TRANSFORMING CARE

••• THE AHS WAY Alexandra Health System Annual Report 2016/2017 Contents

2 Message from Chairman 4 Board of Directors 6 Senior Management 8 Heads of Department 9 The Alexandra Health Story 19 Living Well, Loving Life 25 Turning Illness Into Wellness 31 When Illness Strikes 39 Living and Dying with Dignity 49 Research and Education 53 Our People: The Heart of AHS 61 Creating A Healing Environment 66 Green Report Card 67 Operational Highlights 68 Awards 70 Clinical Research Awards 72 Journal Publications OUR VISION Help our people live a long, healthy life and support them with thoughtful, dignified care to the end.

OUR MISSION Provide good quality, affordable and hassle-free healthcare with science, love and wisdom.

OUR CARE PHILOSOPHY Care that is good enough for our own mothers without making special arrangements. 2 TRANSFORMING CARE

Message from Chairman

The impetus to transform care the Alexandra organisations, the three Wellness Kampungs Health System (AHS) way can be traced back started operations in April 2016. They to the transformation story of Alexandra encourage ageing in place for residents by Hospital (AH) in the year 2000. The enabling a network of communal spaces management team, under the leadership of with various programmes where seniors then Chief Executive Officer (CEO) Mr Liak can gather and support each other in Teng Lit, successfully transformed the little physical exercises and do-it-yourself style hospital into one that topped the annual rehabilitation. Community nurses stationed Patient Satisfaction Survey by the Ministry at these spaces maintain a reassuring and of Health (MOH) for six consecutive years. motivating presence for both volunteers and With its physical transformation, AH also residents receiving support. These work in made a name for itself as a healing oasis for tandem with the existing Ageing-in-Place patients. The management team’s relentless home visits by our Community Care Team. pursuit to reinvent healthcare culminated in the building of our integrated regional health Yishun Community Hospital (YCH) officially ecosystem in the northern . opened on 28 November 2016. Care at YCH focuses on helping patients regain their independence so they can manage well CARING FOR when they return home. In shifting beyond SINGAPORE RESIDENTS good quality rehabilitative and sub-acute The year 2016 marked a major shift as care to what is meaningful to patients, we made significant inroads into the YCH collaborated with different partners to community. We brought access to health introduce various activities and programmes and healthcare closer to residents with that enhance patient recovery. One of the opening of three Wellness Kampungs. them is the monthly inter-generational Managed in collaboration with St Luke’s programme by pre-schoolers from The Little Elder Care and Nee Soon grassroots Skool-House By-The-Lake. The children 3

bring liveliness to the wards while the A NEW CHAPTER quality time spent with the elderly provide In January 2017, MOH announced the re- valuable interaction with those who have organisation of the public healthcare system experienced life in its richness. and AHS will be merged with National Healthcare Group by the end of this year. In the acute care setting, The merged entity will offer a comprehensive Hospital (KTPH) continues to improve the range of services that encompasses acute delivery of hassle-free care. The waiting and community hospital care, primary time at KTPH Emergency Department for care, home and community care as well as admission to inpatient wards reduced with medical education. This change presents the opening of the Extended Diagnostic an opportunity to collaborate and scale & Treatment Unit. More initiatives were up AHS’s strengths in promoting health, implemented to deliver rapid diagnosis and wellness and community engagement acute treatment, resulting in better recovery across geographical boundaries. outcomes and shorter length of stay for patients. These initiatives include the set-up As we step into a new chapter, I would like of an Acute Medical Unit, early mobilisation to thank AHS’s Board of Directors past and of Intensive Care Unit patients, and a system present for their support throughout our for emergency surgery and trauma care. In journey. Our Group CEO Mr Liak played a a step forward to better manage complex major role in the AHS story of transforming and chronic disease conditions, KTPH’s care over the past 17 years. His vision and specialist outpatient clinics will be extending leadership shaped the northern regional their services into the housing estate with health system into what it is today. On behalf the opening of Admiralty Medical Centre of the AHS Board, I wish him well as he (AdMC) in July 2017. embarks on his new endeavours outside of the public healthcare sector. AHS is on track to building an integrated health ecosystem in the North. Woodlands I would also like to express my appreciation Health Campus (WHC), the first hospital in to MOH, government agencies, our Woodlands, broke ground on 18 April 2017. community partners and friends. In the Set to open progressively from 2022, the ensuing pages of this report, we chronicle new health campus will be an expansive the story of AHS in transforming care and healing environment that comprises an fulfilling our mission. These achievements integrated acute and community hospital, would not have been possible without the specialist outpatient clinics and a long-term guidance and support of our partners. care facility. In the spirit of transformation for OUR PEOPLE sustainable health care, we are excited to turn the page and start a new one. The story I take this opportunity to congratulate of AHS is evolving, but our vision remains – three of our outstanding clinicians. YCH’s to help our people live a long, healthy life Chairman of the Medical Board, Associate and support them with thoughtful, dignified Professor (A/Prof) Pang Weng Sun was care throughout their lives. recognised with the National Outstanding Clinician Educator Award. Professor C. Rajasoorya and A/Prof Sum Chee Fang were lauded with the inaugural Distinguished Ms Jennie Chua Senior Clinician Award conferred by MOH. Chairman, Alexandra Health System 4 TRANSFORMING CARE

Board of Directors

Ms Jennie Chua Chairman, Alexandra Health System

Ms Mavis Khoo Mr Seah Moon Ming Mr Robert Chew

Mr Ramlee Bin Buang Mr Douglas Foo Ms Teoh Zsin Woon

Chairman's photo: © 2015 SPH Magazines Pte Ltd. Reproduced with permission. 5

Mr Tan Boon Khai Prof Chee Yam Cheng Mr Tow Heng Tan

Ms Chu Swee Yeok Mr Anthony Seah Dr Quek Peng Kiang

Mr Liak Teng Lit Mr Roger Leong Company Secretary

We would like to thank Mr Anthony Seah and Dr Quek Peng Kiang (till 30 September 2016) for their contribution. 6 TRANSFORMING CARE

Senior Management

Mr Liak Teng Lit Mrs Chew Kwee Tiang Dr Pauline Tan Group Chief Executive Officer, Chief Executive Officer, Chief Executive Officer, Alexandra Health System Yishun Community Hospital

Mr Roger Leong Ms Magdalene Chai Dr Wong Sweet Fun Mr Alvin Ong Chief Financial Officer, Group Chief Human Resource Officer, Chief Transformation Officer, Chief Information Officer, Alexandra Health System Alexandra Health System Alexandra Health System, Alexandra Health System Deputy Chairman, Medical Board, Yishun Community Hospital & Senior Consultant, Geriatric Medicine, Khoo Teck Puat Hospital

Dr Howard Foo Ms Caroline Lim Ms Cheong Choy Fong Mr Bastari Irwan Senior Director, Clinical Manpower Director, Alexandra Health Director, Quality Management Office, Director, Transformation Office, Planning, Alexandra Health System Institute and Group Alexandra Health System Alexandra Health System & Chief, Corporate Services, Corporate Communications, Woodlands Health Campus Alexandra Health System 7

Dr Jason Cheah A/Prof Pang Weng Sun A/Prof Pek Wee Yang Chairman, Pro-tem Chairman, Medical Board, Chairman, Medical Board and Planning Committee, Yishun Community Hospital & Senior Consultant, General Medicine, Woodlands Health Campus Senior Consultant, Geriatric Medicine, Khoo Teck Puat Hospital Khoo Teck Puat Hospital

Ms Low Beng Hoi Ms Yen Tan Mr Samuel Ng Chief Nurse, Chief Operating Officer, Chief Operating Officer, Alexandra Health System Khoo Teck Puat Hospital Yishun Community Hospital & Senior Director, Special Projects, Alexandra Health System

Dr Wong Moh Sim A/Prof Terence Tang Mr Donald Wai Mr Lim Theam Siew Deputy Chairman, Medical Board, Deputy Chairman, Medical Board, and Director, Hospital Planning, Director, Corporate Development Head and Senior Consultant, Senior Consultant, Geriatric Medicine, Alexandra Health System and Business Office, Laboratory Medicine, Khoo Teck Puat Hospital Alexandra Health System Khoo Teck Puat Hospital

We would like to thank Mr Liak Teng Lit (till 31 March 2017) for his contribution. 8 TRANSFORMING CARE Heads of Department

KHOO TECK PUAT HOSPITAL

1. Dr Sanjay Patel 12. Dr Chan Keen Loong Head and Senior Consultant, Head and Senior Consultant, Acute & Emergency Care Centre Psychological Medicine

2. Dr Edwin Seet 13. A/Prof Tan Kok Yang Head and Senior Consultant, Anaesthesia Head and Senior Consultant, General Surgery

3. Dr Lee Chee Wan 14. Dr Colin Teo Head and Senior Consultant, Cardiology Head and Senior Consultant, Urology

4. Dr Wu Loo Cheng 15. A/Prof Lim Su Chi Head and Senior Consultant, Dental Surgery Head and Senior Consultant, Clinical Research Unit

5. A/Prof Subramaniam Tavintharan 16. Dr Michael Wong Director, Diabetes Centre Head and Senior Consultant, Health for Life Centre

6. Prof Wilfred Peh 17. Dr Doreen Tan Head and Senior Consultant, Diagnostic Radiology Chief Pharmacist and Head, Pharmacy

7. Dr Phoa Lee Lan 18. Ms Jenny Goh Head and Senior Consultant, General Medicine Head, Medical Social Services

8. Dr Angeline Seah 19. Ms Ng Lih Yen Head and Senior Consultant, Geriatric Medicine Head, Rehabilitative Services

9. A/Prof Yip Chee Chew 20. Ms Gladys Wong Head and Senior Consultant, Chief Dietitian and Head, Ophthalmology & Visual Sciences Nutrition & Dietetics Department Dr David Loke 10. 21. Ms Fatimah Moideen Kutty Head and Senior Consultant, Director, Operations Otolaryngology (ENT), Head and Neck Surgery

11. Dr James Tan 22. Dr Mary Ho Head and Consultant, Orthopaedic Surgery Director, Clinical Services

We would like to thank the following for their contribution: • Dr Francis Lee, Head and Senior Consultant, Acute & Emergency Care Centre (till December 2016) • Dr Ong Hean Yee, Head and Senior Consultant, Cardiology (till October 2016) • Dr Terence Tang, Head and Senior Consultant, Geriatric Medicine (till December 2016) • Ms Wendy Lim, Head, Rehabilitative Services (till January 2017) YISHUN COMMUNITY HOSPITAL

1. Dr Lee Kok Keng 4. Ms Chua Ee Cheng Head, Medical Services Principal Medical Social Worker

2. Mdm Chua Gek Choo 5. Ms Lynn Chua Director, Nursing Senior Principal Physiotherapist, Rehabilitative Services

3. Ms Low Suat Fern 6. Ms Chan Sue Mei Principal Pharmacist Principal Dietitian The Alexandra Health Story 10 TRANSFORMING CARE

AHS MILESTONES

2006 28 November: Groundbreaking ceremony of KTPH 2010 March onwards: Progressive opening of KTPH

15 November: 2008 Official opening of KTPH Establishment of AHS by the late Minister cluster. Officially left NHG Mentor Mr Lee Kuan Yew 2000 to be the Regional Health 1 October: System in the North Restructuring of AH under National Healthcare Group (NHG)

2009 29 June: 2007 Topping out ceremony of KTPH 7 October: Formation of 2004 AHS board 17 March: Challenge of building a “hassle-free and patient- centred hospital” in the North by the then Health Minister Mr 11

2015 10 April: Topping out 2013 ceremony of YCH 23 August: 28 December: Groundbreaking YCH took in its ceremony of YCH first patient 2017 18 January: Ministry of Health (MOH) announcement of merger of AHS with NHG 2016 18 April: 3 September: Groundbreaking Topping out ceremony ceremony of WHC of AdMC 8 July: Scheduled soft opening 15 September: of AdMC Official opening of 2014 Wellness Kampung 28 November: April: Official opening of YCH Set up of Population Health

23 August: Groundbreaking 2011 ceremony of AdMC September: Start of Ageing-in-Place (AIP) programme

October: First Community Nurse Post in the North 12 TRANSFORMING CARE

CARING FOR OUR RESIDENTS IN THE NORTH Sembawang

Sembawang Zone “K” RC Blk 588C Montreal Dr To better serve the 800,000 residents in the north of Singapore, AHS has been steadily Admiralty Pri Sch extending its network of care since KTPH 11 Woodlands Cir Sembawang Zone “J” RC opened in 2010. Subsequently, in 2015, YCH Blk 793 Woodlands Ave 6 Admiralty Medical was opened next to KTPH for better care All Saints Home Church of Our Lady Centre (Yishun) Star of the Sea Wellness integration. Our latest addition, AdMC, will Blk 676 Woodlands Dr 71 551 Yishun Ring Rd 10 Yishun St 22 Kampung @ 115 open in July 2017. It will be followed by WHC, (Chong Pang) Woodlands Wellness Sunlove Marsiling Woodgrove Blk 115 Yishun Ring Rd which is set to open progressively from 2022. Seniors Activity Centre Zone 1 RC Galaxy Kampung @ 260 Community Club 3 Marsiling Rd Blk 521 Woodlands (Nee Soon East) 31 Woodlands Ave 6 We also have 13 Community Nurse Posts that Dr 14 Blk 260 Yishun St 22 NTUC Silver COVE Nee Soon East now reach more deeply into the community – Covenant Evangelical Free Marsiling Chong Pang Social Service Nee Soon East Zone 9 RC Church (Woodlands) making it easy for residents to monitor their Blk 180B Marsiling Rd Hub (Thye Hua Kwan) Community Centre 90 Woodlands Drive 16 health regularly. To support the community to Blk 131 Yishun St 11 Club Blk 398 Yishun 1 Yishun Ave 9 Ring Rd age well in place, AHS set up three Wellness Woodlands Health Campus Sree Narayana Mission Woodlands Drive 17 Home (Yishun) Kampungs in collaboration with partners ACE The Place Marsiling-Yew Tee 12 Yishun Ave 5 to encourage the elderly to drop by daily Community Centre Singapore Anglican 120 Woodlands Ave 1 Community Services Wellness Kampung @ 765 to participate in activities, socialise and Centre @ Floral Spring (Nee Soon Central) Khoo Teck Puat Hospital Blk 426A Yishun Ave 11 even volunteer. (Turn to page 46 for more.) Blk 765 Yishun St 72 90 Yishun Similarly, 13 Share-a-Pot venues encourage Yishun Central Community the elderly to socialise and stay active as they Wellness For Life Hospital @ Nee Soon South 2 Yishun Central 2 gather for a heartwarming bowl of nutritious Blk 839 Yishun St 81 soup. (Turn to page 22 for more.)

Nee Soon Kranji Sec Sch 38 Teck Whye Crescent

LEGEND

Healthcare Wellness Community Share-a-Pot* Institution Kampung Nurse Post

*Three other Share-a-Pot locations not shown in the map are: • Agape Village (7A Toa Payoh Lor 8) • Bukit Panjang Zone 10 RC and Fajar Sec Sch (441 Fajar Rd) • Church of St Vincent de Paul (301 Yio Chu Kang Rd) 13

Sembawang

Sembawang Zone “K” RC Blk 588C Montreal Dr

Admiralty Pri Sch 11 Woodlands Cir Sembawang Zone “J” RC Blk 793 Woodlands Ave 6 Admiralty Medical All Saints Home Church of Our Lady Centre (Yishun) Star of the Sea Wellness Blk 676 Woodlands Dr 71 551 Yishun Ring Rd 10 Yishun St 22 Kampung @ 115 (Chong Pang) Woodlands Wellness Sunlove Marsiling Woodgrove Blk 115 Yishun Ring Rd Seniors Activity Centre Zone 1 RC Galaxy Kampung @ 260 Community Club 3 Marsiling Rd Blk 521 Woodlands (Nee Soon East) 31 Woodlands Ave 6 Dr 14 Blk 260 Yishun St 22 NTUC Silver COVE Nee Soon East Covenant Evangelical Free Marsiling Chong Pang Social Service Nee Soon East Zone 9 RC Church (Woodlands) Blk 180B Marsiling Rd Hub (Thye Hua Kwan) Community Centre 90 Woodlands Drive 16 Blk 131 Yishun St 11 Club Blk 398 Yishun 1 Yishun Ave 9 Ring Rd Woodlands Health Campus Sree Narayana Mission Woodlands Drive 17 Home (Yishun) ACE The Place 12 Yishun Ave 5 Marsiling-Yew Tee Community Centre Singapore Anglican 120 Woodlands Ave 1 Community Services Wellness Kampung @ 765 Centre @ Floral Spring (Nee Soon Central) Khoo Teck Puat Hospital Blk 426A Yishun Ave 11 Blk 765 Yishun St 72 90 Yishun Yishun Central Community Wellness For Life Hospital @ Nee Soon South 2 Yishun Central 2 Blk 839 Yishun St 81

Nee Soon Kranji Sec Sch 38 Teck Whye Crescent 14 TRANSFORMING CARE

AHS Board Members and Senior Management with Guest-of-Honour Minister for Health Mr (middle), Senior Minister of State, Ministry of Health Dr (sixth from left), and Member of Parliament for Nee Soon GRC Er Dr (sixth from right), at the Official Opening Ceremony of YCH on 28 November 2016.

INTRODUCTION: THE AHS WAY efforts to identify and act on chronic illness From its inception, AHS has strived to early, and comprehensively manage the change the way healthcare is delivered. health conditions of those who have been Our healthcare mission is focused not only diagnosed. Our mission also extends to on treating diseases, but also preventing helping the elderly age well in their homes them. We aim to add years to life, as well and neighbourhoods, and to those at the as knowledge, health, and quality. AHS has end of life to find comfort and reassurance also widened its scope of care, extending to die well. services that go beyond its hospitals' Driving this mission of care are longstanding boundaries by providing appropriate types population health efforts that started in and levels of care that are tailored to the 2001. For the last 16 years, we have run needs of the community we belong to. One screening programmes to better understand important characteristic of the AHS way is our community, their health statuses, empowerment. By equipping the community lifestyles and health needs. What we have with tools, resources and platforms, they found is that our residents fall mainly can take charge of their health and make into five segments: the Well Healthy, Well healthier choices. Unhealthy, Unwell Unhealthy (Early), Unwell Preventive health thus forms a large part of Unhealthy (Advanced), and Frail and Dying. what we do to keep people well and healthy. This understanding has helped us to develop Apart from supporting the community targeted programmes for each segment. in healthy activities, we also run holistic 15

MANAGING THE POPULATION IN THE NORTH

Population Stratification

Well Well Unwell Unwell Frail and Healthy Unhealthy Unhealthy Unhealthy Dying (Early) (Advanced)

People who People who are Patients with take ownership unaware that People with Patients with multiple medical of their health their unhealthy medical multiple conditions who by exercising lifestyles may exigencies and medical are usually bed- regularly and put them at risk patients with conditions ridden and living eating healthily of developing existing chronic that are poorly out the last 1,000 chronic illnesses illnesses managed days of their lives

Major Care Prevention, lifestyle change Chronic disease management End-of-life care Thrust

Acute episodic care

Community Nurse Posts Homes, Nursing Homes Care Settings GPs, Polyclinics Admiralty Medical Centre

Khoo Teck Puat Hospital, Yishun Community Hospital, Woodlands Health Campus

Community health programmes Ageing- and Dying-in-place Programmes Wellness Kampungs 16 TRANSFORMING CARE

AHS CARE CONTINUUM Our integrated care pathway identifies illness early, brings patients from acute to intermediate care and back home, in a safe and efficient manner.

