Health managers help cut down hospital visits

SINGAPORE - Elderly patients with many ailments can land in hospital several times a year, sometimes unnecessarily. Others visit the emergency department almost every other month, when some of their complaints can be handled at home.

To cut down such episodes, Tan Tock Seng Hospital (TTSH) has rolled out a free service in which such patients are assigned a "health manager", who is nurse, medical social worker and case manager all rolled into one. Available 24/7, they advise these patients on medication or guide them if their condition takes a turn for the worse. This is done either over the phone or during regular home visits.

About 80 patients have been enrolled in this "virtual hospital" programme since it was launched last August. They each have several chronic illnesses, and are hospitalised at least five times a year.

A recent audit shows visits to the hospital's accident and emergency (A&E) department plunged 60 per cent among patients who have been on the scheme for at least six months. Hospitalisations went down by 30 per cent.

These improvements can be attributed to the elderly folk checking a minor health scare with the health manager first before heading to the A&E department.

Said Associate Professor John Abisheganaden, who heads the initiative: "They pay frequent visits to the A&E and get hospitalised because they don't know how to cope, and don't know who to approach to get the help they need."

Every year, TTSH treats 700 to 800 elderly patients who are admitted at least five times a year.

So, if the pilot scheme is open to more patients, said doctors of TTSH, it can ease the load on the hospital's emergency department, the busiest in Singapore with more than 400 patients a day.

Prostrate cancer survivor Gerard Palaniappa, 75, showed up at TTSH's emergency department more then 30 times last year. The retiree, who lives alone, has trouble urinating and has giddy spells.

"Sometimes I'm tired, sometimes in pain," said Mr Palaniappa, who takes more than 10 different types of medicine each day.

Since a health manager was assigned to him last November, he has been to the A&E department just twice.

When the patients' condition stabilises, their care will be handed over to community organisations near their homes, like the Home Nursing Foundation.

It is one of nine agencies that has partnered the hospital in this project. Its chief executive Yim Sau Kit said four volunteers will visit the "virtual hospital" patients at home to help with daily tasks, medication and make sure they do not sink into depression.

Said Dr Yim: "We can build as many hospitals as we like, but there won't be enough beds. At the end of the day, patients who are 'frequent flyers' will go back to the hospital if they don't feel supported."

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