Patients with chickenpox are no longer admitted for the purpose of isolation. My Ministry is monitoring the situation and has not detected any public health impact arising from the revised admissions policy.

Minister Yaacob Ibrahim will be addressing this House on the national strategy for tackling dengue. So I will just respond to Dr Tan's specific question here.

The number of hospitalisations for dengue fever has increased since May 2005, corresponding to the increase in the number of notifications of dengue fever. In May 2005, the utilisation of bed

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days for patients with dengue fever at public hospitals ranged from 0.8% at NUH to 2.7% at TTSH/CDC. By August 2005, dengue has taken up 6% of available bed days in TTSH/CDC, AH and CGH, and around 3% for NUH and SGH.

The Minister for Health had during an earlier session addressed this House on the issue of hospital capacity. The Ministry will continue to undertake immediate and longer-term measures, to ensure that there is adequate capacity in public hospitals and that no patient will be denied access to medical care.

Dr Tan Sze Wee (Nominated Member): Mr Deputy Speaker, Sir, I thank the Senior Minister of State for providing the answer to my question. However, I was asking the question because of the reply that was made in the previous sitting regarding the capacity of the beds in Tan Tock Seng Hospital resulting in the A&E situation. I find a bit startling to realise that, based on his reply, for the period 2005, Tan Tock Seng A&E has actually closed down about 9% of the time which, on an annualised basis, amounts to about one month per year which is quite alarming, compared to last year which was only 1%. Perhaps, he may wish to clarify that.

The second point is that with the rest of the other questions I have on A&E, what is the knock-on effect on the other hospitals' A&E workload, as a result of Tan Tock Seng A&E closing down? What is the patient waiting time in the rest of the acute hospitals that have A&E services that were being overflowed now as a result of Tan Tock Seng A&E being closed down. The additional questions are actually relating to length of stay. What I have asked for is the average length of stay for rehabilitative and geriatric patients in Tan Tock Seng Hospital and across the other public hospitals which the Senior Minister of State has actually provided. However, what the Senior Minister of State has not

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provided is the average length of stay of rehabilitative and geriatric patients in the other hospitals as well. We note that the average length of stay has a bearing on ---

Mr Deputy Speaker: Dr Tan, what is your question? Can you ask your question?

Dr Tan Sze Wee: The question I wanted to ask is that, for the average length of stay, the Senior Minister of State has actually accounted that by age alone because Tan Tock Seng Hospital has a high rate of patients. But if you account by the age itself, Tan Tock Seng Hospital could, in terms of efficiency or turning round the patient, look at it as well. So perhaps one of the factors, besides providing the building of hospital beds because the length of stay has a bearing on the hospital bill, is that the length of stay should be looked at as one of the performance indicators of hospitals as well.

Dr Balaji Sadasivan: First of all, I would like to explain that the reason why the percentage of time it has been closed has increased is due to the larger number of cases that the Emergency Department has been seeing because of dengue, and that certainly has a knock-on effect on all the hospitals which is why tackling the dengue outbreak is very, very important. But in the meantime, we have formed an expert committee to look at the problem of admission of dengue patients to all the hospitals as well as the Emergency Department to see if our resources could be used more efficiently so that the closure will be less frequent.

With regard to the length of stay, it is more than just the age that differentiates the hospitals. The type of patients is also different. For example, Tan Tock Seng Hospital sees a disproportionate number of stroke patients for rehabilitation as opposed to rehabilitation for other causes, and hence there can be a disparity in the

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length of stay for rehabilitative patients. Specifically, for example, in NUH, rehabilitation medicine patients stay an average of seven days, whereas in Changi Hospital, it is 22 days, and Tan Tock Seng Hospital, it is 33 days, and a large part of this difference is because of the different types of patients.