Resident has access Patient is admitted Patient undergoes Patient is discharged to health services in to KTPH for an rehabilitation in YCH home with the community acute episode follow-up care

Decentralised gym in each rehabilitation ward enables proactive rehabilitation

During admission, Multidisciplinary the patient is assessed team from AIP-CCT Health professionals at for suitability for programme Community Nurse Posts, community hospital markets, community Gardens linked to each centres and senior activity rehabilitation ward provide centres provide health a healing environment screening and advice

Specialist Outpatient Clinic Caregiver Art and music follow-up in KTPH and AdMC Once the patient’s condition training therapy has stabilised, he will be Support network at Wellness transferred to YCH via Kampung provides wellness the link bridge and active ageing activities

Communal area designed to feel like home, with TV, self-service snack kiosk and dining tables, encourages interaction and independent living 17

YISHUN COMMUNITY part of the hospital. Dr Tan said, “Patients HOSPITAL OPENS at YCH enjoy a host of activities, from On 28 November 2016, YCH marked its horticulture to paper quilling and art classes. official opening in a ceremony graced by These sessions are run by volunteers from Health Minister Mr Gan Kim Yong. In his all walks of life, including young students opening speech, Mr Gan recognised the from The Little Skool-House. Our volunteers important role YCH will play in the delivery contribute their time and talents to keep of seamless healthcare that spans the patients active and engaged during their range of needs from acute illness to rehabilitation, helping patients get better and recovery. He noted that acute and return home. Together we bridge the care community hospitals should collaborate from hospital to home.” closely so patients can move smoothly from acute care to intermediate care, and eventually home convalescence. Services in demand Even before its official opening, YCH served more than “That is why we have built new community 1,400 patients since its “soft launch” in December 2015. hospitals like YCH next to acute hospitals to strengthen the care continuation and integration, and to act as a bridge from ON TRACK TO SERVE: the acute hospital to the home and the ADMIRALTY MEDICAL CENTRE community,” he said. AHS’s AdMC is on track to open in the third quarter of 2017. The two-floor medical To commemorate the official opening, Mr centre will be part of Kampung Admiralty, Gan penned a piece of calligraphy reading a unique “modern kampung” that will “养身之道” (meaning the art of wellness). integrate healthcare, community wellness He in turn received a drawing of YCH by a and elder living. Facilities will include a former patient Mr Heng Peng Swan who, childcare centre, Active Ageing Hub and while rehabilitating at YCH, was encouraged studio apartments for the elderly. Minister to draw again after a hiatus of 50 years. of Transport and Member of Parliament In her address, YCH CEO Dr Pauline Tan for Sembawang GRC Mr Khaw Boon Wan highlighted the community hospital’s care officiated the Topping Out Ceremony on ethos, “Respecting Patients, Empowering 3 September 2016. Staff and Integrating Communities.” This, she said, is about treating patients as one With AdMC, residents in Woodlands and would a loved one: spending quality time and Admiralty will have more convenient access communicating with them. This meant that to healthcare services such as specialist when palliative care patient, Mr Shah, 40, diabetes care. The diagnostic and treatment remarked that he wished to dye his hair so centre will also provide day surgery and he could look good again despite his failing treatment for conditions such as cataracts, health, his Occupational Therapist Ms Cara hand injuries and hearing loss. Lee took it upon herself to buy hair dye and help him colour his hair. He passed away a CARING FOR OUR few weeks later. COMMUNITY OF THE FUTURE YCH has made it a point to connect with the WHC, the first hospital in Woodlands, broke community and welcome them as an integral ground on 18 April 2017. The 1,800-bedded 18 TRANSFORMING CARE

SMARTLY integrated development will comprise DRIVING RESEARCH TO DOES IT specialist outpatient clinics, an acute and MEET THE NEEDS OF AN community hospital, and a long-term care WHC will use smart AGEING POPULATION technology to improve facility. It is set to open in phases from 2022. To develop, coordinate and implement care delivery, patient WHC will deliver person-centric and quality initiatives to strengthen geriatric education experience and healthcare by integrating three components: operations and research in Singapore, the Geriatric smart technology, green spaces for Education and Research Institute (GERI) patient healing and a strong ecosystem for was set up by MOH in 2015 as a national community care. It aims to foster health institute. GERI is led by Executive Director, promotion, engage residents and connect A/Prof Pang Weng Sun. them seamlessly to health and primary Telehealth services to make consultations care providers. An ageing population brings with it complex more convenient challenges and there is an important need “Woodlands Health Campus will be a major to conduct geriatric research on areas such health hub where patients can experience as age-related physiological and clinical enhanced access to quality healthcare changes. It is also necessary to translate enabled with smart technology. But more findings of basic sciences and clinical Online, apps and than that, we have also designed it as a research to inform clinical care, treatment mobile-centric vibrant community hub where residents can modalities, disease prevention, risk factors services for greater engage in community activities within the accessibility management, and health promotion. open spaces and enjoy the healing effects of the gardens and the surrounding parkland. Quality education of healthcare professionals We hope the campus will become a vital and involved in the care of older people is cherished asset for the communities we essential. To groom the next generation serve and for future generations to come,” of geriatric care professionals, GERI will In-ward sensors and wearable devices said Dr Jason Cheah, Chairman, Pro-Tem spearhead new curricula, customise training to monitor health Planning Committee, WHC. programmes and integrate training across statuses various institutions and organisations. These will focus on understanding the special Over the years, we’ve grown needs and clinical management of elderly from to a larger patients and incorporating them into their core competencies. Artificial intelligence Alexandra Health System. We’ve for improved decisions made inroads and improved our care The facilities of GERI include space for and cheaper, better delivery. We’ll continue to innovate and faster care six labs and one Smart Home lab to study to provide better value and more the needs of the geriatric population. The efficient care to meet the health first lab in GERI will be kitted out for the challenges of our community. Our Gait Lab, which will study the relationship journey does not end – it will be a between mobility and cognitive decline Robotics for continuing process of being better through gait and falls measures, and test food services, than before. interventions to improve gait and prevent warehousing, falls. GERI also has a Biobank to provide housekeeping and – A/Prof Pang Weng Sun, the Central Sterile Chairman, Medical Board, YCH, and Senior long-term storage of patients’ samples for Supplies Unit Consultant, Geriatric Medicine, KTPH research purposes. Be happy and you will be healthy too!

Mdm Goh Ning, 80

LIVING WELL, LOVING LIFE 20 TRANSFORMING CARE

• Mdm Goh Ning, 80 KEEPING WELL AND HEALTHY Enabling and empowering the community to remain healthy and well, physically, Cheerful and full of vigour, Mdm Goh is an mentally and emotionally form the octogenarian who doesn’t look a day over 70. The foundation of AHS’s goals. We strongly believe in taking proactive steps to keep grandmother of three who recently “graduated” to the community well and healthy. We do great-grandmother status believes that a happy this by engaging people of all ages and spirit is key to a healthy body. backgrounds in community activities, What lifts her spirit is her daily visit to the Wellness educating the populace with informative talks and awareness campaigns or by Kampung @ 115 Chong Pang, which has become providing the platforms to help people take a place to connect with others, make new friends charge of their own wellbeing. and catch up with old ones. She also enjoys taking part in activities at the centre, such as cooking These varied and numerous initiatives all strive to achieve our five pillars of health – demonstrations. Unable to read or write, Mdm Goh eat wisely, exercise regularly, be happy, stop particularly enjoys the health talks as she is able to smoking and practise personal hygiene. ask questions and pick up new information directly from the nurses. Apart from improving her emotional Take Mdm Goh for instance. Having a and social wellness, the Wellness Kampung has Wellness Kampung within her community has had a positive impact on her life. Apart helped her to stay healthy. Mdm Goh occasionally from the social interaction through meeting joins the light exercise classes and sees the new friends and volunteering, the Wellness community nurse regularly to keep tabs on her blood Kampung is a place where she can stay pressure and cholesterol. active and learn new things daily, keeping her healthy in body, spirit and mind. Soon after joining the centre last year, Mdm Goh became a “Kampung Buddy”. She helps deliver lunch to five home-bound and needy residents five days a week, through the Meals on Wheels programme. Giving back to the community as a volunteer was something she couldn’t imagine doing at 80. As a result, she is more energised than before. “I’ve always been active,” she shared. Whether it was helping out on her parents’ farm as a girl, caring for her children while taking on sewing as a homemaker, or entering the workforce in her 40s, Mdm Goh believes in keeping busy and happy. Rather than staying at home, she prefers dropping in at the The Wellness Kampung supports SWAMI’s Meals on Wellness Kampung to interact with others and be Wheels programme to deliver meals to some residents living nearby. This is a programme where meals are an active part of the community. “It’s no good to stay delivered to homebound residents who lack the functional and/or cognitive ability to independently home all day or to worry about things. Your mind will buy and prepare their own meals and do not have a slow down and you will get dementia,” she says with caregiver to help them to do so. a laugh. “Be happy and you will be healthy too!” 21

EMPOWERING THE The second series, held in January 2017, was COMMUNITY WITH a comprehensive look at metabolic syndrome. KNOWLEDGE Crafted in support of the national “war on diabetes”, speakers talked about diabetes, 2000 Education and awareness are the first The Health For Life steps to achieving good health. To arm the lipid metabolism, genomics and the diabetes- Clinic offered screening community with the knowledge to make genetics link. They also shared useful packages to aid information on the impact of carbohydrates the early detection better decisions, improve their lifestyles of lifestyle related in diabetes management, and the effect of and take ownership of their health, AHS diseases. It also ran continued its educational talks and age on weight and fat gain. To date, there health education and intervention community health initiatives, and introduced have been 10 runs of MMS @ KTPH and a total of 1,533 participants have graduated programmes and some new programmes to better serve the connected the public community’s healthcare needs. from the programme. to the healthcare resources and services they needed MINI MEDICAL SCHOOL @ KTPH COMMUNITY HEALTH SCREENING Aimed at improving health literacy through 2001 informative and easy-to-understand talks, AHS’s mission of care is not limited to the AH developed the grounds of its hospitals, but extends far Community Outreach Mini Medical School (MMS) @ KTPH sees Programme, organising medical experts presenting timely and beyond, into the community. We believe in health talks on relevant topics in an interactive setting. bringing healthcare to the heartlands and disease prevention making our presence known and felt in the and community MMS was started in 2013 with the goal of health screenings empowering people to take charge of their community. Since 2013, with funding from health by making positive lifestyle choices, the Ministry of Health, AHS has run a four- 2006 and to be health advocates. year long community screening project as part of its Population Health programme Eighty doctors, nurses and ambulance staff “I was inspired by the American healthcare in the North. This health initiative is in were on hand to provide institutions which used such programmes to partnership with the People’s Association first aid and medical educate the public about the ageing process,” and the Health Promotion Board. Since supervision along the route at the Standard said Dr Ong Chin Fung, who started MMS then, AHS has screened 18,469 residents – Chartered Marathon @ KTPH. “As our society ages, we need surpassing its goal of 17,000. individuals to become more empowered in taking care of their health so that healthcare resources can be better optimised.”

In the past, topics have ranged from age- related illnesses to the management of chronic conditions. In Financial Year 2016, two runs of MMS were held. The first, “TheatreWorks”, in October 2016, was on the topic of surgery. It covered the importance of pre- and post-op preparation. Speakers spoke on the evolution of surgical techniques, transdisciplinary care in surgery, as well as diagnostic evaluation using imaging. Also included was a useful primer on surgical wounds and how to care for them. Students of MMS @ KTPH with their “lecturers” at the graduation ceremony. 22 TRANSFORMING CARE

Our health screenings do more than do periodic physical, functional and psycho- give residents information on their blood social assessments and identify elders in pressure, cholesterol and blood sugar need of early intervention and care. As of 2011 levels. Health screening in the community 31 March 2017, AHS has set up 13 active The transformed Yishun is a form of early intervention for those pond was designed Share-a-Pot sites and registered almost to facilitate an active with risk factors and chronic diseases. Our 1,000 seniors, of whom about 500 are lifestyle with an open screenings are a platform to educate and regular attendees. promenade, custom- empower residents to take responsibility for designed running track, exercise corner and their health and manage their conditions bicycle racks for staff well to prevent complications. More than this, the data collected helps us to understand the health profile and needs 2013 MMS @ KTPH was of the community in the North so we can started to provide useful develop better and more relevant services to health information meet the community’s needs. and education to the community so that they can manage their own health and that of their SHARE-A-POT loved ones Communal meals have long been part and parcel of Singapore’s eating culture and are a way to share and build bonds. To kindle Share-a-Pot volunteers preparing ingredients for the nutritious soup. a sense of community, nurture a spirit of giving and receiving, as well as monitor the wellbeing of vulnerable seniors in the MEATLESS MONDAY neighbourhood, AHS, in collaboration with MOVEMENT community partners, started Share-a-Pot In March 2017, KTPH became the first in September 2014. Singapore hospital to start a Meatless Monday campaign. The aim is to encourage The community-based project aims to the community to reduce meat or animal improve the nutrition and health of seniors product consumption by one day a week for in the community through good nutrition and better health and environment. This is also physical activity in a social setting. The goal based on the growing evidence of the health is to “build bones, brawn (muscle), brain benefits of switching from meat-based to (cognitive reserve) and bonds”. This is done plant-based protein. through the sharing of a hearty bowl of soup that is high in protein and calcium. To this end, AHS dietitians held a three-day roadshow to educate staff and the public The Share-a-Pot sessions are held at about the benefits of a plant-based diet, accessible community locations as well during which 340 people pledged to go meat- as the various Wellness Kampungs. Apart free once a week. They also held two forums from partaking in the soup, the seniors are during the campaign. also encouraged to take part in some light exercises such as aerobics, Zumba and A nutrition public forum showed 178 resistance band exercises. These sessions participants how to create balanced not only offer seniors a platform to socialise meatless diets, how to reduce and recycle and be more active, but also give the AHS food waste, and how to grow edible plants Population Health team the opportunity to at home. Two series of “Garden-to-Table” 23

recipe cards, which have simple instructions encourage suitable inpatients to choose to make healthy and tasty plant-based vegetarian meals on Mondays. meals with eight ingredients or less, were launched. These recipes were developed by 2013 EMPOWERING THROUGH Widespread community KTPH dietitians, chefs, Wellness Kampung EDUCATION health screenings staff and gardening volunteers. At the GP rolled out as part of Symposium, dietitians updated doctors on To better arm the community with knowledge Population Health programme to the latest research on plant-based diets and to make better choices in preventing or managing chronic disease, AHS ran several understand the gave practical food tips for them to share heath profile of the with their patients. Special guest speaker, talks, forums, public events and campaigns in community in the North Dr Lin Ming-Nan from Taiwan Dalin Tzu Chi Financial Year 2016. These events – on topics such disease awareness and the promotion of General Hospital, spoke on “Sustainability 2016 healthy lifestyles – targeted various segments and Health”. In line with promoting of the population and spanned language, age health at all levels, To sustain the momentum of the campaign, groups and demographics. the Foodfare @ KTPH nurses at KTPH and YCH continue to was redeveloped to offer a wider variety of Healthier Choice food and drinks

Panelists sharing on “Kidney Stones – A Hard Problem” at Over 8,800 eyes were screened as part of Age-related the urology public forum. Macular Degenerative Awareness Week 2016.

Participants learning about colorectal cancer through A nutrition public forum “Healthier Waist with Less games at the colorectal cancer forum conducted Waste” educated participants on reducing food wastage in Mandarin. and sustainable eating. 24 TRANSFORMING CARE

OUR FIVE PILLARS OF HEALTH Healthy living is all about making better decisions. AHS provides the right environment to make these choices easier for staff, patients and the community to achieve our five pillars of health.

Practise Exercise Stop Eat wisely regularly Be happy personal smoking hygiene

Foodfare @ KTPH Each Wellness Each year, KTPH KTPH and YCH KTPH won an “nudges” healthier Kampung holds daily celebrates Happiness are Smoke-Free infection control decisions by giving exercise classes Day to remind people hospitals. This award for reducing more prominence that cater to all to find happiness in includes outdoor healthcare- on the menu boards levels of fitness: daily life by practising areas directly associated to Healthier Choice from tai chi and gratitude, enjoying surrounding the Methicillin-Resistant meals, which are Zumba to resistance simple pleasures, hospitals and Yishun Staphylococcus less than 500kcal per band workouts, and finding Pond. This ensures aureus infections in serving. Brown rice modified exercises meaningful pursuits. that our patients 2016. Stepped-up is also served as the for the elderly and and visitors have screening and other default carbohydrate wheelchair-bound fresh air and clean initiatives led to source, while sugar- are also available. Mental health talks environment. rates falling 17.1% sweetened beverages and courses are held in 2015, more than are priced higher to to educate people on the national average deter purchase. At AHS holds daily how to achieve better AHS is working with decrease. KTPH, we continue group exercise such emotional health and Nee Soon GRC to “to make healthier as line dancing and manage stress. This raise awareness choices your easy tai chi at the Yishun includes a monthly of the effects of To drive a culture of choice” by engaging Pond Promenade to Mindfulness- smoking on eyesight. safety and empower our vendor partners promote the benefits Based Cognitive To this end, it has put staff to be safety to provide 80% of an active lifestyle. Therapy Course. up posters at Nee advocates, AHS held healthier choices. Soon’s Designated the Speaking Up for Smoking Points to Safety campaign. Simple messages encourage smokers Staff underwent To increase the located in public to get their eyesight training to speak awareness of eating areas nudge staff checked. up constructively in moderation over and the public to take and respectfully on the Christmas and the stairs, eat better hygiene safety issues Chinese New Year and be mindful of as well as how to holidays, posters one’s weight. respond. were put up to highlight high- calorie foods and the steps required to burn them off. You must take care of yourself, if not who is going to take care of you?

Mr Tamotharan, 74

TURNING ILLNESS INTO WELLNESS 26 TRANSFORMING CARE

• Mr Tamotharan, 74 TAKING CHARGE OF THEIR OWN HEALTH At AHS, screening for chronic disease forms Mr Tamotharan, or Mr Tamo as he prefers to be a keystone of our preventive community called, was only 40 when he was diagnosed with health efforts. Regular and early screening type 2 diabetes. He had constantly felt thirsty alerts those who are unaware of their chronic and lethargic. When diagnosed, he was most conditions or are at risk of developing one due to their lifestyle. In the North, screening concerned about the toll diabetes could take on efforts have an added significance as our him. “My parents had diabetes and I saw them population health efforts estimate that 40% suffering,” he recalled. But instead of dwelling on of the population have an underlying chronic the problem, Mr Tamo took a proactive approach condition they are unaware of. to tackle diabetes head on. Many chronic illnesses do not show He heeded his doctor’s advice on managing the symptoms in the early stages. Screening disease. “Take less sugar; no soft drinks. spots diseases early so treatment can be Eat lots of veggies and just a little bit of rice,” more effective. It presents an opportunity for people to take charge of their health, Mr Tamo shared. Of course, he added, it is manage their conditions well and prevent important to have regular meals, monitor one’s complications. Risk factors are also blood sugar and take medication at the right time identified for early intervention. to prevent blood sugar levels from dropping too much. Mr Tamo also began walking 30 minutes UNDERSTANDING daily – an exercise that has kept him energised THE NUMBERS and happy for 30 years now. When residents collect their health screening Mr Tamo’s positive mindset and diligent self-care reports, they are encouraged to attend the has enabled him to live well with diabetes for 34 Group Health Report Review sessions, which present anonymised reports of how years without complications. The 74-year-old is their health statuses compare with the grateful to KTPH’s diabetes team for empowering community. This puts their results in the him with the knowledge to manage his condition larger context – aiding them to interpret their well: “My medical team is very friendly; it’s like health better. The talks touch on prevention of a family here. I like how I get SMS reminders to complications through the good management ensure I don’t forget to come and see my doctor of chronic diseases such as diabetes and every four months.” The knowledge he has gained high cholesterol. Lifestyle changes are also highlighted so residents can take steps to from nurses on diabetes has been the most reduce risks. important part of good diabetes management. “Understand diabetes and how it works. Only then Last year, about 65% of the residents will you know how to control the disease. You must screened attended the bilingual sessions held at schools, void decks, community take care of yourself, if not who is going to take spaces and KTPH. Participants were also care of you?” advised Mr Tamo. encouraged to sign up for other intervention programmes and to see their own primary care providers or polyclinics for follow-up. 27

Residents of the northern region HEALTH SCREENING Statistics (Financial Year 2016) 7,799 Northern residents screened

Demographics Health Profile

Age High blood cholesterol 55% Less than 40 1% years old Overweight 45%

40-60 High blood 67% years old pressure 29%

High blood More than sugar 14% 32% 60 years old

Race Healthy Unhealthy

85% Chinese 33% 40% 27% Newly discovered Existing cases

7% Malay

5% Indian 3% Other

Doctor's Follow-up Post Screening Gender

40-45% 70-80% 60-65%

64% 36% Collected report on Attended Group Health Female Male Saw doctor Report Collection Day Report Review talk 28 TRANSFORMING CARE

2013 Set up of Community Nurse Posts in the community

Pilot Population Health programme to conduct health screening for residents in the North

2014 Collaboration with SMRT to run a preventive health screening and coaching programme

Started marketplace The accessibility and convenience of health screenings in familiar community spaces such as the marketplace encourage active participation by residents and stall owners. health screenings together with People’s Association (PA) Active Ageing Committees MARKETPLACE Today, 13 such posts serve residents through HEALTH SCREENING blood pressure monitoring and blood glucose AHS brought health screening to the checks, health indicator surveys, and geriatric doorsteps of the Ang Mo Kio community in assessments. In Financial Year 2016, visits to March by setting up booths next to the wet these posts rose by 6% to a total of 8,742. market and hawker centre at Block 628 Ang Mo Kio Avenue 4. For $2, more than CHECK CAR, CHECK BODY 500 residents and hawkers had their Over the last three years, AHS, in cholesterol, blood glucose level, blood collaboration with SMRT and Health pressure and Body Mass Index tested. These Promotion Board, has run a preventive are key indicators of chronic diseases like health screening and coaching programme hypertension and diabetes. The initiative was at the SMRT Taxi Customer Service Centre. organised in collaboration with the National The goal is to bring workplace health Healthcare Group (NHG) and Yio Chu Kang promotion to workers with non-traditional People’s Association (PA) Active Wellness workplaces and shift hours. Programme. The AHS Population Health team is currently collaborating with NHG Every 4–6 weeks, when taxi drivers bring by sharing our community health screening their vehicles for servicing, they can use the model and expanding it to screen the downtime to screen for chronic conditions population in central Singapore. such as high blood pressure, high cholesterol, diabetes and obesity. AHS nurses stationed daily at the Centre provide interactive COMMUNITY-BASED counselling in a learning lab setting. This SCREENING includes advising the taxi drivers on diet To increase access to screening and planning, as well as teaching them special encourage residents to regularly monitor their exercises customised for their profession and health, AHS has set up Community Nurse suitable for their individual ability. Posts in the northern community since 2013. 29

The results in Financial Year 2016 indicated GROWING AND ENHANCING the importance of this programme: 82% DIABETES CARE of the 1,350 taxi drivers screened were AHS has long taken a multidisciplinary unhealthy with high blood cholesterol, blood 2015 approach in the management of diabetes. Implemented pressure, or blood sugar, while 80% of all In 2001, A/Prof Sum Chee Fang set up the Community Falls drivers were overweight. It was heartening Diabetes Centre at Alexandra Hospital, Prevention Programme that 86% of them came back for at least one at Community dedicated to the holistic care of patients with Nurse Posts health coaching session after getting their diabetes. Doctors, diabetes nurses and allied health screening reports, while 45–50% health professionals such as podiatrists, of those with newly discovered medical 2017 dietitians and pharmacists work together in conditions made follow-up appointments Partnered NHG and the same location. This resulted in hassle- Yio Chu Kang PA Active with their own doctors. Since 2014, the free care for patients as they could easily Wellness Programme programme has benefited 2,924 taxi drivers. to expand community flow between healthcare professionals. screening initiatives in central Singapore Today, the Centre has established itself as a leader in diabetes management. After KTPH Diabetes Centre to move to AdMC in 16 years of dedicated service, A/Prof Sum second half of the year stepped down as the director in April 2016. He continues to see patients and focus on medical education. Taking his place is A/Prof Subramaniam Tavintharan, Senior Consultant and Deputy Director of the Clinical Research Unit. The new KTPH A taxi driver learning resistance band exercises from the Diabetes Centre will be based in AdMC nurse stationed at the SMRT Taxi Customer Service Centre. from 8 July 2017.

