COVID-19 Our Experience In and Beyond SGH Kenneth Kwek CEO, Singapore General Hospital Dy GCEO SingHealth (Organisation Transformation and Informatics) Singapore Healthcare Management 2020
Singapore and SingHealth
Singapore COVID-19 Timeline Dorms Cleared: Phase 1: 02 Jun 2020 Start of Circuit Breaker 1 st imported 07 Aug 2020 COVID-19 case: 23 Jan 2020 Phase 2: 19 Jun 2020 1 st cluster identified in Singapore 1 st migrant worker diagnosed
Framework Capacity Capability COVID-19 Management Command Culture
Framework Capacity Capability COVID-19 Management Command Culture
Creating Capacity Attempt to create capacity in anticipation of need Segregated flows for COVID-19 and non-COVID-19 cases C A P A C I T Y Patients and colleagues must be kept safe Capacity must be fit for purpose • Isolation, safe distancing • Cohorting, shared toilets • “Good enough” – cost and speed considerations Flexibility in deployment
Emergency Department Capacity Surge Capacity Phases 1-3: addition of 120 Very tight triage to ensure Existing capacity: pax non-fever cases continue ED Fever Area (11 pax) unaffected – key to diagnosis T otal Fever capacity @ 131 pax C A P A C I T Y FSA at Carpark H (+ 66 pax) Surge Capacity Phase 3 (20 Mar) ASC converted to Linkbridge to OCH converted to ED NOK fever screening area (+ 42 pax) holding area and FSA (+ 12 pax) Surge Capacity Phase 1 (25 Jan) Surge Capacity Phase 2 (09 Feb) First Covid -19 Case (23 Jan)
C A P A C I T Y Inpatient Bed Capacity No.of Patients 100 150 200 250 300 350 50 0 23-… • • Activation Outram Community Hospitals beds to 26-… 29-… create more beds capacity (~250 beds) 1-… and electives admissions/surgery Deferment of non-essential SOC appointments 4-… 7-… 10-… 13-… Confirmed 16-… 19-… 22-… 25-… 28-… 2-… 5-… 8-… 11-… 14-… 17-… Daily Census of Cases in COVID-19 Isolation Wards 20-… Suspect (MOH) 23-… 26-… 29-… 1-… 4-… 7-… 10-… 13-… 16-… Maximum Capacity = 319 19-… 22-… 25-… 28-… 1-… Suspect… 4-… 7-… 10-… 13-… 16-… 19-… 22-… 25-… 28-… 31-… 3-… Total 6-… 9-… 12-… 15-… 18-… 21-… 24-… 27-… 30-… Iso Bed Capacity 3-Jul Peacetime 6-Jul Current Capacity = 85 ------- 9-Jul 12-… 15-… 18-… 21-… Acute Respiratory Infection Beds 24-… 27-… 30-… Circuit breaker 2-… 5-… Start of 8-… 160 11-… Phase 1 229 216 Phase 2
Adjustment of Healthcare Services to Situation Circuit Breaker from 07 Apr – 01 Jun’20 C A P A C I T Y During Circuit Breaker (07 Apr – 01 Jun) 1 • Cases which cannot be deferred more than 2 weeks • Deployed 3 Urology OTs as COVID 19 OTs After Circuit Breaker (02 Jun onwards) 2 • Gradual ramping up of services • Cases which cannot be deferred by 4 weeks Post circuit breaker
Creating New Capacity From Carpark to Ward – 50 negative pressured isolation rooms in 50 days 50 single units C A P A C I T Y • Negative-pressure • Airconditioned • Ensuite toilet and shower • Piped Oxygen • Remote monitoring • Bedside tablet
Ramping Up Our Lab Capacity • 1 Capacity • Usual PCR testing 140/day • Capacity now of 1,600 tests/day – 11-fold increase C A P A C I T Y Current lab capacity from 24 ’ A pr 2020 = 1,000 2 Operating Hours Maintained lab capacity of 1,000 tests/day • Long hours (staggered), 7 days a week • Staff rostered on call 24/7 for urgent tests 3 Supply chain • Ensure sustainability of consumables and devices 4 Buffer Capacity • Possible surge in testing and possibly cases
Framework Capacity Capability COVID-19 Management Command Culture
Developing Capability Clinical Capability Prepared to ramp up from 62 to ~214 ICU beds Room, equipment, people (ICU course), consumables C A P A B I L I T Y Infection Prevention and Control PPE and IPC practice, Safe Distancing Contact tracing, mask fitting Leadership Capability and Teaming Developmental opportunity – trial of fire Recognition of co-dependency Building trust Innovation and Creativity Necessity is the Mother of Invention
Developing Capability and Capacity SGH Campus Approach Trust and Understanding C A P A B I L I T Y Collaboration and Teamwork Coordinated effort by joint team from SGH NDCS SNEC NCCS NHCS NNI All SingHealth institutions collaborating, sharing, exchanging with all clusters
