Our mission to provide good-quality, affordable and hassle-free healthcare with science, love and wisdom has guided our various translational research activities.
Last year, Yishun Health’s clinician scientists, doctors and other healthcare professionals were involved in research into diabetes, cholesterol disorder, and perioperative medicine to explore, ask questions, and drive better understanding of diseases and their complications. This helps to develop more effective methods for prevention and management.
This spirit of curiosity and creativity has also driven our continuous improvement projects. While not all of these are directly related to patient care, they enable us as an organisation to be more efficient and productive. They are also safer and more cost effective, so that we can invest more time and resources in the people that matter most: our patients.
One important facet of our work in driving continuous improvement and excellence is the Alexandra Health Fund (AHF), which has supported 15 key programmes directed at improving the quality of life of our patients through research, innovation and education. The Fund was incorporated in September 2014 as a registered charity under the Charities Act. Since its incorporation, AHF has benefited more than 300 patients each year by providing financial assistance. This has gone towards supporting transportation and home care needs, as well as durable medical equipment, consumables, and medical treatment. The key focus of this financial aid is to allow patients to continue living independently in the community. One new programme funded in FY2017 is IDEA, which focuses on enabling diabetic patients to self-manage their conditions and address challenges faced on a daily basis.
Other AHF developments in FY2017 include:
Alignment of the Fund to NHG as part of the national restructuring of healthcare institutions into three clusters
The successful renewal of our IPC status for another three years (2018–2021)
Expanding the scope of funding as Yishun Health grows to include AdMC
As of March 2018, AHF has $139 million in its coffers, up from $126 million. Apart from investment returns, the growth in funds is attributed to donations and KTPH surpluses.
BETTER CARE THROUGH RESEARCH
Maturity-onset diabetes of the young, or MODY, is a form of diabetes caused by a single gene mutation (i.e. monogenic). It typically affects people below the age of 35 and is estimated to affect 0.5–1% of people with diabetes, which translates to 2,500–5,000 people in Singapore. Accurate diagnosis is crucial to benefit such patients and drive more optimal treatment and management of complications. To this end, the KTPH-NHG MODY Registry was set up in April 2017. To date, 35 patients have been entered into the registry, 80% of whom have benefited directly from genetic testing in terms of disease management.
DYNAMO: Diabetes studY in Nephropathy And other Microvascular cOmplications
In recognition of the increasing need for new approaches to treating and managing diabetic nephropathy (DN), the National Medical Research Council has awarded an Open Fund-Large Collaborative Grant (OF-LCG) of nearly $25 million over five years to a multidisciplinary, multi-institutional team — one of which will be KTPH — to conduct DYNAMO. Despite the substantial public health burden associated with DN, its molecular pathogenesis is not well understood, and no new drugs that address it have been introduced in nearly 20 years. DYNAMO seeks to work towards reducing diabetic kidney disease in Singapore by 30% within the next five years.
FH CARE: Familial Hypercholesterolemia: Case identification Assessment and Reduction in adverse Events
Familial Hypercholesterolemia (FH) is a genetic disorder that impairs the body’s ability to remove low-density lipoprotein (LDL, or bad cholesterol) from the blood. There are 22,000–27,500 people in Singapore with FH, but more than 90% of them are unaware of their condition, raising their risk of developing premature cardiovascular disease by more than 20 times. The goal of FH CARE is to better identify those with FH through diagnosis and active cascade screening, allowing identified individuals to start early or intensify lipid-lowering treatment to reduce morbidity and mortality associated with this condition.