IDENTIFYING FALLS RISKS A passion project Falls in the elderly are a common problem and can significantly impact their wellbeing, Back in 2001, I was in private quality of life and life expectancy. However, practice, but joined AHS because I many falls, especially those in the home, can knew that the restructuring would be prevented. give me an opportunity to do Since July 2015, AHS, together with the something I had always wanted to Ministry of Health, has implemented a do – start one of the first few one- Community Falls Prevention Programme for stop diabetes clinics in Singapore. seniors aged 65 and above living in the north of Singapore. The programme consists of a I’m particularly proud of our simple three-question quiz that determines if integrated healthcare team: our there is an increased risk of falls. Those who nurses, podiatrists, dietitians and answer “Yes” to any of the three questions, other allied health colleagues play such as “Do you avoid going out because just as important a role as our doctors. you are afraid of falling?”, are advised to see Working together, we are better able to community nurses for fall assessment and care for our patients with complicated counselling. This programme is run at four and complex diabetes problems. Community Nurse Posts. In Financial Year 2016, 1,691 elderly were screened. – A/Prof Sum Chee Fang 30 TRANSFORMING CARE

BEST FOOT FORWARD FASTING SAFELY FOR DIABETICS DURING RAMADAN Diabetes increases the risk of complications A group of researchers from the KTPH such as foot ulcers and wounds that are slow Clinical Research Unit, who studied the to heal. When the wounds are not managed impact of fasting (during Ramadan) on well or get infected, they may lead to people with type 2 diabetes, was recognised devastating outcomes such as amputations. for their efforts in 2016 when their study won the Annal’s Gold Best Paper Award. To prevent this, patients with diabetes need to check their feet daily, see a podiatrist Led by Dr Ester Yeoh, Consultant with the regularly and have proper footwear. Diabetes Centre, the team studied the However, AHS podiatrists observed that dietary intake, body composition and many patients with diabetes did not wear metabolic profile of 29 Southeast Asian suitable footwear as they were expensive, Muslim patients with type 2 diabetes. unfashionable, clunky and too stuffy. The study group was given pre-Ramadan The lack of protective footwear hence education on diabetes management during increases the risk of foot problems. the fasting period, including frequent monitoring of blood glucose levels and To help patients take better care of their ways to manage acute episodes of feet, podiatrists and the Innovation Team excessively high or low blood sugar. tapped on Alexandra Health Fund’s Rapid Prototyping Grant to design affordable and The participants were given nutritional fashionable shoes with features suitable for advice and guided on adjusting the dosage feet of patients with diabetes. These slip-on and timing of medications. During the fasting shoes have bumpers to protect the toes, as period, they charted their blood glucose well as deep and wide toe boxes to allow reading five times a day. Results at the end accommodation of custom-made insoles. of Ramadan showed that fasting was not Around 100 pairs will be sold on a trial basis only safe, but conferred improvements to in KTPH and AdMC in 2018. blood glucose levels. In addition, a modest but significant reduction in body fat mass was recorded, especially in women. The study also allowed researchers to identify the various needs of people with diabetes during the Ramadan fasting period.

Principal Podiatrist Ms Chelsea Law worked closely with Mr Lee Wei Chung, an Industrial Designer from the AHS Innovation Team, to design suitable shoes for patients with diabetes. I was encouraged by the nurses and therapists who supported me in my journey to recovery.

Mr Rosli bin Habi, 53 (right)

WHEN ILLNESS STRIKES 32 TRANSFORMING CARE

• Mr Rosli bin Habi, 53 SEAMLESS CARE FROM HOSPITAL TO HOME An estimated 25% of residents in the North Mr Rosli knew something was wrong early one fall into the unwell and unhealthy (early morning when he woke to use the bathroom and stage) category. Some have existing early felt a total loss of sensation all down his left side. stage or well-controlled chronic illnesses Admitted to the KTPH Accident and Emergency that require long-term management and care. Another group of patients are like (A&E) later that morning, his worries were Mr Rosli, who seek initial treatment for acute confirmed – he had suffered a haemorrhagic medical care, followed by care that focuses stroke. He underwent a procedure to remove the on helping them regain their function as well clot and relieve the pressure on his brain, spending as confidence and independence. 19 days under intensive, then acute care. At AHS, our mission of care for this When he was transferred to YCH, Mr Rosli was category of patients is twofold: attend swiftly to acute issues and then support ready for rehabilitation. “I wanted to be able to them in their recovery. “Early, accurate walk again and do things independently so I didn’t diagnosis and prompt interventions are key have to rely on my wife,” he said. It was tough at in resolving medical issues before further first – weakness all through his left side meant complications develop. This applies to both even simple exercises like throwing a small emergencies and chronic illnesses,” said sandbag or gripping an item were difficult. “The A/Prof Pang Weng Sun, Chairman, Medical strangest part was having to train my brain to Board, YCH and Senior Consultant, Geriatric Medicine, KTPH. remember how to walk again!” he recalled with some amusement. INNOVATING TO IMPROVE His dedication to stroke recovery exercises meant PATIENT OUTCOMES Mr Rosli was well enough to be discharged a More Intensive Care Unit (ICU) patients month later. Six months on, he feels that he has receiving early mobilisation regained 70% of his strength and function. He About 85% of KTPH Surgical Intensive has even been certified to return to driving. “The Care Unit (SICU) patients benefited from therapists shared a lot of knowledge with me, early mobilisation from November 2015 to such as exercises to recover my movement, and May 2016 – almost double the number of this helped with my rehabilitation. Throughout patients previously. A multidisciplinary team the process, I was encouraged by the nurses and comprising intensivists, physiotherapists, nurses and respiratory therapists therapists who supported me in my journey to implemented a quality improvement project recovery.” Today, he even volunteers two to three in line with current best clinical practice. times a week at YCH to keep busy and active. The project has improved the well-being of “I am thankful for the patience and support of my patients, shortened their length of nurses and therapists. They never got frustrated hospital stay and better utilised intensive with me. I can see they enjoy their job and in care resources. helping us recover.” 33

ICU patients who are suitable for early mobilisation undergo early rehabilitation under close supervision by the physiotherapists.

SICU patients may spend up to 10 days It received the gold award for the best poster lying in bed due to their critical illness. This in the allied health category at the Singapore increases the risk of muscle wastage, deep Health and Biomedical Congress 2016. vein thrombosis and chest infections. Under the project, suitable patients spend 30 to Showing success: the first dedicated 45 minutes a day completing at least three acute surgery unit out of five weight-bearing exercises aimed In 2014, KTPH took the lead to start at strengthening the body’s muscles and Singapore’s first dedicated acute surgical preventing them from wasting away. unit. The Emergency Surgery and Trauma The early mobilisation project shortened (ESAT) performs emergency surgery the average length of ICU stay to 2.5 days, for patients admitted to the Emergency compared with 3.3 days. This shorter ICU Department (ED). In the past, a patient stay also resulted in a shorter average length needing emergency surgery would be cared of hospital stay – at 12.4 days as compared for by the surgeon on call, regardless of to 12.7 days. surgical discipline. This meant surgeons would have to allocate 30% to 40% of The project has now been expanded to the working hours to attend to emergency Medical Intensive and Cardiac Care Units. surgeries. This puts a strain on surgeons 34 TRANSFORMING CARE

on call and as a consequence, it was not Pain-less hip fracture recovery uncommon for emergency surgeries to be Pain is one of the most challenging issues performed after hours. after hip fracture surgery as it discourages 2010 patients from moving, which delays early Opening of KTPH’s Today, ESAT allows the hospital to more specialist outpatient rehabilitation and contributes to delirium. effectively allocate manpower resources, clinics, day surgery The lack of mobility also increases the risk of centre, A&E and provide prompt and timely care for ED complications such as life-threatening blood inpatient wards in KTPH patients and develop a dedicated team of clots and pneumonia. emergency and trauma surgeons. To improve patients’ comfort and safety, the The team of two consultants, one trainee Hip Fracture Unit (HFU) introduced a simple registrar, one medical officer and three yet effective solution by using a pain relief house officers provides consultation for ED nerve block cathether. This is a simple set- patients requiring surgery from Mondays to up consisting of a bottle of local anaesthetic Fridays from 7.30a.m. to 4p.m., after which filled with an elastic balloon, which other surgeons on roster will take over. automatically drips the drug at set rates Since its implementation, ESAT has: to the targeted nerve.

• halved the average waiting time from Since its introduction in November 2014, ED to operating theatre; over 500 patients have benefited from the device, which has allowed early ambulation • reduced the average length of hospital in all suitable patients. The innovation, which stay from 4.7 days to 3.4 days; has raised the standard for perioperative hip • reduced the average length of ICU fracture care in Singapore, was published as stay from 8.6 days to 4.9 days; and a poster at the International Congress of the • decreased surgical complications and European Union Geriatric Medicine Society overall mortality rate. in Lisbon, Portugal in 2016. It was also presented in April 2017 in London at the BHJ/IHI International Forum for Quality and Safety.

The pain relief innovation marks another milestone for KTPH’s hip fracture service. Since 2013, KTPH has developed a framework and a tripartite set-up of Geriatrics, Orthopaedics and Anaesthesia teams to tackle three key areas:

• fall prevention via screening for fall risks at polyclinics and community nursing posts; • treatment of fractures by the integrated

The KTPH ESAT unit speeds up access for patients requiring emergency surgery, thereby team from the time of A&E admission reducing surgical complications and the average length of hospital stay. 35

through to surgery and recovery; and Family AMU

• rehabilitation that starts the day after surgery, to help patients regain mobility 2011 and independence in less time. Start of the Dyad Up to Engagement & Acute care “reloaded” 48 hours Enrichment Programme (DEEP) by KTPH’s To better address complex and acute dementia team medical cases, KTPH started a 32-bedded Acute Medical Unit (AMU) on 28 February 2013 2017. The AMU provides high-quality, rapid Opening of the assessment, close monitoring and treatment Further Fit for CAMIE Ward (Care for treatment discharge the Mentally Infirm for patients with urgent medical needs. Elderly) in KTPH Patients are clustered in a single dedicated ward – instead of being warded throughout Ward Discharge lounge KTPH. This allows a multidisciplinary medical team, which is equipped to deliver rapid diagnosis and acute treatment, to respond to them efficiently. Within 48 hours, Home the consultants develop and review a care plan with the team of medical staff. This care plan will be communicated to the family via their nominated spokesperson. Expanding A&E diagnostics and treatment Patients are then transferred to another To better manage the demand for beds, ward for further treatment if they are KTPH has expanded its A&E with a new expected to stay longer than two days. Extended Diagnostics and Treatment Unit This model enhances patient safety and (EDTU). Launched on 28 September 2016, turnaround to enable timely discharge. the 20-bedded unit allows patients to be observed for up to 24 hours and treated without having to be admitted to a ward. The AMU service is more intensive and includes: At the EDTU, patients receive intensified therapy and extended diagnostic testing. • enhanced staffing levels; This allows patients to be more accurately • proactive and expedited specialist assessed and managed. Patients may be referral and review where needed; treated at the EDTU for eight to 23 hours • expedited and comprehensive and then discharged home with follow-up clinical investigative services such advice or admitted to the wards for further as pathology, radiology, etc.; and treatment. Since it started operations, the daily average number of EDTU patients has • team-based, multidisciplinary increased from five to 14. As of March 2017, continuous improvement and learning. a total of 2,157 patients have been treated at the facility, translating to savings in inpatient 36 TRANSFORMING CARE

bed days, which were used to treat other Feedback from patients’ family members patients who needed to be warded. The Listening Clinic allowed us 2014 A different way to treat frail elderly to clarify care plans and clear our Implementation of the ESAT unit and In an effort to deliver the most suitable doubts, especially on fluid restriction. pain relief nerve level and type of care for frail elderly, KTPH My mother can now have her favourite block catheter by HFU Department of Geriatric Medicine started soup for lunch or dinner. the Geriatric Frailty Unit (GFU) in Ward D78. 2015 Instead of the traditional way of grouping This was a good opportunity for me First patient geriatric patients by their age group, received by YCH and to clarify issues and discuss the goal of diseases or syndromes, the approach groups opening of CARMIE care for my aunt. (Comprehensive them according to similar levels of frailty, as Assessment & they have more in common when it comes to Rehabilitation of the goals and approaches to treatment. Mentally Infirm Elder) Diving DEEP into dementia care Ward in YCH, early mobilisation of ICU This is especially so for patients with The Dyad Engagement & Enrichment patients in KTPH advanced frailty – the treatment appropriate Programme (DEEP) is a mandatory for the disease may no longer be appropriate group clinic for patients with dementia for them and some of their most pressing and their family members after the needs are not attributable to individual initial clinical assessment. The briefing diseases. Therefore the GFU’s view is that provides information about dementia, the patient is more than the sum of his medical treatment, as well as services and diseases and should be treated as such. programmes in KTPH and in Singapore.

The GFU is a novel approach to frailty care Significantly, it prepares patients and that addresses a very real need. Currently, caregivers for the days to come and how to there are no established guidelines or provide the best care. A Q&A session allows protocols for care of frailty care around the participants to clarify their doubts. During world and few inpatient set-ups specifically DEEP, a multidisciplinary team assesses addressing these needs. patients and their findings are shared with caregivers, who are given guidance on Current initiatives at the GFU include a follow-up programmes. Dementia-specific Listening Clinic, medication review to reduce ACP discussions are also incorporated medication, liberalisation of non-essential into the twice-monthly sessions, which diet restrictions and development of a are conducted concurrently in English and future care plan, including crisis planning Mandarin. It was started in 2011 and has in case of certain medical issues such as benefited more than 1,500 patients so far. breathlessness. The Listening Clinic allows the next-of-kin to clarify their doubts, DEEP complements existing dementia understand the condition and prognosis. initiatives at AHS. CAMIE (Care for the Acute The medical team can better understand Mentally Infirm Elder) is an acute person- the patient’s individual values, goals and centred care service provided at KTPH expectations. It is also a time to broach for patients with dementia with confused Advance Care Planning (ACP) and other end- behaviours, who require hospitalisation for of-life issues. 37

the treatment of common problems such as patients improve their functions, they falls, fractures, pneumonias, urinary tract complement patients’ prescribed medical infections, challenging behaviours, decline in and rehabilitation activities. Together, staff function and more. and volunteers offer patients respectful and 2016 Official opening of YCH personalised care to help them regain their and launch of new sub- CARMIE (Comprehensive Assessment confidence to look after themselves when acute palliative service & Rehabilitation of the Mentally Infirm they go home. in YCH and expansion of Elder) is a sister ward in YCH that cares A&E with a new EDTU for patients with dementia with less acute medical conditions or who need physical SERVICE IMPROVEMENTS FOR 2017 rehabilitation. As of 31 March 2017, CAMIE BETTER PATIENT EXPERIENCE Opening of AMU and CARMIE have recorded 1,452 and 458 in KTPH Sub-acute palliative service restraint-free days respectively. YCH introduced a number of new clinical and non-clinical services in Financial Year 2016, YISHUN COMMUNITY including a new sub-acute palliative service. HOSPITAL: “SLOW” MEDICINE FOR RECOVERY Launched in June 2016, the service provides AND REHABILITATION the right level of medical treatment and interim care for patients while they await Unlike KTPH, which is an acute care transfer to an inpatient hospice or other hospital that delivers prompt and precise long-term healthcare institutions. The “fast medicine” for short-term illnesses multidisciplinary team addresses patients’ or emergency cases, YCH offers “slow sub-acute needs such as adjustment medicine” and provides intermediate care for of symptom control medications and recuperating patients who do not require the completion of antibiotics. intensive services of an acute care hospital. Caregivers and family members are not left The ethos of care at YCH is to help out of the equation. They receive caregiver patients regain their physical and mental training and are consulted on the various independence, so they can remain active discharge options available in accordance when they return home. By bridging care with the health condition, care needs and from hospital to home, YCH complements wishes of the patient and family. KTPH to deliver a hassle-free continuum of care. In Financial Year 2016, YCH received Support on the road to recovery more than 1,800 patients from KTPH. After discharge from YCH or other At YCH, patients do not lie in their beds all community hospitals, some patients may day. They are encouraged to participate need follow-up rehabilitation. To support in various rehabilitation and recreational this group of patients, YCH launched its activities drawn up by staff and volunteers to outpatient day rehabilitation programme ease their transition back home. Activities at Therapy Services D37 in August 2016. such as adaptive table tennis, horticulture It is a holistic programme comprising therapy, music and art activities are physiotherapy and occupational therapy led by volunteers. Not only do they help to maximise mobility and functional 38 TRANSFORMING CARE

independence through detailed assessment and customised treatment programmes. Since the launch of Therapy Services, 108 patients have benefited from it.

Outpatient Therapy Service at D37:

More than 108 600 new referrals repeat visits

Getting patients out of bed and back A patient undergoing therapy at YCH after a spinal operation. Source: Straits Times © Singapore Press Holdings Limited. Reproduced with permission. into action

In line with its promise to prevent patients from staying in bed for prolonged periods, YCH has a varied daily programme to stimulate the senses, promote interaction among patients, and to reintroduce convalescing patients back into daily activities. This takes the form of inpatient rehabilitation at the gyms located on each floor, as well as volunteer-led activities such as art, music or gardening therapy.

Patients are encouraged to take walks, have their meals in a communal dining hall, and participate in the daily activities. YCH welcomes visits by children from The Little Skool-House By-The-Lake nursery to promote intergenerational bonding. Since August 2016, the children and patients have engaged in YCH’s activities include intergenerational bonding, allowing elderly patients to interact with young children as part of the rehabilitation process. Source: Straits Times © simple cooking, and arts and crafts activities Singapore Press Holdings Limited. Reproduced with permission. together. Over 100 YCH volunteers give their time, energy and resources to brighten up the lives of our patients. Some, like Mr Rosli, were former YCH patients who have returned to pay it forward. By doing an ACP, my father prepared his family so we could focus on celebrating his life.