Testing Capability • 1 Manpower • Cross-training of colleagues – other labs, research labs C A P A B I L I T Y 2 • Tests and Systems • Started with in-house testing based on WHO test • MOH-developed test • High throughput platform (1-2-3 machines) 3 Digitalisation of Process • Registration, labelling, lab tracking • From paper to laptop 4 Consumables • Dacron swabs, Copan/Miraclean swabs • 3-D and IM swabs
Role Beyond the Hospital C A P A B I L I T Y CCF Operations Dormitory Ops Moving Downstream Moving Upstream - facilitate discharge - reduce attendance - bypass admission - bypass admission
Supporting External Operations Dormitory Operations • Sharp rise in the number of cases in the dormitories • Essential to move Upstream to manage COVID-19 patients C A P A B I L I T Y • National effort to support more vulnerable • Deployment of staff to the following: • 8 Dormitories - ~40,000 patients seen • 2 Swab Isolation Facilities (SIFs) • 1 Community Care Facility (CCFs) • Provide essential primary care and screening - swab testing
Swiftly Swung into Action to Support External Ops Swab Isolation Facility C A P A B I L I T Y Community Care Facility - Expo
Swiftly Swung into Action to Support External Ops Objectives in Community Care Facility (CCF): • Zero transmission to Healthcare Workers • Zero adverse event to patient C A P A B I L I T Y • Innovate to: Reduce transmission risk Good patient experience Enhance value Nurse Station
Conducted ~20,000 mobile swabs and mass serology tests [1] 25000 25,000 Mobile Swabs (Cumulative) Serology Tests (Cumulative) 21,281 19,817 17,773 20000 20,000 13,758 12,754 15000 15,000 C A P A B I L I T Y 10000 10,000 4398 5000 5,000 2,418 0 0 Apr May Jun Jul May Jun Jul [1] Based on number of tests conducted by SGH Serology Team
Relatively Low Case Fatality and Population Fatality Population Fatality (per 100,000 people): 0.47 As of 2019, population of SG is 5.70 million [1] Case Fatality Rate: 0.05% Outcomes (27/55,104) [1] Department of Statistics Singapore
Framework Capacity Capability COVID-19 Management Command Culture
Leadership Structure • Early recognition of value of coordination and load Concerted National Effort - MMT (Multi-Ministry T askforce) levelling at national level – patients and staff • Standardised criteria for • Suspect cases, admission, testing, • Transfer to step-down care facilities • PPE usage • Engagement and 2-way communication • Consolidation and/Rationalisation of • Supply chain and procurement • Manpower and resource deployment SingHealth Disease Outbreak Taskforce (SDOT) • Cluster and Institutional Leadership • Domain Leads • Reporting and tracking outcomes and supplies • Harmonisation of Policies • PPE, IPC SDOT visit to Ward@Bowyer SDOT • HR preparing gift packs for staff
Crisis Leadership – Establishing Authority of Domain Experts “ Central Focus on COVID-19 ” • Early establishment of command center to navigate whirlwind of activities • Collective leadership with a flattened hierarchy • Primarily led by domain experts e.g. ID & IPE while C O M M A N D Management took a supportive role • Clinical protocols continually reviewed From L-R: InfectiousDisease department led by Dr Tan Thuan Tong, Dr Limin and Dr Indumathi Source: McKinsey & Company Dr Ling Moi Lin, Dr Kenneth Tan, Prof Tan Ban Hock, Infectious Prevention Department of Chief Quality Officer, & Epidemiology Emergency Medicine W68 Nursing Colleagues Preparedness & Response Colleagues SGH department
Decision Making is Backed by Data T aking reference from Global & National Intelligence Launch of thrice daily COVID-19 Dashboard with the use of T ableau Visualizer T ool • Reduce increasingly laborious manual efforts • Reduce strain on duplicative reporting across frontline C O M M A N D departments John Hopkins University COVID-19 Dashboard • Provide a holistic one-source view of key reporting metrics of Covid vs Non-covid for management oversight UpCode Academy SG COVID-19 Dashboard SGH COVID-19 Dashboard
Framework Capacity Capability COVID-19 Management Culture Command
Recommend
More recommend