Recognising Excellence in Research and Education
Yishun Health clinicians and allied health professionals were recognised and rewarded in various arenas for their efforts in improving patient care:
A/Prof Yip Chee Chew, Head and Senior Consultant, Ophthalmology and Visual Sciences, was awarded the Health Professions Education Research Investigator Gold award at the 2017 Singapore Health and Biomedical Congress
A/Prof Edwin Seet, Head and Senior Consultant, Anaesthesia, collaborated with the Agency for Science, Technology & Research and the Singapore University of Technology and Design
Sylvia, Research Officer, Clinical Research Unit, was awarded the Gold in the Best Poster Award (Allied Health) at the Singapore Health and Biomedical Conference 2017
Dr Zhang Xiao, Senior Epidemiologist, Clinical Research Unit, was awarded the Bronze in the Best Poster Award (Basic Science/Translational Research) at the Singapore Health and Biomedical Conference 2017
Dr Angela Moh, Senior Research Officer, Clinical Research Unit, was featured in national Mandarin daily Lianhe Zaobao
Dr Serena Low, Consultant, Clinical Research Unit, won the Best Investigator Award at the 2017 Actualizing the Future Endocrine Science Congress
BETTER CARE THROUGH INNOVATION
Electronic Kanban Replenishment Inventory System
To improve the overall efficiency in surgical consumables stock management, the Ophthalmology and Visual Sciences department collaborated with Day Surgery Centre (DSC), Biomedical Engineering, Operations, and the Materials Management Department (MMD) to create a hassle-free e-inventory system to track and replenish stock in a timely manner without physical inventory checks. Called Electronic Kanban Replenishment Inventory System (E-KRIS), the system uses the Kanban approach and deploys barcode scanning to trigger replenishment and shelf-stocking.
E-KRIS presentation at the Kaizen Festival
Electronic Collection of Type and Screen
The Laboratory Medicine department collaborated with the Office of Clinical Informatics to implement an electronic process for the collection of Type and Screen specimens. This improvement makes the entire blood transfusion process entirely electronic. This includes bi-directional communication between the Blood Bank Information System and the Electronic Medical Record System, and is a first in Singapore.
Point-of-Care Equipment Refresh
The Laboratory Medicine department refreshed all of the hospital’s Point-of-Care Testing (POCT) equipment. This exercise included 125 glucose meters, six blood gas analysers, three coagulation meters, eight cholesterol meters, two urinalysis dipstick readers, and one pregnancy test from three different equipment vendors.
Driving Medication Safety and Efficacy
Yishun Health’s Pharmacy department set up the Medication Management Workgroup in April 2017 to influence and support appropriate, safe and efficacious prescription of medications for patients, and has evolved from identifying inappropriate polypharmacy to looking at medication appropriateness.
A Ruler for Medication Safety
The Pharmacy department has developed a Ruler for Medication Safety. The Ruler flags worrying trends objectively through a review of near misses and hospital incident reporting tools. In addition to this, regular coffee talks are held to understand why certain errors occur, and flag challenges and concerns.
Saying Appropriate Yes through Yishun Health Empowerment Sheet (SAY YES)
In tandem with the Ministry of Health’s Appropriate Care Guide on type 2 diabetes mellitus, the Pharmacy and Therapeutics Committee implemented a new initiative in November 2017. SAY YES encourages the appropriate use of oral hypoglycaemic agents. This has led to the increased use of more cost-effective drugs. The second SAY YES initiative will focus on oral anticoagulants to drive their appropriate use.
Using Genes to Improve Drug Effectiveness
The Pharmacy and Cardiology departments developed new workflows to identify patients with high enzyme activity to that they can be offered the cheaper of two antiplatelet drugs. This may amount up to $1,848 worth of savings a year for these patients. Going forward, more genotype testing services will be rolled out to other specialties.
A pharmacist sending medication via the pneumatic tube system
Faster Pharmacy Pick-Ups After Discharge
The Central Discharge Pharmacy initiative was piloted in June 2018 for patients warded in KTPH’s Tower B. The aim was to increase efficiency and facilitate faster dispensing of discharge medicines. The Pick & Go service, developed in collaboration with the Nursing department and Inpatient Operations, has shown positive results and good patient response: 96% of patients received their medicines within 15 minutes of arriving at the pharmacy, and close to half of them waited just five minutes.