Mr James Ong, 52

LIVING AND DYING WITH DIGNITY 40 TRANSFORMING CARE

• Mr James Ong, son of late Mr Ong Tian Chiang ENABLING QUALITY (1931–2016) END OF LIFE About 1% to 2% of the population in the When he learnt that he had only six months to live, North have life-limiting conditions or Mr Ong Tian Chiang, 85, took the news stoically. advanced progressive illnesses for whom The elderly gentleman reasoned he had already curative treatments no longer work. This been given many “bonus” years, having had a heart group of patients, like the late Mr Ong, are cared for under KTPH’s Palliative bypass 15 years ago. “He felt that he was very Care Service, which comes under the fortunate – that he had lived a good life,” his son Department of Geriatric Medicine. James, 52, recalled. Palliative care integrates the skills and It was at this point that medical social workers at knowledge of a specially trained team of KTPH stepped in to offer more support to aid the clinicians from various disciplines. This, family and the senior Mr Ong in his end-of-life care coupled with the support of a strong allied – such as funding for assisted care devices. They health team, offers patients comprehensive, person-centered care. Palliative care is also tactfully brought up the idea of Advance Care available in both the inpatient and outpatient Planning (ACP). settings, where the team delivers holistic, interdisciplinary care to patients with both “My father resisted at first, because he didn’t really cancer and non-cancer illnesses. Unlike understand what it meant, but after the process hospice care, palliative care does not deter was explained, he saw the logic of it and was attempts to cure or prolong life. In fact, very open to the idea,” said James. The senior palliative care is often offered concurrently Mr Ong viewed it as a way to make his wishes with curative care. known, avoid any conflict among his family, and Palliative care provides patients and their help his children and grandchildren move on families with a supportive environment peaceably after his death. “He even chose his own which focuses on relieving the physical, biodegradable urn,” shared James. psychosocial and spiritual distress. James Ong, for instance, was grateful for the team’s “When someone is at the end of life, there’ll be help in assisting the family to access funds many viewpoints and unknowns. By doing an ACP, for home care devices for their father. “The my father prepared his family so we could focus on oxygen apparatus, an electrical hospital celebrating his life.” They took new family portraits bed, wheelchair, walking aid, commode and and went on a big family cruise before he passed recliner chair were of great assistance,” said James, who was his father’s primary away in May 2016. “I’m inspired by the way my caregiver. “It really gave my dad a better father planned his last days,” said James, who has quality of life during his stay at home and since drawn up his own ACP, as has his mother. lightened our load as well.”

Apart from collaborating with the Ageing-In- Place Community Care Team (AIP-CCT) to ensure comprehensive end-of-life care for patients at home, the Palliative Care Service works closely with home hospice care 41

organisations such as HCA Hospice undergone ACP training – usually initiates Care, Singapore Cancer Society’s home the conversation at an appropriate stage hospice section, Agency for Integrated in a patient’s illness to understand and Care HOlistic care for MEdical advanced document the patient’s values, beliefs, care 2001 Health for Older patients (AIC HOME) and Agape Methodist preferences and what it means to live well. Persons Programme Hospice (Homecare). These conversations may also include the (HOP) is launched by nomination of a healthcare spokesperson. To AH’s Geriatric Centre. HOP pro-actively advance the acceptance of ACP, KTPH set up ADVANCE CARE PLANNING equips the elderly in an ACP Clinic in September 2013. Each week, the community with the An important aspect of care at the end of the Clinic sees an average of 10 patients and skills to live confidently life is ACP. ACP is an ongoing conversation their nominated healthcare spokespersons to and independently, between the patient, his/her family well into old age facilitate ACP conversations. members and healthcare professionals to understand his/her future healthcare The ACP Office at KTPH also provides plans, as well as medical or personal training to equip hospital staff and preferences and decisions. community partners with the required knowledge to become ACP advocates, As James noted, ACP reduces crisis General ACP facilitators or Preferred Plan of decision-making for family members and Care facilitators. They also work closely with safeguards a patient’s best interest by the AIP-CCT, who visits patients at home ensuring medical decisions are made in after they are discharged from the hospital. accordance to his/her wishes. In the case of The home care team nurses, who are trained Mdm E B (see below), it also gives patients ACP facilitators, can conduct these ACP the opportunity to fulfil their last wishes. conversations in the patients’ homes, where A trained ACP facilitator – who can be a families may feel more at ease to share their doctor, nurse, medical social worker or healthcare preferences and wishes. any other healthcare professional who has

Small touches, big difference: Story of Mdm E B (1950–2016) Suffering from a rare form of terminal liver cancer, Mdm E B was admitted to the palliative care ward at YCH in March 2016. In pain and frustrated about needing assistance for her daily care, she was often bad-tempered. She also insisted on going home as she worried about her wheelchair-bound elder sister whom she lived with. Independent and headstrong, she demanded to be discharged, only to be back at YCH less than a week later. Medical social worker (MSW) Cynthia Lau recalled: “She was very jaundiced and frail and I could tell she was aware that she had not much time left.” Wistfully, Mdm E B wondered if she would live to see her next birthday, so Cynthia proposed an early celebration. Nurse Manager Nurashikin Sidek, who runs the palliative care ward, and her team ordered an ice cream cake and dressed Mdm E B up – make up and all – for the occasion. They even bought her favourite kueh and roped in an MSW from the community to bring Mdm E B’s sister to YCH. “Palliative care is about bringing comfort and giving compassion, looking beyond a patient’s illness and tending to them as a person,” said Nurse Manager Nurashikin. That simple act transformed Mdm E B. She became calmer, more content and passed peacefully not long after. Said Nurse Manager Nurashikin: “We were very happy to do what we could so she could live her last days on her own terms, especially to celebrate her life even as she was at the end of it.” 42 TRANSFORMING CARE

ADVANCE CARE PLANNING

Talking about end-of-life issues can be difficult. We train our staff and volunteers to become ACP advocates and facilitators. In Financial Year 2016, we had:

15 96 810 ACP advocacy New ACP facilitators New ACP advocates courses for facilitators ACP facilitators are individuals ACP advocates are and advocates who are equipped with individuals who skills to go through the ACP introduce ACP to discussion, assess patients’ patients and families. decision-making abilities and document ACP for patients.

New ACP e-Learning Course An e-Learning module for ACP advocacy was designed for all staff to have basic understanding of ACP. The module also teaches staff on soft skills in communication and motivational interviewing. 1,213 staff participated from April 2016 to March 2017. 43

2004 Home for Independent Persons Studio, a developmental programme, was launched to complement HOP and help ease the transition into old age

In partnership with Assisi Hospice, KTPH started No One Dies Alone, a volunteer- centred programme that provides companionship to dying patients without family or close friends

This photo was the winning entry of the AHS Living Well Photo Competition held in conjunction with the World Hospice and Pallliative Care Day on 8 October 2016. To drive awareness and understanding of end-of-life issues and ACP, the ACP team also organised an art exhibition “Before I Die” from 22 to 29 October 2016. Visitors, patients and their families were invited to write down their wishes on chalkboards before they die. “Before I Die” is a global move that encourages people to think about their lives and share their aspirations on a wall.

GIVING SUPPORT TO AGE IN PLACE Complementing the patient care work and initiatives run in the hospital is the AIP-CCT programme for patients who need extra help at home for a transitional period to cope with poorly-managed chronic illness, end-stage diseases or conditions requiring 300 long-term care. patients were admitted The programme – originally the AIP almost four times a year programme – was started in 2011 to address a group of patients affectionately named “frequent flyers”. Beset with one of the highest bed occupancy rates among taking a total of public hospitals, KTPH studied patterns of readmissions to identify a particular group of some 300 patients who were admitted almost four times a year. They took up a 7,900 total of 7,900 beds in six months. beds in six months 44 TRANSFORMING CARE

The AIP programme was developed to productivity, lowers administrative costs and provide medical, health and social care resources and makes it more convenient for to “frequent flyers” and their caregivers patients to receive medications. The time 2011 in their homes. This helps them manage savings also allow nurses to focus on their The AIP programme was rolled out to their chronic conditions well, maintain core care duties better. tackle the problem of their health and independence, and prevent “frequent flyers” who complications from arising – thus reducing contributed to the high Paperless Prescription chances of readmission. demand for subsidised beds and to provide Time savings of better care for them in To expand the scope of care, the AIP the community programme was merged with the Transitional Care (TC) programme in 2015 to 8H 25M 2012 form the AIP-CCT. The AIP-CCT programme per patient To better ensure is a post-discharge, nurse-led home visit seamless care service that comprises a multidisciplinary between discharge and team of nurses, doctors, therapists, Putting AIP-CCT within reach returning home, AHS started the TC service pharmacists, medical social workers and To improve their reach, a team of five healthcare assistants. They offer clinical, AIP-CCT nurses shifted to the Wellness psychosocial and home environmental Kampung @ 115 Chong Pang on a trial basis. support so patients and their caregivers can The move, which took place in November manage well at home and in the community. 2016, puts the team closer to the residents As of March 2017, the AIP-CCT programme they serve and eliminates travelling time to has served more than 6,600 patients. and from KTPH.

AIP-CCT goes digital TRANSFORMING PATIENT CARE The web- and mobile-based AIP System To improve AIP-CCT’s efficiency and reach, went live in February 2017, harnessing the new initiatives were introduced in 2016 to save power of technology to improve home visits time, improve productivity and reduce the and streamline documentation. Instead of amount of paperwork so that the team can dealing with paper records and multiple focus on what matters most – patient care. spreadsheets, AIP-CCT staff now record home visit assessments and case notes, Paperless Prescription access patients’ documents, and book visit Started in July 2016, the Paperless schedules on the single, seamless platform Prescription initiative is a collaboration via their iPads. between the AIP-CCT and KTPH Outpatient Pharmacy to make dispensing of medications safer and more efficient. It TRI-GENERATIONAL does away with handwritten prescriptions HOMECARE @ NORTH WEST and the need for nurses to confer face-to- RECOGNISED AT 2016 PATIENT face with a doctor or pharmacist. Instead, ACTION AWARDS nurses can make medication requests via AHS’s Tri-Generational HomeCare @ North a call or SMS to a doctor, who can then West was recognised at the 2016 Patient enter the prescription into an online system, Action Awards under the Singapore Patient iPharm. This paperless process enhances Support Group/Volunteer Group category. 45

The project is a collaboration between residing in the northern community so that AHS’s AIP-CCT programme, North West healthcare and wellness services could be Community Development Council (NWCDC) matched to their needs. The Chong Pang and student volunteers from the National neighbourhood was selected because, with 2013 As part of the efforts University of Singapore (NUS) Medicine, one in four residents aged 55 and above, it to improve end-of- Nursing, Pharmacy and Social Work has one of the highest proportions of seniors life care, AHS started faculties. As of March 2017, they have in the North. its ACP programme, training healthcare offered assistance to 136 AIP-CCT patients. professionals to The team spent time within the community, understand a person’s The Tri-Gen Project is unique as it is observing them in their everyday preferred mode of care initiated, led and organised by NUS activities and how they interacted with the and personal wishes students trained by AIP-CCT and NWCDC environment. Through open conversations, in healthcare and social service skills, as the team uncovered their perceptions well as proper responses to emergency about ageing, what mattered to them, what situations. Paying forward the guidance motivated them, including their values, and mentorship received, the NUS student habits, and needs. The study provided volunteers in turn lead secondary school insights for the design of the Wellness students in service learning outreach efforts. Kampung as a flexible communal activity Started in August 2014, the Tri-Gen team space that could foster social interaction has since grown to comprise 309 NUS and address the sense of displacement felt students and 397 secondary school students by many of the seniors who have seen the from West Spring Secondary, Woodlands neighbourhood undergo great changes. Secondary, Yishun Secondary, Orchid Park Secondary, Yishun Town Secondary, and THROUGH THEIR EYES Chung Cheng High. Significantly, the Quotes from the ethnographic study of student volunteers have taken ownership Chong Pang residents. of the work, showing leadership and managerial skill to form a comprehensive Being able to sleep well, eat well organisational structure. and go anywhere you want to - that is health. UNDERSTANDING A COMMUNITY: Now we are all like in birdcages. PROJECT ORANGE People don’t have time to stop by and say hi, because they are busy Exhibition: Project Orange, an exhibition all the time. of poignant anecdotes and stories, is a collection of observations and insights It’s stifling to be home, time passes gained from a seven-month ethnographic by too slowly because there’s nothing study held in 2015 to better understand for me to do. My wife handles all the the older people in the community that AHS serves. chores. Being out here allows me to talk to my friends. It was initiated by AHS’s Innovation Team with the goal to gain deep insights into the In Singapore, you can die, but attitudes, mindsets and daily lives of seniors cannot afford to fall sick. 46 TRANSFORMING CARE

2015 Aimed at better monitoring frail and vulnerable elderly and providing a platform to interaction, the first Share-a-Pot was held. It offers healthy homemade soups high in calcium and protein

AIP programme and TC service merged to form the AIP-CCT which broadens the efficacy of care to the community

The Wellness Kampung serves as a “third place” where residents can gather to participate in activities that foster social bonding and holistic well-being, enabling them to age well in place.

WELLNESS KAMPUNG: and ensure they have the support they need. GIVING THE ELDERLY SPACE A wide range of programmes such as daily TO BE HEALTHY morning exercise classes, games, arts and crafts, and healthy cooking demonstrations Since 2016, three Wellness Kampungs have are held to engage residents and connect been set up at the void decks of Block 260 them with each other. These activities Nee Soon East, Block 115 Chong Pang serve to foster social bonding and support and Block 765 Nee Soon Central with the holistic well-being. Significantly, they give partnership of St Luke’s ElderCare and Nee the elderly a sense of place and belonging. Soon GRC. Furthermore, residents are also empowered Located near to St Luke’s ElderCare senior to organise their own events as a way of care centres, these open, welcoming encouraging ground-up participation. wellness and care centres were developed As of March 2017, the Wellness Kampungs based on the concepts of Ibasho Café and have served over 1,250 residents and see a Ray Oldenburg’s concept of a “third place” regular attendance of 65 residents daily at where people congregate other than work each of our centres. or home. The café-like interiors and modular spaces The centres are spaces to help the of Wellness Kampung @ 765 won an SG community age well in place – where they Mark design award in early 2017 for its can drop-in, hang out and take part in the transformation of a HDB void deck into a goings-on. liveable, welcoming space with features For AHS’s Population Health team, the such as simulated skylight and “blackboard centres also serve as a node from which menu” walls. they can better identify vulnerable elderly 47

ENGAGING THE discuss and recommend treatment together. MALAY COMMUNITY Six nurses graduated from the course in November 2016, with a total of 80 nurses KTPH nurses, physiotherapists and trained so far. 2016 occupational therapists took part in the In preparation for an Majilis Ugama Islam Singapura (MUIS) Another GeriCare@North initiative is ageing population, AHS Befrienders Learning Day at the Singapore initiated its Yishun-wide a palliative care course for long-term Dementia-Friendly Expo on 6 November 2016. During the day, care nurses. Launched in 2016, it is a Community campaign they spoke to some 350 befrienders from collaboration between KTPH, Ang Mo Kio to improve education and awareness of MUIS Mosque Befrienders Scheme and Thye Hua Kwan Hospital, the nursing homes dementia and provide shared tips on how to be more effective in under GeriCare, YCH and GERI. Fourteen dignified services for approaching needy zakat (tithe) recipients. nurses have since been trained to care for those afflicted They showed volunteers how to use devices their residents who are at the end-of-life in Three Wellness for assisted daily living, such as redesigned the nursing homes. The second run of the Kampungs were spoons and mugs and demonstrated the course, which started in February 2017, has launched. These social spaces serve proper use of wheelchairs and walking aids. 13 nurses currently undergoing training. as a platform for The befrienders were also shown how to health outreach Most recently in April 2017, the GeriCare transfer the wheelchair or bedbound safely and grassroots-led as well as how to reduce the risk of falls Education and Training (GREAT) course was social activities in homes. launched. GREAT focuses on getting nursing aides and health care attendants (many of whom are foreign-trained) up to the same GERICARE@NORTH standard in general and geriatric nursing GeriCare@North is a KTPH initiative care skills. In the same month, the GeriCare to provide access to specialist care to Communication Skills Workshop for nurses nursing home residents of eight nursing was also launched. homes in Singapore.

GeriCare uses telemedicine to give clinical care support to the nursing homes’ nurses and doctors, while training the homes’ nurses in geriatric and palliative nursing care. For instance, the GeriCare team of clinical educators and geriatricians are on call daily from 9a.m. to 5p.m. to advise on semi-urgent cases. Nursing home residents can also be referred directly for admission to KTPH via teleconsults without having to go through Accident and Emergency (A&E).

One of the training courses provided by GeriCare@North is a six-month telegeriatrics nurse training course that started in 2010. It teaches nurses to perform physical assessment, identify medical problems and A/Prof Philip Yap, Senior Consultant and Director of KTPH Geriatric Centre, provides raise them to the geriatricians so they can clinical care support for nursing homes through teleconsultations. 48 TRANSFORMING CARE

KEEPING AN EYE ON PROBLEMS up appointments with an eye doctor and After a successful pilot run from May to June have not seen one in more than a year. 2016, Community & Home Eye Screening First-level Community Eye Screening Services (CHESS) was launched in February (FiLCES) are conducted by community 2017. The initiative, by the Ophthalmology nurses, healthcare assistants and AIP-CCT & Visual Sciences Department and the nurses. Second-level Eye Consultation AHS Programme Office, aims to improve (SeLEC) are done by optometrists at AHS elderly residents’ access to eye care and Wellness Kampungs under the tele- to identify eye diseases early through supervision of an Ophthalmologist to screenings and consultations. manage stable eye conditions. It targets residents aged 50 and older, and diabetics of any age who do not have follow-

SEEING BETTER

residents have undergone 669 FiLCES since February 2017

164 90 26 were referred were referred to were referred to polyclinics to SeLEC opticians and General Practitioners for follow ups

4 1 for Diabetic Retinal was referred Photography to A&E RESEARCH AND EDUCATION 50 TRANSFORMING CARE

The AHS mission to provide good quality, enhance our ability to conduct more affordable, hassle-free healthcare with rigorous research. Science, Love and Wisdom is bolstered 2002 by the work of our clinician scientists. Our efforts are not limited to research, but The Clinical Their work in the translational research also in growing research talent. Apart from Research Unit (CRU) grooming clinicians, we have also brought was established field takes discoveries made in the laboratory two years after the to treatments that improve outcomes for in PhD scientists trained in basic science to restructuring of AH our patients. become clinical scientists. The collaboration between clinicians and scientists has greatly enhanced the synergy for “bedside to bench 2003 RESEARCH THAT CRU built a cell culture and back to bedside” translational research. facility, which was MAKES A DIFFERENCE housed in a make- At AHS, we have seen clinical research grow shift container in leaps and bounds, buoyed by Singapore’s biomedical research and inquiring minds of 2008 our passionate clinician scientists. In giving CRU organised AH’s them the space and resources to try out ideas, first Research Forum, Research Teaching “The Next Lap” our institution has pursued relevant research that tackles some of the most common diseases and medical challenges. These 2009 AHS partnered the include work in areas such as dementia, National Healthcare obesity and diabetes. We have also partnered Group (NHG) to run the other research institutions in Singapore to Healthcare Excellence NHG-AHPL (Alexandra Health Pte Ltd) Residency

2010 CRU moved to KTPH - the facilities expanded by 10 times with thrice the manpower in order to support the burgeoning research

With the funding support from the Clinician Scientist Award, A/Prof Lim Su Chi and his team will be studying the metabolomics of progressive diabetic kidney disease in young-onset type 2 diabetes. From left: Dr Serena Low, Dr Liu Jian Jun, Dr Wang Jiexun, A/Prof Lim Su Chi, Dr Keven Ang and Ms Babitha Jeevith. 51

