How ‘virtual hospitals’ are caring for Singapore’s elderly

By Medha Basu

Interview with Tan Tock Seng Hospital’s Ayliana Dharmawan.

Elderly patients in Singapore don’t have to spend weeks in hospital after an operation. They are allowed to return home and recover with their family at their side.
Tan Tock Seng Hospital in Singapore specialises in caring for the elderly - it was the first in the country to set up a geriatric care unit. Elderly patients tend to make more hospital visits and have multiple illnesses. The hospital wants to make the best use of its limited beds and is helping patients recover at home.

It has set up a “virtual hospital” scheme, which allows doctors to take care of patients at home, says Ayliana Dharmawan, head of the hospital’s management information department. "We must find innovative ways to provide care without physical limitations."

Caring at home

The hospital assigns a team to monitor each discharged patient - this includes doctors, nurses, therapists and dieticians. They monitor the patient’s clinical readings, but also assess how they cope at home and perform daily activities.

If they are recovering well, they don’t need to come back to the hospital for specialist care. Beyond a certain point, they can be transferred to the primary care system - either a general practitioner or family doctor in a polyclinic.

A study over six months found that 30% of such patients did not need to be readmitted to the hospital. 60% were safe without needing urgent treatment at the emergency department, it found.

The hospital is looking at more extensive use of electronic medical records so that staff can access patients’ details on the go. Digital records allow the care team to collaborate and stay updated on the patient’s treatment. “Caregivers in the team are able to have comprehensive information on the care and treatment given to a particular patient," Dharmawan says.

The hospital is also looking at videoconferencing so that doctors can be consulted remotely. This would allow general practitioners to directly consult with specialists in the hospitals. Existing popular apps in the market are not secure enough for this purpose, however.

Data, yes. Drones, no

The hospital should also use data analytics to detect illnesses in advance and provide early care, she says. Dharmawan is a professor of healthcare analytics at the National University of Singapore. "We should be able to catch patients at every stage before they get very sick, so that we can provide early intervention and optimise the care."

It is also using data to make operational decisions. For instance, staff can be better prepared for patients who don’t show up for appointments. Nurses must prepare in advance of appointments with patients, and when they don’t turn up, it is a waste of resources for the hospital. "When we know the profile of the patients who are no-shows, we can manage resources better. These resources can be used for other patients who really need the urgent specialist care," Dharmawan says.

The hospital is not going gaga over drones, however. Why? Because it “did not find sufficient justification for return on investments through our assessments”, she says.

The hospital tested drones in two areas: delivery and monitoring. The hospital’s infectious diseases unit tried out drones to transport blood samples to and from labs. But the volume of use was not high enough to sufficiently lower costs.

It also tested drones with cameras to monitor patients, but it found that cheaper technologies that can do the job as well. "We can invest in CCTV which is cheaper and easier to implement. We have yet to find cost effective applications where we can immediately implement drones," she says.

No drones whizzing around the hospital any time soon then. But its staff are working to ensure the elderly more time with family and less time in the hospital.