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Coordinated approach at KTPH to lessen risk of complications
AN ELDERLY patient requiring colorectal surgery in Singapore’s newest hospital can expect a team of doctors, nurses and other medical professionals to come a-calling at his bedside within hours.
This new health-care model of holistic care will be in place at Khoo Teck Puat Hospital (KTPH) when the 550-bed facility in Yishun begins full operations next month.
At the same time, the geriatric surgery service (GSS) will also be employed in the outpatient geriatric clinic, which has been open since March.
The idea is not just to treat an elderly patient for his illness, but also coordinate all aspects of care to lessen the risk of complications.
A surgeon, geriatrician, cardiologist and anaesthetist will work alongside allied health-care professionals, such as dieticians, nurse clinicians, pharmacists, medical social workers and physiotherapists.
The surgeon plans the surgery in consultation with the team. The cardiologist picks up potential heart problems, the geriatrician checks for undetected dementia, which increases a patient’s risk of post-surgical delirium. The physiotherapist identifies how well a patient is functioning and maps out conditioning if required.
Patients due for surgery will find a listening ear for their anxiety in a hospital operations executive, who is also part of the hospital’s GSS team.
Colorectal surgery currently accounts for more than half of all abdominal surgery performed on elderly patients at Alexandra Hospital (AH).
Post-surgical complications include kidney failure and chest infections.
The aim of the model is to pre-empt any issues that may arise from the treatment of a vulnerable patient.
Dr Tan Kok Yang, 38, consultant at the surgery department of KTPH, said: “The management of elderly patients can be quite complex and we cannot take it upon the surgeon alone to treat the patient.
“We need to have a system of coordinated care from a team of specialists to address the different aspects of health care.”
Dr Tan added that the system comes at no extra cost to the patient.
A pilot project at AH from January 2007, showed such a system works.
A patient had her colorectal surgery postponed when the geriatrician and cardiologist discovered she had a heart condition.
The doctors then chose to operate on her heart first, as it would have affected the outcome of the colorectal surgery.
At AH, 29 out of 81 elderly patients aged 75 years and older admitted for colorectal surgery were put under this model of care.
They were seen by the 12 health-care workers in the team within 36 hours of being identified.
The results: The 29 had an average of seven hospital days, compared to 9.5 days for those not on the system. Also the patients with post-operative complications nearly halved from 30.8 per cent to 17.2 per cent.
Only elderly patients undergoing colorectal surgery will be placed on GSS now, but Dr Tan said there are plans to extend it to other surgical patients.
Since 2004, the National University Hospital has also employed this multi-disciplinary approach at its geriatric clinic.
When a hospital patient is referred to the geriatric team for assessment, he will be seen by the geriatrician, therapist, care coordinator and nurse clinic within 24 hours of the referral, said an NUH spokesman.
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