First Clinician Scientist Award Healthcare for the future for KTPH The third Alexandra Health Forum, held in In recognition of his outstanding work in the conjunction with Nursing Fest 2016, was translational and clinical research field, the held on 25 August 2016. The Forum 2011 KTPH welcomed the National Medical Research Council awarded was attended by some 600 delegates first cohort of residents A/Prof Lim Su Chi with a Clinician Scientist and showcased more than 200 abstract under the NHG-AHPL Award in 2016. submissions. The focus was on “Healthcare Residency for the Future: Shifting Paradigms for the AH’s Research Forum “This award recognises that a clinician from Population, Patients and Professionals”. was renamed the a non-academic medical centre can also Alexandra Health actively contribute to research. The award Speaking at the Forum, Guest-of-Honour Forum and had its inaugural run under the will empower me and my team to bring our Dr , Senior Minister of State for new name at KTPH research to the next level,” said A/Prof Lim, Health and Environment & Water Resources, Senior Consultant, Department of Medicine shared, “The theme is particularly relevant 2012 for the changing realities that confront the and Clinical Director, CRU. The Alexandra Health healthcare landscape in Singapore as well as Forum was held in The award, which provides funding support, the region.” conjunction with will enable A/Prof Lim and his team to Nursing Fest continue their work in progressive diabetic With the combined challenges of a rapidly kidney disease (DKD) among young patients ageing population, increasing life expectancy 2013 with diabetes. and pressures to keep healthcare affordable, KTPH was awarded healthcare institutions must shift the $3 million Centre Grant Young-onset type 2 diabetes (YT2D) is paradigm of care from delivering healthcare from the National Medical Research an emerging clinical challenge that is to maintaining good health. Council to develop and increasingly prevalent in Singapore due to strengthen research childhood and adolescent obesity. People One was a study of 116 young patients with capabilities for type 1 diabetes. Titled “Young, reckless Common and Complex with YT2D often experience steep challenges Chronic Conditions in diabetics, take heed!”, the research in achieving and maintaining good diabetes Singapore control. They are also prone to diabetic revealed that four in 10 of these patients do not monitor their blood glucose the Launch of the Research complications, such as DKD, sooner. Gallery to showcase recommended three times a day, raising the diverse research A/Prof Lim’s study (“Metabolomics of the risks of complications. The study also activities and results revealed that the negligence was not due progressive diabetic kidney disease in Set up of Education young-onset type 2 diabetes”) aims to better to a lack of knowledge. This highlights the Development Office understand the biological processes which need to relook diabetes education and the in AH drive DKD in YT2D. Using metabolomics, the importance of monitoring blood glucose study aims to develop tools to better predict levels for younger patients. disease progression amongst those at risk. Improved sleep apnoea monitoring Metabolomics is the high-resolution with a mobile phone app profiling of small chemical molecules called Dr Edwin Seet, Head and Senior Consultant, metabolites in us. Metabolomics gives a Department of Anaesthesia, and Dr Daniel detailed and comprehensive picture of how Chia, Director, Transformation Office, have our metabolic processes work, allowing developed an oximetry app for mobile phones researchers to pinpoint the pathways that to improve the remote monitoring of blood go awry in disease. oxygen levels for those at risk of obstructive 52 TRANSFORMING CARE

sleep apnoea. The condition occurs when professionals from AHS guide students from the airways become completely or partially Institute of Technical Education, polytechnics blocked during sleep, causing gasping or and universities in learning and practising the 2015 abrasive snoring. Significantly, it repeatedly requisite clinical skills to work competently The Health Services Research and shuts off oxygen flow, interrupting sleep and safely as healthcare professionals. Evaluation (HSRE) Mini and stressing vital organs. The condition is As of Financial Year 2016, the EDO has Forum 1.0 was held underdiagnosed and poses a risk for those to share the latest supported 12 Healthcare Professional who are undergoing surgery. knowledge in this field Training Programmes for students from the The mobile app will help patients and medical, nursing, pharmacy and allied health 2016 caregivers track sleep apnoea, and allow professions. In April 2016, Prof C Rajasoorya HSRE Mini Forum 2.0 doctors to better assess the risks before was appointed as EDO’s Education Director. was held in conjunction He has close to 30 years of extensive clinical with the signing of and after surgery. The abstract for this a Memorandum of innovation project won third place at the teaching and leadership experience. He took Understanding between 6th Society of Anaesthesia and Sleep over from A/Prof Sin Fai Lam – who served AHS and National Medicine Annual Meeting, 2016. Going the EDO for three years. In that time, A/Prof University of Singapore forward, Dr Seet and Dr Chia will be Sin championed the development of clinical The Geriatric Education continuing the work to see how we can use teaching activities within KTPH. and Research Institute the app in the routine clinical setting. (GERI) and CRU “A/Prof Sin, our first educational director, collaborated to set up an off-site bio- Enhancing health with was instrumental in establishing the EDO banking facility Alexandra Health Fund from scratch and in ensuring a seamless integration of undergraduate education A/Prof Lim Su Chi The Alexandra Health Fund Limited (AHFL) won the Clinician is a registered charity under the Charities Act in the hospital. In my role, I aim to refine Scientist Award with about $126 million as of 31 March 2017. and define processes, responsibility and Since its incorporation in September 2014, accountability, integrate education that cuts AHFL has supported 14 major programmes across inter-professional boundaries and directed at improving the quality of life of professionals and create a seamlessness our patients through research, innovation undergraduate to postgraduate programme. and education. It has also funded various Going forward, I hope to tap the strengths of community outreach programmes for the NHG in developing the Yishun Health Campus benefit of the less fortunate. In the area Education,” said Prof C Rajasoorya. of direct patient assistance, the Fund has Residency Program Office (RPO) benefited 348 needy individuals by providing AHPL has partnered NHG to host the NHG- them financial support in the form of home AHPL Residency since 2009. Run from AHS’s care needs, durable medical equipment and RPO, it is headed by Dr Ong Chin Fung consumables, and medical treatment. (Associate Designated Institutional Official).

EDUCATING THE Today, RPO supports 19 residency NEXT GENERATION programmes as well as the Postgraduate Year 1 training in KTPH. RPO also coordinates Education Development Office (EDO) the postgraduate Basic Specialist Training, The EDO was set up in 2013 to oversee and Advanced Specialist Training and Seamless coordinate the delivery of pre-employment Training programmes. clinical training. Senior healthcare OUR PEOPLE: THE HEART OF AHS 54 TRANSFORMING CARE

BUILDING PEOPLE Group CEO Mr Liak Teng Lit, commended THE AHS WAY A/Prof Pang on being a great role model Our ability to deliver our mission of care and mentor: “He spends time and effort to 2000 teach, advise, coach and counsel individual Mr Liak Teng Lit, lies in our people. Our staff are integral to Mrs Chew Kwee Tiang our growth and success as a healthcare doctors, inspiring many to become better and Prof C. Rajasoorya organisation; they form the heart of who doctors and even more importantly – better were appointed as human beings.” CEO, Chief Operating we are. This underscores our commitment Officer and CMB of to building our human capital, to leverage the restructured AH the varied expertise of our diverse staff OUTSTANDING CLINICIANS respectively and nurture people who have the hearts, HONOURED minds and passion for healthcare and Two of our highly-regarded and outstanding 2001 service to others. Achieved ISO9001:2000 clinicians were recognised for their and 14000 certifications Importantly, we believe in the continued contribution at the 2016 AHS Awards pursuit of learning and improvement, and Ceremony. They received the inaugural Distinguished Senior Clinician Award by 2002 of grooming talent for new generations of Won the People healthcare professions to carry on the values the Ministry of Health (MOH). It recognises Developer Standards we hold dear. veteran doctors or surgeons for their Award, Singapore contributions in clinical, education and Quality Class, PS21 Organisational research practices. Excellence Award INSPIRING MENTOR RECOGNISED Professor C Rajasoorya is a Senior Consultant, General Medicine, and Education 2003 Exemplifying our philosophy of learning Director for the Education Development Battled against the and mentorship is A/Prof Pang Weng Sun, Office. He is internationally recognised SARS virus and AH YCH’s Chairman of Medical Board (CMB) managed to remain in the field of hypothalamo-pituitary and SARS-free. and KTPH’s Senior Consultant Geriatrician. adrenal disease. His focus in the last 12 He won the National Outstanding Clinician years have been on medical education where Won the Singapore Educator Award in 2016 for his contribution HEALTH (Helping his guidance and mentorship has benefited Employees Achieve to educating and inspiring generation of many, including senior physicians, medical Life-time Health) Award medical leaders. This is Singapore’s highest students and junior doctors. clinical teaching accolade. 2004 Described as a “one-in-a-million” clinician Achieved the Singapore HEALTH Award and mentor, A/Prof Pang is a pioneer in the (Gold), HEALTH fields of geriatric and palliative medicine. He Promoter Award was one of the founding practitioners who and the Singapore Family Friendly built, shaped and developed the training of Employer Award both specialties and services. A/Prof Pang who wears many hats (he is also Executive Director of the Geriatric Education and Research Institute, and Vice-Dean, Clinical Affairs, Lee Kong Chian School of Medicine, Nanyang Technological University) has also taught extensively in both geriatric and palliative medicine, and is an

inspirational mentor to many clinicians, Prof Raja has served in public and restructured hospitals medical students, doctors and nurses. for more than 35 years. 55

GROWING THE RIGHT TALENT To continue extending our outreach into the community, what we need most is a family 2005 of dedicated healthcare professionals, Achieved first in MOH administrators and operational support staff. Patients’ Satisfaction Based on this belief, AHS is committed to Survey in AH, Joint Commission attract and nurture people with the right International (JCI) heart and mindset for serving others. For accreditation, instance, we continue to develop our staff Singapore HEALTH Platinum Award and with 156 scholarships and sponsorships re-certification of awarded over the past year. Fifty-eight staff People Developer also embarked on their formal education Systems award

and Health Manpower Development Plan A/Prof Pang Weng Sun A/Prof Sum was instrumental in setting up the Diabetes sponsorships in Financial Year 2016. was appointed CMB Centre and recently stepped down as the director in of AH April 2016. ALWAYS IMPROVING AT AHS A/Prof Sum Chee Fang, Endocrinologist 2006 To foster a strong culture of service, Topped the MOH and Senior Consultant, General Medicine, lifelong learning and innovation, staff are Patients’ Satisfaction is recognised in the field of diabetes actively engaged in improvement activities Survey and won the Singapore HR Awards, management and research. His dedication throughout the year. To keep staff up to to patients spurred him to leave a successful Strong Believer Award date with developments in medical science, (Job Recreation private practice in 2001 to return to public clinical forums and clinicopathological Programme Awards), Work-Life Achiever healthcare to start the multidisciplinary lectures are held monthly. Apart from weekly diabetes centre at AH. Under his leadership, Award and renewal of book review sessions, AHS also holds regular Singapore Quality Class the Diabetes Centre has earned a reputation talks for staff. In 2016, 47 lunchtime talks for managing complex diabetes cases using and book review sessions were held, with a holistic patient-centred model. A/Prof Sum 2007 topics ranging from leadership to finance Topped the MOH is also a respected educator who teaches and mental health. Patients’ Satisfaction both medical and nursing students. Survey and achieved ISO Reaccreditation, JCI Accreditation and MAKING A DIFFERENCE Lifelong Learner Award THROUGH NURSING In November 2016, Principal Assistant Nurse Rostihar Bte Abdul Karim from KTPH Eye Clinic was a recipient of the 10th Nursing Award for Enrolled Nurses (ENs). This is the highest accolade for ENs in Singapore. In the field for 29 years, the experienced nurse is qualified to perform advanced nursing procedures and basic medical tests. She also works closely with the Eye and Anaesthesia teams in the Eye Clinic, acting as a physician extender to conduct pre-surgery anaesthetic Principal Assistant Nurse Rostihar Bte Abdul Karim assessments for patients. received the 10th Tan Chin Tuan Nursing Award for ENs. 56 TRANSFORMING CARE

The “Speaking up for Safety” campaign was Mr Nathan took the time to share his launched to empower AHS staff to raise thoughts and insights from his life journey patient safety concerns with colleagues with our staff. Other distinguished speakers 2008 through graded assertiveness communication include Mr S Dhanabalan, Prof Tommy Koh, Topped the MOH Patients’ Satisfaction skills training. Techniques include using Mr Liu Thai Ker, and Dr G Natchiar from Survey and won the respectful questioning approaches, Aravind Eye System. Inaugural AARP communicating graduated concern using International Innovative constructive language, and responding Employer Awards, MOM Work-Life gracefully when questioned. Fifteen clinical Achiever Award, and non-clinical staff were presented with Singapore Human certificates for successfully completing the Resource Institute for Leading HR Practices Safety Champions accreditation programme (Fair Practices conducted by Cognitive Institute, , Employment) Award in 2016. Mdm Chua Gek Choo (now YCH’s Director Fifty-five senior management members of Nursing) received and clinical heads of department were also the President’s Award introduced to the “Promoting Professional for Nurses Accountability” programme last year. AHS commemorated the passing of Singapore’s Through data collection and monitoring former president Mr S R Nathan in August 2016. 2009 tools, staff with repeated reports of Senior management led staff to pay their last respects at Parliament House, while staff also penned their Topped the MOH unprofessional behaviour can be identified. Patients’ Satisfaction tributes in condolence books. Survey The right procedures can then be applied to escalate engagement with them, so EVER PREPARED FOR THREATS that they are aligned with a culture of 2010 On 15 October 2016, a “bomb” went off in Official opening of KTPH satety and excellence. by Minister Mentor Yishun. In the “chaos” that ensued, 1,600 Mr Lee Kuan Yew staff members from various departments CONVERSATIONS WITH “delivered” emergency medical attention KTPH topped the MOH Patients’ Satisfaction LEADERS WHO HAVE MADE and “decontaminated” casualties. The civil Survey in its first year A DIFFERENCE emergency exercise codenamed ‘Kingfisher” A key component of our learning ethos is to was the culmination of months of practice learn from exceptional individuals through drills and dry runs – all to ensure that AHS is our Simply Said conversation series. In ready to handle a civil emergency or terrorist January 2017, we learned from Prof Lui Pao attack should it arise. Chuen, former Chief Defence Scientist and current Adviser at the National Research Foundation, Prime Minister’s Office. He shared the art of persuading people to come on board for an “impossible” project, and how leadership should change to sustain a culture of constant innovation.

This Simply Said series was introduced in 2011, and our inaugural speaker was Staff rallied together to go through a simulated Mr S R Nathan who was a friend of AHS. bomb attack to ensure the hospital is well prepared After stepping down as President in 2011, for civil emergencies. 57

WALKING THE TALK AS A HEALTH-PROMOTING HOSPITAL Aligned with the healthy principles set out in our Five Pillars of Health, AHS runs a wide range of wellness and work-life initiatives to help staff achieve a healthy and active lifestyle.

• Sports and Social Interest Groups AHS’s 11 sports and social interest groups ensure staff play just as hard as they work. They include activities like line dancing, brisk walking, running and Zumba. Craft workshops such as paper cutting, balloon sculpting, brush lettering During June holidays, staff and their family members took a trip to Malacca. and typography were also conducted. These activities maintain work-life balance, and help staff from different departments bond over shared interests.

• Inter-department Games and Group Exercise Nurturing sportsmanship and teamwork, the AHS League is a series of inter- department competitions in badminton, basketball, bowling, Captain’s Ball and futsal. The friendly competition and camaraderie has fostered bonding within departments. In addition, group exercises are held on hospital grounds after work hours, giving staff a convenient way to Staff showing off their creations at the balloon sculpting workshop. integrate exercise into their daily routine. In 2016, new exercise classes such as muay thai, bootcamp, KpopX Fitness, pilates and cycling injected more fun and variety.

CELEBRATING TOGETHER Each year, AHS celebrates its diversity during the festive and cultural occasions. As a family, we bond over Chinese New Year, Hari Raya, Deepavali, and National Day. In addition, we also take time to recognise and appreciate our staff during Nurses’ Day, AHS Awards Ceremony, and our annual Dinner and Dance. AHS departments competing with each other in futsal. 58 TRANSFORMING CARE

2011 A/Prof Kenneth Mak appointed as CMB of KTPH, A/Prof Pang Weng Sun appointed as CMB of YCH

Achieved the first JCI accreditation in KTPH, FutureGov Awards – Healthcare Organisation of the Year and the NTUC 50 Model Partnership Award

2012 Handover of leadership – Mr Liak promoted to AHS’s Group CEO and Mrs Chew Kwee Tiang promoted to CEO of KTPH We bade goodbye to our Group CEO Mr Liak Teng Lit and thanked him for his 38 years of hard work and visionary leadership. The farewell party was a walk down memory lane for Mr Liak as many of the people he Topped the MOH had worked with and known over the years were secretly invited to join us in celebrating his work at AHS. Patients’ Satisfaction Survey and won Best Contact Centre Awards and Singapore HEALTH Award (Platinum)

Mrs Chew Kwee Tiang, CEO of KTPH, joined in to serve food to staff during the S.T.A.R.S Day 2016 (Showing Thanks, Appreciation, Respect to Staff). This event was organised to show appreciation for our staff as we topped the MOH’s Patient Satisfaction Survey for the 10th time. This demonstrated our consistent commitment to patient care from 2006 to 2015. 59

A FAMILY THAT PLAYS Rainbow Centre and Singapore Chinese TOGETHER, STAYS TOGETHER Orchestra, to perform at the main lobbies of our institutions. These groups brought Being healthy includes having healthy, much joy to the community, patients from 2013 meaningful and connected relationships. Won the Global Healthy KTPH and YCH, as well as residents from the Family ties, in particular, need care too. AHS Workplace Award 2013 nearby nursing homes in the Nee Soon area. believes in helping staff maintain strong (Large Enterprise), Most Innovative Project family connections through the annual Caring for the environment / Policy award (Gold) Family Day and regular excursions. in PS21 Excel Awards On 12 March 2017, we celebrated World & Convention for the Water Day, together with our partners Ageing-In-Place (AIP) GIVING BACK TO THE from the Nee Soon South Constituency programme COMMUNITY and Public Utilities Board. The event was graced by Guest of Honour Er Dr Lee Bee 2014 Delighting the community Wah. This year, the theme was “Make Every Topped the MOH Being part of the community means AHS Drop Count”, emphasising the role of the Patients’ Satisfaction Survey and won the JCI not only reaches out to our residents, individual in taking ownership of Singapore’s and Work-Life Achiever but welcomes them to hold events within water resources. In typical AHS style, the Award, United Nations our grounds. In fact, our lunchtime event was followed by litter-picking at the Public Service Award for the AIP programme, performances are a platform to showcase Yishun Pond and nearby HDB blocks to put and the 14th CCAS the arts. We have invited groups such as our environmental concern into practice. We International Contact students from Huamin Primary School, picked up 60kg of litter. Centre Awards Silver Award for the Best In- House Contact Centre

Nurse Clinician Sim Lai Kiow, KTPH won the President’s Award for Nurses

AHS staff practising one of the Five Pillars of Health – exercising regularly! 60 TRANSFORMING CARE

2015 Topped the MOH Patients’ Satisfaction Survey for the 10th year

Dr Pauline Tan appointed CEO of YCH

President’s Award for Nurses, Ms Velusamy Poomkothammal, Assistant Director of Nursing, KTPH

2016 Won the Community Chest SHARE Platinum Award

2017 Ms Rostihar Abdul Karim, Principal Assistant Nurse, AHS staff formed a contingent at The Purple Parade 2016 to show support towards persons with special needs. received first runner- up for the Tan Chin Tuan Nursing Award, Building an inclusive workforce YCH also partnered closely with the Singapore's highest AHS showed its support for The Purple Movement for the Intellectually Disabled accolade for ENs Parade, a movement that supports the of Singapore coaches to develop A/Prof Pang Weng inclusion and celebrates the abilities of targeted programmes to help persons Sun appointed acting persons with special needs. Within AHS, with disabilities adapt to the Group CEO of AHS with Mr Liak Teng Lit’s we have worked with the below agencies healthcare environment. departure from public to create job opportunities for people with healthcare disabilities, as well as building an inclusive • KTPH’s Main Lobby has a new weekly workforce and culture. performer: 16-year-old Chang Xun from Rainbow Centre - Yishun Park School • As part of SG Enable’s Project IN, students plays the piano after school most from Metta School and Woodlands Garden Mondays and Fridays. School take on nine-month internships under the School-To-Work Programme. • The Bettr Barista Coffee Cart was opened This gives them valuable working at KTPH in September 2016. This is a experience to build up their confidence collaboration between Income OrangeAid and capabilities. At present, four student and Bettr Barista Coffee Academy. This interns are serving as Environmental provides gainful employment and nurtures Service Associates in YCH. the entrepreneurial spirit of graduates from Bettr Barista’s Holistic Training • To date, YCH has hired eight persons Programme, which empowers with disabilities and they are currently marginalised women and youth-at-risk attached to the Environmental Services through coffee. and Materials Management Department. CREATING A HEALING ENVIRONMENT 62 TRANSFORMING CARE

AHS’s greening efforts started 16 years ago Therapist – has since continued to gift the when the hospital was still in Queenstown. hospital with her green thumbs, overseeing the greening of the Yishun Pond, KTPH 2001 “We transformed the former Alexandra and YCH. AH began transforming Hospital from a dilapidated pre-war building its grounds. The idea to a place known for its lush garden; even Gardening and greenery, she points out, was to build a lush healing oasis that would tourists would visit it to see the plants and play an important role in achieving AHS’s welcome patients and see butterflies,” said Rosalind Tan, Senior vision of ensuring the best outcomes for visitors to the hospital Executive, Operations, who is affectionately patients, especially in their rehabilitation. known as the “Chief Gardener” of AHS. “For one, gardening is an extension of 2002 occupational therapy because it strengthens Singapore “When we moved to Yishun, we wanted to muscles, eyesight, mental function and Environmental green the hospital too, but with a quarter of hand-eye coordination.” Achievement Award the land space of what we had previously, we had to do it differently. We’ve gone up – The enjoyment of the landscaping, complete 2004 growing vertical gardens and rooftop farms. with water features and local wildlife is also AH’s Butterfly trail We even transformed Yishun pond into a multi-sensory and aids in healing and stress featured in The New Paper. By this time, 74 green activity space for the community to relief, she added. Apart from adding beauty species of butterflies enjoy. Although we have less space, there and promoting healing to the hospital, the were spotted in its is still natural light and greenery all around gardens also bring in the community. grounds wherever you turn, so people can enjoy a beautiful view,” said Rosalind. The rooftop gardens at both KTPH and YCH 2005 – which grow an abundance of fruit and AH won the inaugural Rosalind, who spearheaded the garden vegetables – are tended by a dedicated team Community in Bloom initiative, started transforming the garden of 23 volunteer gardeners. Some produce are Award, a heartening as a retirement present to the hospital. The used for patients’ meals while the extras are recognition of its greening efforts passionate gardener – who had dedicated sold every Monday, Wednesday and Friday at 37 years to the hospital as an Occupational AHS’s own farmer’s market. Building and Construction Authority (BCA) Award – Green Mark Gold

The AH gardens were transformed into a tropical healing oasis which included a Butterfly Trail with over a 100 species of butterflies. 63

2008 Community in Bloom Award (Best Community Garden) and Community in Bloom Platinum Award for AH

Ministry of the Environment and Water Resources President’s Award for the Environment for AH

2009 BCA Green Mark Platinum Award

2010 SIA-NParks (Singapore Institue of Architects- AHS gardeners and volunteers, showing off their harvest at the KTPH rooftop garden. From left: Mr Jason Loke, National Parks Board) Mr Low Lum Soon, Mr Joe Lum, Mr Simon Chan, Mr Jeffrey Tay, Mr Hur Tze Huan, Mr Lim Ah Sien, Ms Wong Skyrise Greenery Yoke Chan, Ms Rosalind Tan and Mr Robert Lo. Awards – First Prize

AHS officially adopted Yishun Pond; rejuvenation works transformed Yishun Pond and its surroundings into a multi-generational, health-promoting garden

Mr Robert Lo, a longtime volunteer, harvesting starfruit for the tri-weekly “market” where fresh and organic produce from the rooftop gardens are sold to staff and members of the public. 64 TRANSFORMING CARE

AHS WINS DIAMOND A wide range of energy- and water-efficient COMMUNITY IN technologies are also integrated into the BLOOM AWARD design to make daily operations more 2011 sustainable. For instance, the calibration of Design & Health KTPH’s efforts in urban farming were toilet flush sensors and installation of a dry International Academy recognised with the top Diamond Award pump system for the pond to provide 95% Award – International at the 2016 Community in Bloom Awards Health Project of irrigation needs for KTPH’s landscape (over 40,000 m2) after attaining the Platinum achievement resulted in a 6.4% drop in NEWater use banding for the fourth consecutive year. The FutureGov Awards – in 2016. Community in Bloom Awards is a biennial Healthcare Organisation of the Year competition spearheaded by NParks and Despite an increased patient load of about is aimed at promoting the efforts of 3% (43,457 patients) in 2016 over 2015, President's Design Award community gardeners. potable water use fell 3%. This can be attributed to various water saving measures Landscape Industry Association (Singapore) A GREEN ENVIRONMENT and the renovation of Foodfare from July to Gold Award and IS A HEALTHY ONE November 2016. Best of Category (Implementation, AHS’s mission of health extends to its For these efforts, KTPH was re-certified Commercial); Silver environment. Going beyond meeting under the Singapore Standard SS 577:2012 Award (Turnkey) for environmental legislation requirements, Yishun Pond for its Water Efficiency Management System AHS has developed a comprehensive in June 2016. Six months later – after a FutureArc Green sustainability framework to create a clean, rigorous series of audits – KPTH’s Energy Leadership Award – Institutional green and healthy environment for patients, Management System (EnMS) achieved Architecture staff and visitors. ISO50001 certification.

Singapore Institute of Architects Design Award for Healthcare Facility 2011

BCA Universal Design Award (Gold) – Institutional Building

SIA Building of the Year

Chief Gardener Rosalind Tan with AHS’s homegrown giant pumpkin, which weighed 12kg and had a girth of almost 170cm. It snagged the top prize in the yearly Community Garden Edibles Competition in 2016. The mega-pumpkin was so heavy that a harness had to be constructed to support it on the vine. 65

Cementing its green commitment, KTPH KTPH also partnered the National became a member of the Global Green and Environment Agency in food wastage Healthy Hospitals network on 1 October reduction outreach. The aim is to address 2016. We have committed to achieving two the problem of rising food waste in Singapore 2012 AHS won first of of the 10 Agenda Goals: to reduce, treat and go towards a national goal of becoming three consecutive and safely dispose healthcare waste; and to a Zero Waste Nation under the Sustainable Community in Bloom purchase and serve sustainably-grown and Singapore Blueprint 2015. Platinum Awards healthy food. SUSTAINABLE DESIGN FACTS 2013 NPark's Landscape RECYCLING AND The hospitals are orientated in north-east Excellence Assessment REDUCING WASTE and south-west direction to reduce exposure Framework (LEAF) – Certificate Today, AHS’s recycling efforts have increased to direct sunlight and lower the demand on of Recognition from seven categories to 10. Added to the cooling systems. for development list are batteries, fabrics and recyclable projects with Open spaces, large windows in the wards outstanding greenery electronic items. In 2016, a total of 140,575 and being located next to Yishun Pond kg of recyclable waste was collected improve air flow and ventilation. These have (averaging 11,715kg per month). This marks 2014 helped to reduce indoor temperature by one BCA Green Mark a small increase of 3,052kg (2%) over 2015. degree Celsius overall. Platinum Award for YCH Public Utilities Board (PUB) Water Efficient Building (Hospital Sector) – Gold Certificate

Community in Bloom Award (Best Community Garden) and Community in Bloom Platinum Award

2015 PUB Watermark Award

2016 Community in Bloom Diamond Award

ISO50001 Certification for KTPH’s EnMS

Recycling bins are clearly marked, making it easier for staff to dispose their items in the correct bins. 66 TRANSFORMING CARE Green Report Card For the year ended 31 March 2017

Dragonflies and Birds Butterflies Damselflies

66 83 26 species species species

Fish Plants Rooftop Gardens

100 70 7 species species

Electricity Gas Indoor Consumption Consumption Temperature

2.5% 4.8% 1°C increase increase decrease

NeWater Potable Water Recyclable Consumption Consumption Waste 3.0% 6.4% 2.2% decrease decrease increase 67 Operational Highlights For the year ended 31 March 2017

KTPH YCH Beds in A&E Beds in Service Attendances Service 659 136,186 255 3% from 132,171 Bed Bed Occupancy Inpatient Occupancy 92% Admissions 61.7% 4% from 96% 41,841 17% from 35,869 Total Total Inpatient Days Inpatient Days Surgery 49,028 219,013 52,734 6% from 207,526 6% from 49,893 Average Length of Stay 1 Average Day Length of Stay 1 Surgery 23.5

5.1 36,630 Inpatient 9% from 5.6 5% from 34,736 Admissions

Outpatient Inpatient 2,199 Attendances Surgery 396,006 16,104 3% from 385,418 6% from 15,157 68 TRANSFORMING CARE Awards

Community in Bloom 2016 Healthcare Humanity Awards 2016 • Diamond Award: • A/Prof Philip Yap, Senior Consultant and Director, KTPH Geriatric Centre, KTPH • Ms Toh Hai Moy, Senior Nurse Clinician, KTPH People’s Association Community Spirit Award 2016 May Day Awards 2016 • Merit Award: • May Day Comrade of Labour Award: AHS Ms Mary Chan, Nurse Clinician, Ward B85, KTPH

SCDF Star Customer Award 2016 Ministry of Health Nurses’ Merit Award 2016 • KTPH • Ms Si Chanjuan, Nurse Manager, Ward B45, KTPH Singapore Good Design Mark 2017 • Ms Lynette Thng, Nurse Manager, Ward A82, KTPH • SG Mark: Wellness Kampung@765 in conjunction with • Ms Sathiya Veerarhagavan, Nurse Manager, St Luke’s Eldercare Nee Soon Central Centre Ward A71, KTPH • Ms Foo Meow Ling, Nurse Clinician, Infection Control, KTPH Singapore Patient Action Awards 2016 • Ms Sangeetha D/O Sodimani, • Singapore Patient Engagement Assistant Nurse Clinician, Ward B86, KTPH Initiative Award (Team-based): • Ms Kimberly Lim, Senior Staff Nurse, Tri-Generation HomeCare @ North West AIP-CCT, AHS

BioImages Competition 2016 National Day Awards 2016 • Citation of Merit and Medical Education Award in the Still Media Division: The Public Service Medal: Mr Albert Sim, Senior Imaging Specialist, • Mr Anthony Seah Ophthalmology and Visual Sciences, KTPH Board Member, AHS The Commendation Medal (Military): • Mr Tan Boon Khai Distinguished Senior Clinician Award 2016 Board Member, AHS • Prof C Rajasoorya, Senior Consultant, The Public Administration Medal (Bronze) and General Medicine, KTPH The Long Service Medal: • A/Prof Sum Chee Fang, Senior Consultant, • Dr Wong Sweet Fun General Medicine, KTPH Chief Transformation Officer, Hospital Administration, AHS

Ministry of Health Gold Medal for The Public Administration Medal (Bronze) (Military): Professional Conversion Programme • A/Prof Kenneth Mak Senior Consultant, General Surgery, KTPH • Nicholas Cheong, Staff Nurse, A&E, KTPH 69

The Commendation Medal: • Ms Norizah Bte Aziz • Mr Donald Wai Nurse Manager, Nursing Administration, KTPH Director, Hospital Planning, AHS • Ms Rosnah Bte Shahdan The Efficiency Medal: Senior Staff Nurse, Customer Contact Centre, • Ms Lilian Eileen Cheah KTPH Nurse Manager, Ward D87, KTPH • Ms Seow Geok Huay • Ms Foo Tock Cheng Assistant Nurse Clinician, Ward B95, KTPH Senior Patient Service Associate, Dental Clinic, KTPH • Ms Tan Soon Kiow Principal Assistant Nurse, ICU 1 (CCU), KTPH The Long Service Medal: • Mr Abdul Jamal Bin Yahaya Senior Staff Nurse, ICU 2 (Surgical), KTPH National Healthcare Innovation & Productivity Awards 2016 • Dr Azman Johan Senior Consultant, Respiratory Medicine, KTPH • Best Practice Medal (Workforce Transformation Category): • Dr Chan Keen Loong Nurse-led Peri-operative Care for Cataract Head & Senior Consultant, Surgery under Topical Anaesthesia Psychological Medicine, KTPH

• Ms Hamidah Bte Abdul Hamid Senior Staff Nurse, Home Care Service, KTPH National Outstanding Clinician Educator Award 2016 • Ms Hasmah Bte Tomin • A/Prof Pang Weng Sun, Senior Staff Nurse, Ward B105, KTPH Chairman, Medical Board, YCH & • Mr Jamal Bin Rashid Senior Consultant, KTPH Senior Staff Nurse, Geriatric Outpatient Clinic, KTPH PS21 Excellence in Public Service • Ms Kamisah Bte Hassan Awards 2016 Assistant Nurse Clinician, Day Surgery Centre, KTPH • Star Service Award: Mr Mok Chee Peng, Senior Medical Social • Ms Lau Bee Leng Worker, Medical Social Service, KTPH Senior Supervisor, Customer Contact Centre, KTPH Tan Chin Tuan Nursing Award for • Ms Lim Siew Khim Enrolled Nurses 2016 Senior Staff Nurse, Medical Records Office, KTPH • Ms Rostihar Bte Abdul Karim, Principal Assistant Nurse, Ophthalmology and Visual Sciences, KTPH • Dr Lim Tow Poh Senior Consultant, Urology, KTPH

• A/Prof Lim Su Chi Tan Tock Seng Hospital Achievement Award Senior Consultant, General Medicine, KTPH Top Student for Advanced Diploma in Nursing (Gerontology) • Ms Mary Getrude • Wen Rou, Senior Staff Nurse, Nurse Manager, Ward B75, KTPH Geriatric Outpatient Clinic, KTPH 70 TRANSFORMING CARE Clinical Research Awards

Name of Awardee Department Project Title Type of Award Awarding Agency

Dr Edwin Seet, Anaesthesia Melatonin Premedication Best Research Paper Singapore Medical Dr Mei Liaw, Versus Placebo In Wisdom Award - 2nd prize Journal, Singapore Dr Sylvia Tay, Teeth Extraction: A Randomised Ms Chang Su Controlled Trial

Dr Kumar Chandra Anaesthesia Eye Surgery and Anticoagulation Invited International World Congress of Mohan Speaker Anaesthesiologists, Hong Kong

Dr Kumar Chandra Anaesthesia Regional Anaesthesia for Invited International World Congress of Mohan Ophthalmic Surgery Speaker Anaesthesiologists, Hong Kong

Dr Kumar Chandra Anaesthesia Ophthalmic Regional Anaesthesia Invited Workshop World Congress of Mohan Workshop Leader Anaesthesiologists, Hong Kong

Dr Kumar Chandra Anaesthesia Anatomy for Ophthalmic Invited International 4th World Congress Mohan Regional Anaesthesia Speaker of Ophthalmic Anaesthesia, India

Dr Kumar Chandra Anaesthesia Sub-Tenon’s Block Workshop Invited International 4th World Congress Mohan Speaker of Ophthalmic Anaesthesia, India

Dr Kumar Chandra Anaesthesia Problem Based Learning, Eye Blocks Invited International European Society of Mohan Speaker Regional Anaesthesia, Netherlands

Dr Kumar Chandra Anaesthesia The Role of Spinal Anaesthesia in Invited International European Society of Mohan Abdominal Surgery Speaker Regional Anaesthesia, Netherlands 71

Name of Awardee Department Project Title Type of Award Awarding Agency

Dr Kumar Chandra Anaesthesia Myths & Mysteries of Continuous Invited International Philippines Society of Mohan Spinal Anaesthesia Speaker Anaesthesiologists, Philippines

Dr Kumar Chandra Anaesthesia Role of Continuous Spinal Anaesthesia Invited International Philippines Society of Mohan in Major Abdominal Surgery Speaker Anaesthesiologists, Philippines

Dr Paul Wong Anaesthesia Hip Fracture: Pain Control - “Our Top Project: Invited National Health Story in a Bottle” National Speaker Group Annual Clinical Practice Improvement Programme (CPIP) Graduation, Singapore

Dr Edwin Seet, Anaesthesia & Mobile Phone App-Based Novel Best Abstract Award Society of Dr Daniel Chia Transformation Oximetry System Anaesthesia and Office Sleep Medicine, USA

Dr Sharon Pek Clinical Research Prevalence of Peripheral Arterial Singapore Young Singapore Health and Unit Disease and Peripheral Neuropathy Investigator Award Biomedical Congress, in Early-Onset Diabetes in a Cohort – Clinical Research Singapore of Multi-Ethnic Patients With Type 2 (YIA-CR) (SILVER) Diabetes

A/Prof Lim Su Chi Clinical Research The Metabolomics of Progressive Clincial Scientist National Medical Unit Diabetic Kidney Disease (DKD) in Award Research Council Young-Onset Type 2 Diabetes (NMRC)

Dr Ester Yeoh, General Medicine Fasting during Ramadan and Annals’ Gold Best Annals, Academy of Dr Sueziani Binte Associated Changes in Glycaemia, Paper Award Medicine, Singapore Zainudin, Caloric Intake and Body Composition Ms Loh Win Nie, with Gender Differences in Singapore Ms Chua Chin Lian, Ms Sharon Fun, A/Prof Subramaniam Tavintharan, A/Prof Sum Chee Fang, A/Prof Lim Su Chi

Dr Lang Tee Ung, Laboratory Medicine Accuracy Rate of Fine Needle Best Poster Award Diagnostic Dr Vijayadwaja Desai Aspiration in Lymph Node Cytopathology Workshop, Yong Loo Lin School of Medicine, Singapore

Ms Nithiya Isnarti, Pharmacy Structured Competency Training for Commended Poster Singapore Pharmacy Ms Mariem Bte Anwar, Pharmacy Technician in Khoo Teck Award, Quality Congress, Singapore Ms Jessie Chang, Puat Hospital Improvement (Allied Ms Lee Siok Ying, Health) Ms Claudine Oh 72 TRANSFORMING CARE Journal Publications

Department Authors Title of Paper Published Journal Name Volume Page No.

Acute and Ahn Jung Hwan, Jeon A Novel Point of Care Ultrasound SEARCH 8Es 12(3) doi: Emergency Care Jin, Toh Hong-Chuen, Protocol for Patients with Chest 10.1371/ Vicki Elizabeth Noble, Pain, Dyspnea or Symptomatic journal. Jun Su Kim, Young Hypotension in the Emergency pone. Sik Kim, Han Ho Do, Department 0174581 Young Rock Ha

Acute and Ashish Chawla, Electrocardiogram: The Saviour Netherlands Heart 24 366-367 Emergency Care Shobhit Swarup, for This Patient Journal Vishal Pralhad Gaikwad

Acute and Desmond Mao, Public Access Defibrillation: British Medical 118 25-32 Emergency Care Marcus Ong Improving Accessibility and Bulletin Outcomes

Acute and Desmond Mao, High-Rise Residential Canadian Medical - doi: 10.150 Emergency Care Marcus Ong Resuscitation - Scaling Journal 3/cmaj.151 the Challenge 044

Anaesthesia Chandra Mohan The Wiley Spinal Catheter-Over- Regional July-August - Kumar Needle System for Continuous Anesthesia and 2016, Spinal Anesthesia: Questions Pain Medicine 41(4):546-7 Remain

Anaesthesia Chandra Mohan Stopping Antithrombotics During British Journal of Feb;118(2) 154-158 Kumar, Edwin Seet Regional Anaesthesia and Eye Anaesthesia Surgery: Crying Wolf?

Anaesthesia Chandra Mohan Effective and Cost-Saving Indian Journal of Jan;61(1) 84-85 Kumar, Edwin Seet Incisionless Sub-Tenon’s Block Anaesthesia

Anaesthesia Chandra Mohan Time to Abandon Routine British Journal of January 2016, - Kumar, Edwin Seet Preoperative Tests Before Anaesthesia Correspondence Cataract Surgery under Local Anaesthesia

Anaesthesia Chandra Mohan Cataract Surgery in Dementia British Journal of 117 421-425 Kumar, Edwin Seet Patients - Time to Reconsider Anaesthesia Anaesthetic Options

Anaesthesia Chandra Mohan Glycaemic Control During British Journal of 117 687-691 Kumar, Edwin Seet, Cataract Surgery under Loco- Anaesthesia Tom Eke, Ketan Regional Anaesthesia: A Dhatariya, Girish P. Growing Problem and We Are Joshi None the Wiser

Anaesthesia Chandra Mohan Reply from the Authors: British Journal of 116 432 Kumar, Foo Chong Schneider Regimen Vs a Anaesthesia Wee, Chen Xinying Volatile Inhalation Anaesthetic (Desflurane) for Laparoscopic Adrenalectomy and Additional Considerations for Delivery of Anaesthesia

Anaesthesia Daryl Tan, Tan Leng Low-Skill Flexible Bronchoscopic Journal of Clinical May;38 83-84 Zoo, Edwin Seet Intubation - Overcoming Anesthesia Common Pitfalls

Anaesthesia Edwin Seet, Chandra Intubation: Never Blind Trends in 6 32 Mohan Kumar Anymore (Editorial) Anaesthesia and Critical Care 73

Department Authors Title of Paper Published Journal Name Volume Page No.

Anaesthesia Edwin Seet, Chandra Clinical Relevance of Human British March 2016, Online Mohan Kumar Cadaveric Studies on Journal of Correspondence Oesophageal Sealing Pressures Anaesthesia for Supraglottic Airway Devices

Anaesthesia Edwin Seet, Chandra Paradigm Shifts in Anaesthesia Trends in 9 doi: Mohan Kumar (Editorial) Anaesthesia and 10.1016/ Critical Care j.tacc.2016. 09.001

Anaesthesia Kumaresh C-MAC Videolaryngoscopy British Medical June 2016, Online Venkatesan, Tan Leng Associated with Higher Force on Journal Correspondence Zoo, Koh Kwong Fah, Maxillary Incisors Edwin Seet

Anaesthesia Liaw Chen Mei, Author’s Reply: Comment On: Singapore Medical 57 102 Maureen Chua, High STOP-Bang Questionnaire Journal Edwin Seet Scores Predict Intraoperative and Early Postoperative Adverse Events

Anaesthesia Murukuti Muruthee Tracheal Injury Using a Gum Anaesthesia 44 428 Vara Prasad, Lim Elastic Bougie within a RAE and Intensive Care Kim Seong, Chandra Endotracheal Tube Mohan Kumar

Anaesthesia Shahla Siddiqui A Physician’s Moral Dilemma J of Emergency 51 748-749 in the Emergency Department: Medicine Going Against a Patient’s Perceived Wishes

Anaesthesia Shahla Siddiqui What are the Situations that Asian Bioethics May 2016, 143-145 Trouble Me Professionally?: The Review Volume 8, Story of “Uncle Fred” Issue 2

Anaesthesia Shahla Siddiqui Ethical Challenges Facing Asian Bioethics March 2016 53-65 Advance Care Planning Review Volume 8, Issue 1

Anaesthesia Shahla Siddiqui Dying within Dying: Ethical Indian Journal May 2016, 56 Dilemmas of Treating Terminally of Critical Care Volume 20, Ill Patients with Acute Life Medicine Issue 5 Threatening Illnesses

Anaesthesia Shahla Siddiqui The Use of Four‑Point Indian Journal of May 2016, 79 Transversus Abdominis Plane Anaesthesia Volume 60, Block for Liver Resection Issue 5

Anaesthesia Shahla Siddiqui, Having It All - Burnout and Moral Int J of health 6 47-51 Alyssa Chiew, Karen Distress in Working Female Sciences and Soh, T Thirumoorthy Physicians in a Developed Research Asian Country

Anaesthesia Van Zundert AA, Gatt Vision-Guided Placement of British Journal of Mar 1;118(3) 462-463 SP, Chandra Mohan Supraglottic Airway Device Anaesthesia Kumar, Van Zundert TC Prevents Airway Obstruction: A Prospective Audit

Anaesthesia Van Zundert AAJ, Malpositioning of Supraglottic British Journal of 116 579-582 Chandra Mohan Kumar, Airway Devices: Preventive and Anaesthesia Van Zundert TC Corrective Strategies (Editorial) 74 TRANSFORMING CARE Journal Publications

Department Authors Title of Paper Published Journal Name Volume Page No.

Anaesthesia & Shahla Siddiqui, A Survey of Knowledge About Journal of April 2016, 346 Nursing Anusha Kannan, Ebola Haemorrhagic Fever the College of Volume P. Sivamalar, Chai Amongst Anaesthesia Staff Physicians and 26 (4) Chee Peng Surgeons Pakistan

Anaesthesia & Shahla Siddiqui, A 6‑Month Audit of Epidural Indian Journal May 2016, 101-107 Nursing Claudia Quek, Analgesia in a Teaching Hospital of Pain Volume Murukuti MV Prasad, 30, Issue 2 Kumaresh Venkatesan

Anaesthesia, Woo Jyh Haur, Ng Perioperative Glycaemic Singapore Medical 57(2): 64-8. doi: Ophthalmology and Wei Di, Salah Maaz Control in Diabetic Patients Journal 10.11622/ Visual Sciences Mohammad, Kumari Undergoing Cataract Surgery smedj. Neelam, Au Eong under Local Anaesthesia: 2016029. Kah-Guan, Chandra A Survey of Practices of Mohan Kumar Singapore Ophthalmologists and Anaesthesiologists

Anaesthesia, Ong Yu Zheng, Shahla The Prevalence of Post- Annals Academy of May 2016, 215-217 Psychological Siddiqui, Surej John, Traumatic Stress Disorder in Medicine Singapore Volume Medicine & Nursing Zen Chen, Chang Su Intensive Care Unit Staff and the 45, No. 5 Common Coping Strategies Used

Cardiology Cruz Patrick John Swinging Through Life: A Case of CASE: Cardiovascular 1 23-27 Jacinto a Pendulum Heart Imaging Case Reports

Cardiology William Kong, Victoria Prognostic Implications of Raphe JAMA Cardiology 2(3): 285-292. doi: 10.1001/ Delgado, Kian Keong in Bicuspid Aortic Valve Anatomy jamacardio. Poh, Madelien Regeer, 2016.5228 Arnold Ng, Louise McCormack, Tiong Cheng Yeo, Miriam Shanks, Sarah Parent, Roxana Enache, Bogdan A. Popescu, Michael Liang, James Yip, Lawrence Ma, Vasileios Kamperidis, Philippe J. van Rosendael, Enno T. van der Velde, Nina Ajmone Marsan, Jeroen J. Bax

Clinical Research Angela Moh, Association of the Anti- Journal of Diabetes doi:10.1016/j. - Unit Sum Chee Fang, Angiogenic Factor Secreted and its Complications jdiacomp. Tavintharan Protein and Rich in Cysteine 2016.03.029 Subramaniam, Sharon (SPARC) with Vascular Pek, Yeoh Lee Ying, Complications Among Chinese Ng Xiaowei, Simon Type 2 Diabetic Patients in Lee, Tang Wern Ee, Singapore Lim Su Chi

Clinical Research Ang Su Fen, Lim A Preliminary Study to Evaluate Diabetes Research doi:10.1016/j. - Unit Su Chi, Clara Tan, the Strategy of Combining and Clinical Practice diabres. Jessie Fong, Winston Clinical Criteria and Next 2016.06.008 Kon YC, Joyce Generation Sequencing (NGS) for Lian, Tavintharan the Identification of Monogenic Subramaniam, Sum Diabetes Among Multi-Ethnic Chee Fang Asians 75

Department Authors Title of Paper Published Journal Name Volume Page No.

Clinical Research Dorajoo Sreemanee Hba1c Variability in Type 2 Diabetes doi:http://dx.doi. - Unit Raaj, Ng Shi Ling Diabetes is Associated with Research org/10.1016/j. Joceline, Goh Hui Fen the Occurrence of New-Onset and Clinical diabres. Jessica, Lim Su Chi, Albuminuria within Three Years Practice 2017.02.007 Yap Chun Wei, Chan Alexandre, Lee Yu Chia Joyce

Clinical Research Huo Jianxin, Ma Yi, Loss of Fas Apoptosis Inhibitory Cell Death 7 e2091 Unit Liu Jian Jun, Ho Ying Molecule Leads to Spontaneous and Disease Swan, Sylvia Liu, Soh Obesity and Hepatosteatosis Li Ying, Chen Shuwen, Xu Shengli, Han Weiping, Hong An, Lim Su Chi, Lam Kong Peng

Clinical Research Joel Lim, Ang Su Fen, Cessation of Multiple Daily Diabetes doi:10.4172/ - Unit Clara Tan, Jessie Insulin Injections in a Person Case Report 2572-5629. Fong, Lim Su Chi with Twenty-Nine Years of “Type 1000122 1 Diabetes”

Clinical Research Lim Su Chi, Rajkumar Genetic Variants in the Receptor Nephrology Dialysis doi:10.1093/ndt/ doi:10.1093/ Unit Dorajoo, Zhang Xiao, for Advanced Glycation End Transplantation gfw263 ndt/gfw263 Wang Ling, Ang Su Products (RAGE) Gene Were Fen, Clara Tan, Yeoh Associated with Circulating Lee Ying, Ng Xiaowei, Soluble RAGE Level (Srage), But Li Na, Chang Su, Sylvia Not with Renal Function Among Liu, Melvin Wong, Asians with Type 2 Diabetes: A Serena Low, Amy Genome-Wide Association Study Yao, Babitha Jeevith, Sharon Fun, Zhou Shiyi, Simon Lee, Tang Wern Ee, Tavintharan Subramaniam, Sum Chee Fang, Liu Jian Jun

Clinical Research Liu Jian Jun, Lim Ethnic Disparities in Risk of Diabetic Medicine 33 332-339 Unit Su Chi, Yeoh Lee Cardiovascular Disease, End- Ying, Chang Su, Stage Renal Disease and All- Tai Bee Choo, Cause Mortality: A Prospective Serena Low, Sharon Study Among Asian People with Fun, Tavintharan Type 2 Diabetes Subramaniam, Chia KS, Tai E Shyong, Sum Chee Fang

Clinical Research Liu Jian Jun, Sylvia Liu, Urinary Haptoglobin Predicts The Journal doi:10.1210/ 101(10): Unit Melvin Wong, Resham Rapid Renal Function Decline in of Clinical jc.2016- 3794-3802 Lal Gurung, Lim Su Chi Asians with Type 2 Diabetes and Endocrinology & 2094 Early Kidney Disease Metabolism

Clinical Research Liu Jian Jun, Sujoy Profiling of Plasma Metabolites Kidney doi:10.1016/j. - Unit Ghosh, Jean-P Suggests Altered Mitochondrial International ekir.2016. Kovalik, Ching Fuel Usage and Remodelling Reports 12.003 Jianhong, Choi Hyung of Sphingolipid Metabolism in Won, Tavintharan Individuals with Type 2 Diabetes Subramaniam, Ong and Kidney Disease Choon Nam, Sum Chee Fang, Scott A. Summers, Tai E Shyong, Lim Su Chi 76 TRANSFORMING CARE Journal Publications

Department Authors Title of Paper Published Journal Name Volume Page No.

Clinical Research Sharon Pek, Sum Circulating and Visceral Adipose Molecular doi:10.1016/j. - Unit Chee Fang, Michelle Mir-100 is Down-Regulated in and Cellular mce.2016.03. Lin, Anton Cheng, Patients with Obesity and Type 2 Endocrinology 010 Michael Wong, Lim Diabetes Su Chi, Tavintharan Subramaniam

Clinical Research Serena Low, Tai E Onset and Progression of Kidney Journal of doi:10.1016/j. - Unit Shyong, Yeoh Lee Disease in Type 2 Diabetes Diabetes and its jdiacomp.2016. Ying, Allen Liu, Liu Among Multi-Ethnic Asians Complications 05.020 Jian Jun, Kristin Tan, Population Sharon Fun, Zhang Xiao, Tavintharan Subramaniam, Sum Chee Fang, Lim Su Chi

Clinical Research Serena Low, Lim Development and Validation of Diabetes Research doi:http://dx. - Unit Su Chi, X Zhang, SY A Predictive Model for Chronic and Clinical Practice doi.org/10.1016/ Zhou, Yeoh Lee Ying, Kidney Disease Progression in Type j.diabres.2016. Allen Liu, Tavintharan 2 Diabetes Mellitus Based on A 13- 11.008 Subramaniam, Sum Year Study in Singapore Diabetes Chee Fang Research and Clinical Practice

Clinical Research Serena Low, Lim Su The Effect of Long-Term Journal of Diabetes doi:10.1111/ - Unit Chi, Yeoh Lee Ying, Glycemic Variability on Estimated 1753-0407. Allen Liu, Liu Jian Glomerular Filtration Rate 12512 Jun, Sharon Fun, Decline Among Patients with Chang Su, Zhang Type 2 Diabetes Mellitus - Xiao, Tavintharan Insights from the Diabetic Subramaniam, Sum Nephropathy Cohort in Singapore Chee Fang

Clinical Research Tavintharan Association of Apolipoprotein- Metabolism doi:10.1016/j. - Unit Subramaniam, Lim Su CIII (apoC-III), endothelium- metabol Chi, Sum Chee Fang dependent vasodilation and Peripheral Neuropathy in a multi-ethnic population with Type 2 Diabetes

Clinical Research Yoong Hun Ong, Wei Glutamic Acid Decarboxylase Diabetic doi:10.1111/ - Unit Choon Alvin Koh, Mei and Islet Antigen 2 Antibody Medicine dme.13358 Li Ng, Lim Su Chi Profiles in People with Adult- Onset Diabetes Mellitus: A Comparison Between Mixed Ethnic Populations in Singapore and Germany

Clinical Research Zhang Xiao, Liu Central Arterial Stiffness is Diabetes and doi:10.1177/ - Unit Jian Jun, Sum Chee Associated with Systemic Vascular Disease 147916411 Fang, Yeoh Lee Inflammation Among Asians with Research 6635021 Ying, Tavintharan Type 2 Diabetes Subramaniam, Ng Xiaowei, Chang Su, Serena Low, Simon Lee, Tang Wern Ee, Lim Su Chi

Clinical Research Zhang Xiao, Liu Ethnic Disparity in Inter- Journal of the doi:https://doi. - Unit Jian Jun, Sum Chee Arm Systolic Blood Pressure ASEAN Federation org/10.15605/ Fang, Yeoh Lee Difference and Its Determinants of Endocrine jafes.031.02.02 Ying, Tavintharan Among Asians with Type 2 Societies Subramaniam, Li Na, Diabetes: A Cross-Sectional Study Chang Su, Serena Low, Simon Lee, Tang Wern Ee, Lim Su Chi 77

Department Authors Title of Paper Published Journal Name Volume Page No.

Diabetes Centre Jeremy Hoe, Ester Validation of A New Formula Diabetes doi:http://dx.doi. - Yeoh, Chee Fang Sum, (SMART2D) for Estimation of Research org/10.1016/ Lim Su Chi, Moh Sim LDL Cholesterol in Patients with and Clinical S0168-8227 Wong, Aznan Omar, and without Diabetes Practice (16)31036-1 Steven Tsai, Ping Ying Heng, Tavintharan Subramaniam

Diagnostic Radiology Ashish Chawla, Tan The Perianal “Horseshoe” Abdominal 41(1) 203-204 Min On, Manickam Radiology Subramanian, Jerome (New York) Iral Ezhll Bosco

Diagnostic Radiology Ashish Chawla, Schematic Interpretation of Emergency 23(1) 79-87 Jagadish Narayana Lateral Neck Radiographs Radiology Shenoy, Lim Tze of Adults in the Emergency Chwan, Dinesh Department: A Pictorial Review Rambachan Singh

Diagnostic Radiology Ashish Chawla, Jerome Systemic-Pulmonary Artery Journal of Medical 61(1) 82-84 Iral Ezhll Bosco, Lim Shunt; A Rare Cause of False Imaging and Tze Chwan, Vishal Positive Filling Defect in the Radiation Oncology Pralhad Gaikwad, Pulmonary Arteries Raymond Chung

Diagnostic Radiology Chou Hong, Chin Teck Dual-Energy CT in Gout - A Journal of Medical 64(1) 41-51 Yew, Wilfred Peh Review of Current Concepts and Radiation Sciences Applications.

Diagnostic Radiology Cynthia Assimta Peter, A “Doughnut” in the Abdomen Abdominal 42(3) 973-974 Dinesh Rambachan Radiology Singh (New York)

Diagnostic Radiology Dinesh Rambachan Turtleback Liver Abdominal 42(1) 326-327 Singh, Mukherjee P, Radiology Ashish Chawla (New York)

Diagnostic Radiology Goh Lin Wah, Wong Su Four Cases of Echogenic Breast Singapore Medical 57(6) 339-343 Lin, Tan Puay Hoon Lesions: Case Series and Review Journal

Diagnostic Radiology Goh Lin Wah, Dinesh Clinics in Diagnostic Singapore Medical 57(3) 161-165 Chinchure, Lim Tze Imaging (166). Nonketotic Journal Chwan Hyperglycaemic Chorea- Hemiballismus

Diagnostic Radiology Kabilan Chokkappan, Review of Diagnostic Uses of Annals of Thoracic 11(2) 155-160 Kannivelu A, Shunt Fraction Quantification with Medicine Sivasubramanian Technetium-99m Macroaggregated Srinivasan, Suresh Albumin Perfusion Scan as Balasubramanian Babu Illustrated by a Case of Osler- Weber-Rendu Syndrome

Diagnostic Radiology Kabilan Chokkappan, An Approach to Various Gastric Current Problems 45(1) 23-38 Dinesh Chinchure, Pathologies Using an “Image in Diagnostic Ashish Chawla, Appearance-Based Classification” Radiology Manickam on Computed Tomography Subramanian, Vijay Krishnan, Jagadish Narayana Shenoy, Sivasubramanian Srinivasan 78 TRANSFORMING CARE Journal Publications

Department Authors Title of Paper Published Journal Name Volume Page No.

Diagnostic Radiology Manickam The Embedded Organ Sign Abdominal 42(1) 330-331 Subramanian, Dinesh Radiology Rambachan Singh, (New York) Ashish Chawla

Diagnostic Radiology Manickam Subramanian, Clinics in Diagnostic Imaging Singapore Medical 58(2) 79-84 Chou Hong, Kabilan (174). L5 Vertebral Superior Journal Chokkappan, Wilfred Peh Facet Osteoblastoma (OB)

Diagnostic Radiology Mukherjee P, Ashish The “Gallbladder Pearl Abdominal 41(5) 1001-1002 Chawla, Dinesh Necklace” Sign Radiology Rambachan Singh, (New York) Raymond Chung

Diagnostic Radiology Raymond Chung, Philip Endovascular Management of CardioVascular 39(1) 36-43 Touska, Robert Morgan, True Renal Arterial Aneurysms: and Interventional Anna-maria Belli Results from a Single Centre Radiology

Diagnostic Radiology Vishal Pralhad Clinics in Diagnostic Imaging Singapore Medical 58(1) 29-33 Gaikwad, Ashish (173). Scimitar Syndrome with Journal Chawla, Lim Tze Horseshoe Lung Chwan, Wilfred Peh

Diagnostic Radiology Vijay Krishnan, Lim Tze Clinics in Diagnostic Imaging Singapore Medical 58(3) 121-125 Chwan, Francis Ho, (175). Corpus Callosum Journal Wilfred Peh Glioblastoma Multiforme (GBM): Butterfly Glioma

General Medicine Ester Yeoh, Boon Efficacy of Self-Monitoring Nephrology doi: 10/1111/ epub Khim Lim, Sharon of Blood Glucose Versus (Carlton) nep.12978 Fun, Julia Tong, Lee Retrospective Continuous Ying Yeoh, Chee Fang Glucose Monitoring in Improving Sum, Tavintharan Glycaemic Control in Diabetic Subramaniam, Lim Kidney Disease Patients Su Chi

General Medicine Wei Xin Khong, Kalisvar Tracking Inter-Institutional Journal of - 3081-3089 Marimuthu, Jeanette Spread of NDM and Identification Antimicrobial Teo, Yichen Ding, of a Novel NDM-Positive Chemotherapy 2016 Eryu Xia, Jia Jun Lee, Plasmid, Psg1-NDM, Using Rick Ong, Indumathi Next-Generation Sequencing Venkatachalam, Approaches Benjamin Cherng, Surinder Kaur Pada, Weng Lam Choong, Nares Smitasin, Say Tat Ooi, Rama Narayana Deepak, Asok Kurup, Raymond Fong, My Van La, Thean Yen Tan, Tse Hsien Koh, Raymond Lin, Eng Lee Tan, Prabha Unny Krishnan, Siddharth Singh, Johann D. Pitout, Yik-Ying Teo, Liang Yang, Oon Tek Ng

General Medicine & Marius N. Stan, Vikram Riedel’s Thyroiditis Association Clinical doi:10.1111/ doi: 10.1111/ Endocrine Sonawane, Thomas J. with Igg4-Related Disease Endocrinology cen.13238 cen.13238 Sebo, Prabin Thapa, Rebecca S. Bahn 79

Department Authors Title of Paper Published Journal Name Volume Page No.

General Medicine & Vikram Sonawane, A Laparascopic Revelation Singapore - - Endocrine Reyaz Singaporewalla, - Incidental Nodule 1 in Medical Nga Min En, C a Patient with Bilateral Journal Rajasoorya Phaeochromocytoma in MEN-2A

General Medicine & Shail Govani, Eric Predictors of Suboptimal Bowel World Journal of 8(17) 616-622 Gastroenterology Elliott, Stacey Menees, Preparation in Asymptomatic Gastrointestinal Stephanie Judd, Sameer Patients Undergoing Average- Endoscopy Saini, Constantinos Risk Screening Colonoscopy Anastassiades, Annette Urganus, Suzanna Boyce, Philip Schoenfeld

General Surgery Danson Yeo, Tan Chun Laparoscopic Transhiatal Repair Case Studies in 2(2) 44-48 Hai, Tay Siew Hua, of Esophageal Rupture in Surgery Eugene Lim, Anton Cheng Boerhaave Syndrome is a Safe and Effective Treatment

General Surgery Daniel Lee, Tan Yen Pin, Salvage Technique for World Journal 9(1) 1-5 Reyaz Singaporewalla Intraoperative Hemorrhage of Endocrine During Laparoscopic Resection of Surgery Large Pheochromocytoma: A Case Report and Literature Review

General Surgery Jun Su, Clement Chia, Laparoscopic Hartmann Reversal: Asian Journal 9(2) 161-162 Surendra K Mantoo Video Presentation of a Case of Endoscopic Surgery

General Surgery Ng Zhi Xu, Eugene Cerebellar Strokes: A Clinical Singapore 56(3) 145-149 Yang, Edwin Seet, Koh Outcome Review of 79 Cases Medical Journal Kiok Miang, Teo Ke Jia, Low Shiong Wen, Chou Ning, Yeo Tseng Tsai, Venketasubramanian N

General Surgery Quah Boon Leong, Is There an Optimal Time for World epub - Low Hu Liang, Mark H. Performing Cranioplasties? Neurosurgery Wilson, Alexios Bimpis, Results from a Prospective Vincent Nga, Sein Lwin, Multinational Study Noor Hazlina Zainuddin, Nasser Abd Wahab, Md Al Amin Salek

General Surgery Reyaz Singaporewalla, Clinicopathological Correlation of World Journal epub - Hwee Jolie, Lang Tee Thyroid Nodule Ultrasound and of Surgery Ung, Desai Vijayawada Cytology Using the TIRADS and Bethesda Classification

General Surgery Sachin Mathur, Jerry Changing Models of Care for Singapore 57(6) 282-286 Goo, Tan Kok Yang, Emergency Surgical and Trauma Medical Journal Kenneth Mak Patients in Singapore

General Surgery & Serene Goh, Ester Yeoh, Impact of Perioperative Int J Colorectal 32 (2) 209-214 General Medicine Tan Kok Yang Hypoglycaemia in Subjects with Dis Diabetes Undergoing Colorectal Surgery

General Surgery Tan Chun Hai, Heidi Laparoscopic Removal of Journal of 26(1) 47-50 Chang, Cheah Yee Lee Intrahepatic Foreign Body: A Laparoendoscopic Novel Technique for Management & Advance Surgical of an Unusual Cause of Liver Techniques Abscess-Fish Bone Migration 80 TRANSFORMING CARE Journal Publications

Department Authors Title of Paper Published Journal Name Volume Page No.

General Surgery Ting Hway Wong, Gek Buckling Up in Singapore: BMC Public Health 16 402 Hsiang Lim, Khuan Residency and Other Risk Yew Chow, Nyi Nyi Factors for Seatbelt Non- Zaw, Hai Van Nguyen, Compliance - A Cross- Hoong Chor Chin, Sectional Study Based on Marcus Eng Trauma Registry Data

Geriatric Education Michael J. Penkunas, The Role of a Multicomponent Journals of 00 1-12 and Research Institute Angelique Chan, Chek Home-Health Intervention in Gerontology: Social & AHS Transformation Hooi Wong, Dirk F. de Reducing Caregiver Stress in Sciences [The Office Korne, Tan See Mieng Singapore: A Qualitative Study Gerontological Tan, Wong Sweet Fun Society of America]

Geriatric Medicine Cheong Chin Yee, Jane Creative Music Therapy in an Dementia and doi:10.1159/ - Tan, Foong Yi-Lin, Acute Care Setting for Older Geriatric Cognitive 000445883 Koh Hui Mien, Denise Patients with Delirium and Disorders Extra Chen, Jessie Tan, Ng Dementia Chong Jin, Philip Yap

Geriatric Medicine Iris Rawtaer, Qi Gao, Psychosocial Risk and Journal of 57 (2017) 603-611 Ma Shwe Zin Nyunt, Protective Factors and Incident Alzheimer’s Disease Lei Feng, Mei Sian Mild Cognitive Impairment Chong, Wee Shiong and Dementia in Community Lim, Tih-Shih Leed, Dwelling Elderly: Findings from Philip Yap, Keng Bee the Singapore Longitudinal Yap, Tze Pin Ng Ageing Study

Geriatric Medicine Jane Tuomola, Soon Lived Experience of Caregivers of Journal of (2):157-72 doi:10.1007/ Jiaying, Paul Fisher, Persons with Dementia and the Cross-Cultural s10823-016- Philip Yap Impact on Their Sense of Self: A Gerontology 9287-z Qualitative Study in Singapore

Geriatric Medicine Liang Feng, Ma Shwe Physical Frailty, Cognitive Impairment, Journals of Volume 72 No. 3, 369- Zin Nyunt, Qi Gao, Lei and The Risk of Neurocognitive Gerontology: 375 Feng, Tih Shih Lee, Disorder in the Singapore Longitudinal Medical Sciences Tung Tsoi, Mei Sian Ageing Studies Chong, Wee Shiong Lim, Simon Collinson, Philip Yap, Keng Bee Yap, Tze Pin Ng

Geriatric Medicine Lo Tong Jen, Ngoc Unmarried Patients with Early International - PubMed Huong Lien Ha, Ng Cognitive Impairment Are More Likely Psychogeriatrics PMID: Chong Jin, Gabriel Than Their Married Counterparts to 27876108 Tan, Koh Hui Mien, Complete Advance Care Plans Philip Yap

Geriatric Medicine Michael Penkunas, Evaluation Methodology for a Home- International 2016;16(6): doi:http:// Wong Chek Hooi, Based Integrated Care Program Journal of A297 doi.org/ David Matchar, Targeting Frequently Hospitalised Integrated Care 10.5334/ Angelique Chan, Older Adults in Singapore ijic.2845 Wong Sweet Fun

Geriatric Medicine Tam Wai Jia, Philip Yap Health Care for Older Adults Journal of the doi:10.1111/ - in Uganda: Lessons for the American Geriatrics jgs.14560 Developing World Society

Geriatric Medicine Toh Hui Jin, Lim Zhen Factors Associated with Prolonged Singapore Medical doi:10.11622/ - Yu, Philip Yap, Terence Length of Stay in Older Patients Journal smedj.2016158. Tang 81

Department Authors Title of Paper Published Journal Name Volume Page No.

Geriatric Medicine Wang Pei, Philip Yap, Quality of Life and Related Health and Quality 14(1):112 - Gerald Koh, Chong Factors of Nursing Home of Life Outcomes Jia An, Lucy Jennifer Residents in Singapore Davies, Dalakoti Mayank, Fong Ngan Phoon, Tiong Wei Wei, Luo Nan

Geriatric Medicine Shan Huang, Konstandina Non-Use of Day Care Services International doi:https://doi. 1-12 & Psychological Griva, Christina Bryant, for Dementia in Singapore - A Psychogeriatics org/10.1017/ Medicine Philip Yap Dilemma for Caregivers S1041610216 001940

Laboratory Medicine Wei Xin Khong, Kalisvar Tracking Inter-Institutional Journal of Vol 71, 3081-3089 Marimuthu, Jeanette Spread of NDM and Identification Antimicrobial Issue 11 Teo, Yichen Ding, Eryu of a Novel NDM-Positive Chemotherapy Xia, Jia Jun Lee, Rick Plasmid, Psg1-NDM, Using Twee-Hee Ong, Indumathi Next-Generation Sequencing Venkatachalam, Benjamin Approaches Cherng, Surinder Kaur Pada, Weng Lam Choong, Nares Smitasin, Say Tat Ooi, Rama Narayana Deepak, Asok Kurup, Raymond Fong, My Van La, Thean Yen Tan, Tse Hsien Koh, Raymond Tzer Pin Lin, Eng Lee Tan, Prabha Unny Krishnan, Siddharth Singh, Johann D. Pitout, Yik-Ying Teo, Liang Yang and Oon Tek Ng

Nursing Ong Shu Fen, Pamela Learning Needs of Hospitalised The Journal of - - Foong, Juanna Seah, Patients with Heart Failure Nursing Research Lavanya Elangovan, Wang in Singapore: A Descriptive Wenru Correlational Study

Ophthalmology and Catherina Josephine The Effect of a Diving Mask Case Rep doi: 10.1159/ - Visual Sciences Goenadi, David Law, Lee on Intraocular Pressure in a Ophthalmol. 000446423. Jia Wen, Ong Ee Lin, Healthy Population Chee Wai Kitt, Jason Cheng

Ophthalmology and Cheung Ning, Tan Shu- Prevalence and Risk Factors British Journal of doi:10.1136/ - Visual Sciences Pei, Lee Shu Yen, Gemmy for Epiretinal Membrane: The Ophthalmology bjophthalmol- Cheung, Gavin Tan, Singapore Epidemiology of Eye 2016-308563 Neelam Kumar, Cheng Disease Study Ching-Yu, Wong Tien Yin

Ophthalmology and Colin Tan, Milton Chew, Measuring the Precise Area British Journal of doi:10.1136/ - Visual Sciences Jano van Hemert, of Peripheral Retinal Non- Ophthalmology bjophthalmol- Michael Singer, Darren Perfusion Using Ultra-Widefield 2015-306652 Bell, SriniVas Sadda Imaging and Its Correlation with the Ischaemic Index

Ophthalmology and Colin Tan, Milton Chew, Advances in Retinal Imaging Indian Journal of doi:10.4103/ - Visual Sciences Louis Lim, SriniVas for Diabetic Retinopathy and Ophthalmology 0301-4738. Sadda Diabetic Macular Edema 178145

Ophthalmology and Kelvin Li, Colin Tan Comment on Visual Impact of International doi:10.18240/ - Visual Sciences Sub-Tenon Anesthesia During Journal of ijo.2016.02.29 Combined Phacoemulsification Ophthalmology and Vitrectomy Surgery

Ophthalmology and Tan Li Li, Sanjay Repeatability of Infrared Ocular Contact Lens & doi:10.1016/j. - Visual Sciences Srinivasan, Philip Morgan Thermography in Assessing Anterior Eye clae.2016.01.010 Healthy and Dry Eyes 82 TRANSFORMING CARE Journal Publications

Department Authors Title of Paper Published Journal Name Volume Page No.

Ophthalmology and Tan Li Li, Sanjay Static and Dynamic Journal of 2016:7285132. doi: 10.1155/ Visual Sciences Srinivasan, Philip Measurement of Ocular Surface Ophthalmology 2016/7285132 Morgan Temperature in Dry Eyes . Epub 2016 Jun 28.

Ophthalmology and Yee Hah Yan, Case Report: An Ominous Advances in doi:10.15406/ 6(5): 00195 Visual Sciences Benjamin Chang, Red Eye Ophthalmology & aovs.2017.06. Yip Chee Chew, Visual System 00195 Alvin Wong, Thomas Choudary Putti, Srinivasan Sanjay

Orthopaedic Surgery Antony Xavier Rex Outcomes and Financial Journal of doi:10.1007/ - Premchand Implications of Intra-Articular Orthopaedics and s10195-016- Distal Radius Fractures: A Traumatology 0441-8 Comparative Study of Open Reduction Internal Fixation (ORIF) with Volar Locking Plates Versus Nonoperative Management

Orthopaedic Surgery Aravind Kumar The Accuracy of Prognostic The Spine Journal 16 S89-S90 Scoring Systems in Predicting Survival of Lung Cancer Patients with Spinal Metastases

Orthopaedic Surgery Aravind Kumar Blood Loss in Spinal Tumour The Spine Journal 16 S90 Surgery: Evaluation of Influencing Factors

Orthopaedic Surgery Aravind Kumar Evaluation of the Safety of Using The Spine Journal 16 S62 Intra-Operative Salvaged Blood in Metastatic Spine Tumour Surgery: Using Microwell Technique

Orthopaedic Surgery Aravind Kumar The Influence of Histological The Spine Journal 16 S90 Subtype in Predicting Survival of Lung Cancer Patients with Spinal Metastases

Orthopaedic Surgery Aravind Kumar Are We Ready for Transfusing The Spine Journal 16 S61 Intraoperative Salvaged Blood in Metastatic Spine Tumour Surgery

Orthopaedic Surgery Aravind Kumar Versatility of Percutaneous The Spine Journal 16 S90-S91 Pedicular Screw Fixation in Metastatic Spine Tumour Surgery

Orthopaedic Surgery Aravind Kumar Flowcytometric Evaluation of The Spine Journal 16 S61 Intraoperative Salvaged Blood Filtered with Leucocyte Depletion Filter in Metastatic Spine Tumour Surgery

Orthopaedic Surgery Aravind Kumar Metastatic Spine Tumour Surgery: The Spine Journal 16 S63 Minimally Invasive Approach Versus Open Approach

Orthopaedic Surgery Aye Sandar Zaw, Perioperative Blood Transfusion: The Spine Journal doi:10.1111/ - Shashidhar B. Does It Influence Survival and trf.13912 Kantharajanna, Cancer Progression in Metastatic Karthikeyan Maharajan, Spine Tumor Surgery? Barry Tan, Balamurugan Vellayappan, Naresh Kumar 83

Department Authors Title of Paper Published Journal Name Volume Page No.

Orthopaedic Surgery Aye Sandar Zaw, Dhiraj Metastatic Spine Tumour The Spine Journal 3 S17-18 Sonawane, Karthikeyan Surgery: Does Perioperative Maharanjan, Dennis Blood Transfusion Influence Hey, Aravind Kumar, Postoperative Complications? Naresh Kumar

Orthopaedic Surgery Jonathan Tan, Kimberly Evaluation of Prognostic The Spine Journal 3 S16 Anne Tan, Aye Sandar Factors and a Modification to Zaw, Dennis Hey, the Modified Tokuhashi Score in Aravind Kumar, Naresh Patients with Spinal Metastases Kumar from Breast Cancer

Orthopaedic Surgery Naresh Kumar, Kimberly The Influence of Histologic The Spine Journal 3 S17 Anne Tan, Jonathan Tan, Subtype in Predicting Survival Aye Sandar Zaw, Aravind of Lung Cancer Patients with Kumar Spinal Metastases

Orthopaedic Surgery Rajaratnam Vaikunthan, A Snapshot Survey of Perceptions Postgraduate July 2016 - & Anaesthesia Chandra Mohan of Healthcare Professionals on Medical Journal Kumar, Anupama Roy Ageing Surgeons Chowdhury, Chang Su

Orthopaedic Surgery Tang Zhi Hao, Incidence and Anatomical Singapore Medical doi:10.11622/ - Vaikunthan Rajaratnam Distribution of Hand Tumours: Journal smedj.2016147 A Singapore Study

Orthopaedic Surgery Tang Zhi Hao, Nicholas A Radiographic Study of Proximal Singapore Medical doi:10.11622/ - Yeoh, Jeffrey Tan Femur Morphology of Elderly Journal smedj.2016148 Patients with Femoral Neck Fractures: Is There a Difference Between Ethnic Groups?

Orthopaedic Surgery Timothy Teo, Nicholas Tibial Fixation in Anterior Cruciate Journal of doi: 10.1177/ - Yeoh, Andy Wee Ligament Reconstruction - Is Orthopaedic 23094990176 Supplementary Staple Fixation Surgery 99743 Necessary?

Sports Medicine Dinesh Sirisena Sports Medicine in Singapore: British Journal of doi:10.1136/ - Centre Integrating Into Public Hospitals Sports Medicine bjsports- and Secondary Care 2016-096072

Sports Medicine Dinesh Sirisena National Football League British Journal of doi:http://dx.doi. - Centre Concussion Lawsuit: What It Means Sports Medicine org/10.1136/ for Other Sports and Observations bjsports-2016 from Singapore Rugby -096565

Sports Medicine Dinesh Sirisena, Enrica Clinical Assessment of Antero- Knee Surgery Sports doi:10.1007/ - Centre Papi, Eleanor Tillett Medial Rotational Knee Laxity: A Traumatology s00167-016- Systematic Review Association 4362-0

Sports Medicine Dinesh Sirisena, Annie Singapore Rugby Union Injury British Journal of doi:10.13140/ - Centre Henderson Surveillance: How Do We Compare Sports Medicine RG.2.2.13290. to Previous Findings in Rugby 52167 Union and Do We Need to Improve?

Sports Medicine Dinesh Sirisena, Joanne International Rugby Sevens British Journal of Online Blog - Centre & Acute and Probert Returns to Singapore: The Medical Sports Medicine Emergency Care Team’s Perspective! 84 TRANSFORMING CARE Journal Publications

Department Authors Title of Paper Published Journal Name Volume Page No.

Sports Medicine Ong Joo Haw, Julian The Effects of Eccentric Journal of Strength 30 747-754 Centre & Singapore Lim, Edwin Chong, Conditioning Stimuli on and Conditioning Sports Institute Frankie Tan Subsequent Counter-Movement Research Jump Performance

Pharmacy Anita Hu, Fan Process Re-Engineering at Singapore Medical - - Weishan, Tifanny Lum the Outpatient Pharmacy: Journal Implementation of a Medication Self-Order Form

Pharmacy Adeline Wee, Ester Reducing Inpatient Singapore Medical - - Yeoh Hypoglycaemia Amongst Journal Inpatients with Diabetes in 2 Pilot Wards

Pharmacy Brenda Chong Impact of Transdisciplinary Singapore Medical - - Pharmacist-Physician Journal Collaboration on Cardiovascular Disease Outcomes in Khoo Teck Puat Hospital Cardiology Pharmacist Clinic

Pharmacy Constance Neo Characterisation of Interventions Singapore Medical - - Performed in the Outpatient Journal Pharmacy

Pharmacy David Ha Potential Technology Innovation Singapore Medical - - to Transform Processes in Khoo Journal Teck Puat Hospital Outpatient Setting

Pharmacy Debbie Do Nguyen The Capsule- Redesigning Singapore Medical - - Medication Processing and Bill Journal Collection Flow at the Outpatient Pharmacy in Khoo Teck Puat Hospital (KTPH)

Pharmacy Elissa Wong Reducing Fentanyl Errors Singapore Medical - - Journal

Pharmacy Joyce Tan Inappropriate Medication Use Singapore Medical - - in Nursing Home Residents and Journal Association with the Healthcare Consequences

Pharmacy Lim Tze Kai Evaluation of Risk Assessment Singapore Medical - - Models (Padua & Caprini) Journal in the Prediction of Venous Thromboembolism Events: A Retrospective Review

Pharmacy Low Suat Fern Use of Cognitive Enhancers Singapore Medical - - in Khoo Teck Puat Hospital Journal Memory Clinic - A Retrospective Study

Pharmacy Oh Jing Wen Reducing Non-Formulary Drug Singapore Medical - - Requests in the Outpatient Journal Setting Through Formulary Reformation 85

Department Authors Title of Paper Published Journal Name Volume Page No.

Pharmacy Tyson Tan, Prevalence of Latanoprost Singapore Medical - - Lim Yu Cai Intolerance and Subsequent Journal Travoprost Tolerance in a Singaporean Population

Pharmacy Vidhya Segar A Proton Pump Inhibitor Singapore Medical - - Deprescribing Frame Work, Journal Pharmacist-Physician Collaborative Approach

Pharmacy Vincent See, Joyce Identifying Potentially Avoidable Pharmacotherapy: doi:10.1002/ - Tan, Doreen Su-Yin Readmissions: A Medication- The Journal of phar.1896 Tan, Manee Based 15-Day Readmission Risk Human Pharmacology Stratification Algorithm and Drug

Pharmacy Wee Yueting, Doreen Developing a Model of Care for Singapore Medical - - Tan, Gloria Sustainable De-Prescribing in Journal KTPH

Pharmacy Wee Xueting Efficacy and Safety of Singapore Medical - - Antithrombotics in Newly Journal Diagnosed Non-Valvular Atrial Fibrillation: A Multi-Centred Retrospective Study

Pharmacy Xiang Ling The Safety and Efficacy of Singapore Medical - - Venous Thromboembolism Journal Prophylaxis in Khoo Teck Puat Hospital

Pharmacy Yuen Kay Incidence of Venous Thrombo- Singapore Medical - - Embolism (VTE) in Hip Fracture Journal Unit Patients

Psychological Chan Keen Loong Anxiety and Depression in Annals Academy Of 45(10) 451-455 Medicine Patients with Atopic Dermatitis Medicine Singapore in a Southeast Asian Tertiary Dermatological Centre.

Psychological Chan Keen Loong A Prospective Cross-Sectional Journal of the 30(7) 1159-1164 Medicine Study of Anxiety and Depression European Academy in Patients with Psoriasis in of Dermatology and Singapore Venereology

Psychological Ng Tze-Pin, Ma Shwe Multi-Domains Lifestyle The Journal of doi:10.1007/ 1-9 Medicine Zin Nyunt, Lei Feng, M Interventions Reduces Depressive Nutrition, Health and s12603-016- Niti, Tan Boon Yeow, Symptoms Among Frail and Pre- Aging 0867-y Gribson Chan, Khoo Frail Older Persons: Randomised Sue-Anne, Chan SM, Controlled Trial Philip Yap, Yap Keng Bee 86 TRANSFORMING CARE

Alexandra Health System Alexandra Health System is a regional healthcare system established on 1 April 2008 to take care of 800,000 residents living in northern Singapore. Our goal is to make a difference to the population in the North by working together with our partners and empowering the community and residents to manage their health for life.

Khoo Teck Puat Hospital Opened in June 2010, KTPH is a 590-bed general and acute care hospital which combines medical expertise with high standards of care, set within a healing environment.

Yishun Community Hospital Opened in December 2015, YCH is a 428-bed community hospital which will cater to the sub-acute and rehabilitation needs of patients.

Woodlands Health Campus Opening in stages from 2022, WHC will comprise a large acute care hospital, a community hospital, a nursing home and other associated facilities and services.

Admiralty Medical Centre Located in Kampung Admiralty, AdMC will be a one-stop diagnostic and treatment centre, providing outpatient specialist services when it opens in July 2017.

90 Yishun Central Singapore 768828 www.alexandrahealth.com.sg

Khoo Teck Puat Hospital | Yishun Community Hospital | Woodlands Health Campus | Admiralty Medical Centre