As if life as an emergency medicine physician is not hectic enough, Dr Ivan Chua is also involved in planning for a bigger emergency department (ED) — possibly one of the largest multistorey emergency facilities in Singapore.

But then, he is one cool dude. He does not seem to get easily rattled, be it the stress and pressure of racing against time to save lives or getting the new ED ready. “I think my background in pre-hospital emergency care and trauma care is useful for this role,” said Dr Chua, Senior Consultant, Department of Emergency Medicine (DEM), Singapore General Hospital (SGH). “Besides, I get to have a say in what goes into the new ED. Knowing that we’re actually helping to create a facility to serve our community and save lives over the coming years also makes me feel that I’ve made an impact.”

The massive project, started almost a decade ago, is in its last stages of construction. The new 12-storey building, sited across the road from the hospital’s current ED, houses not just the ED but also the short-stay Acute Medical Ward, hospital decontamination station, and the National Neuroscience Institute.

Dr Chua and his colleagues had to think about the most efficient way for patients to be given treatment. “Our biggest priority is the patient’s journey. We need a design that caters to optimal patient flow. The sickest patients go directly to the resuscitation area, so it’s situated right behind the triage area on the first floor after the initial assessments are done,” said Dr Chua, whose area of planning is the resuscitation area. This has the best capabilities for urgent diagnosis and treatment of patients who have collapsed or need emergent treatment as a result of a heart attack, stroke, major trauma, or other illnesses.

To avoid taking up precious time travelling to the imaging and other departments in the main SGH blocks, the ED will house a dental orthopantomagram unit, a dedicated sonography room, and an angiography suite that can be used for endovascular treatment for stroke cases, said Dr Chua.

As with the overall bigger ED, the resuscitation area is double the size of the current one — with 12 resuscitation bays, including four dedicated trauma bays — in anticipation of greater demand for emergency services in the coming years.

To pre-empt sudden worsening of conditions of less sick patients, who may have been sent to the ambulatory areas on the upper floors, measures are also in place for quick transfer back to the resuscitation area. “We have an internal ‘code blue’ system, where the patient is given immediate care and then transported via dedicated lifts to the resuscitation area. When the code is activated, the lifts are locked so that no one can use them except us. This helps prevent treatment delays for the patient,” said Dr Chua.

The team had to think well ahead — by at least a decade — about the demands and needs of Singapore’s ageing population. This is because the silver tsunami is approaching quickly, while the recent experience of COVID-19 highlighted the possibility of pandemics recurring. How would patients suspected of being infected with an unknown virus be kept away from others — from the time they step into the ED all the way through to admission? During COVID-19, hospitals faced limited and ageing facilities; SGH had to erect temporary ward space and convert other facilities, like car parks, into testing and vaccination centres. “We’re also prepared for bioterrorism events. The ambulance parking area can be converted to a decontamination station with shower facility, where we’ll have nine lanes to decontaminate patients. This is three times more than what we have currently,” said Dr Chua.

Another challenge presented itself when the team found that actual space was far smaller than envisaged on paper.

The team, Dr Chua added, had to look at reconfiguring the space without compromising patient care. Dr Chua takes these challenges — unexpected and perhaps upsetting — in his stride. His ability to stay calm and cool, and to think quickly without panicking may be the reason he has thrived in his chosen discipline. “ED is fast paced, and the opportunity to make lifesaving decisions is satisfying,” said Dr Chua, who also conducts workshops for the USbased Resuscitation Academy to help improve cardiac arrest survival rates in countries around the region.

Given his intense interest and involvement in emergency medicine, it is surprising to hear that Dr Chua had seriously mulled a career in finance. He blogged about the subject when younger, although he has stopped through lack of time. Still, he is considered an expert among friends and colleagues, who regularly seek his advice.

Dr Chua, who is single, has a younger brother who works in the finance sector. One can only imagine their dinner conversations!

<<To ensure the smooth running of the much larger ED when it opens, large-scale exercises to test systems and processes are held regularly, like the one involving many people at one of the observation wards.>>

Fast-tracking care

When Ms Lee Chee Woei was posted to Ward 73 as a young nurse in 2008, she could hardly have anticipated the big role she would play in the future Acute Medical Ward (AMW). The Senior Nurse Manager (SNM) is now one of two SNMs leading the charge to set up four floors of the AMW in the soonto- be-opened emergency building at the Singapore General Hospital (SGH).

Ms Lee was there when one of the wards was converted to the AMW under the care of the Department of Internal Medicine in 2015. It was a move to improve patient care for individuals being admitted from the Emergency Department. “I’ve been involved in the AMW’s development since it first started operations, working closely with various stakeholders to shape and improve our care model. Since then, I’ve been given the opportunity to lead multiple quality improvement projects to streamline the work processes there,” said the 42-year-old.

The AMW, a short-stay facility for SGH patients, delivers early assessments, treatment and rehab interventions to facilitate earlier patient discharge. Typically, patients stay for three to five days at the AMW, thanks to this care model.

Engagement of patients, families and domestic helpers starts from admission, ensuring patients receive the same care when they are discharged for home. Having caregivers by the bedside comforts patients in an unfamiliar hospital environment, and their early engagement also boosts their knowledge and confidence. “Because we have dedicated physiotherapists, occupational therapists, patient navigators, medical social workers and pharmacists stationed in the ward, they are able to work with the patients daily, which reduces the patient’s length of stay significantly. We also offer caregiver training upfront, so patients are more confident when discharged,” said Ms Lee.

Her current challenge is scaling up the efficiency of the AMW to the expanded facility, which has 152 beds across four levels. She arranges comprehensive training programmes for the staff to help them understand the new workflows and protocols for the expanded facility. For instance, nurses must learn to manage isolation rooms as well as run peritoneal dialysis and haemodialysis as these services will be offered at the new facility.

Coordinating care and ensuring seamless communication between teams on different levels are challenging. Thus, the multidisciplinary teams meet regularly so that staff are on the same page on the care plan of patients. “We have to also make sure the nurses are familiar with the layout of the bigger space. They need to know the fastest routes to the patients for resuscitation cases, or the safest way to move patients in case of fire and so on,” said Ms Lee. About 200 nurses are currently undergoing training, and plans are in place for recce trips to the new AMW for orientation to “empower the nurses and make them more equipped”.

Ms Lee enjoys being part of this major project, especially as she knows that her efforts directly improve patient care. “Personally, I found the constant need to adapt and improve to be both challenging and exciting. Coordinating with multiple stakeholders and ensuring smooth communication across different teams were sometimes tough, but it has been a great learning experience.”

Ms Lee finds joy in watching her staff grow, develop their skills, and become more confident in their roles. “I truly enjoy listening to them and creating a family-like atmosphere in the workplace. It’s important to me that they feel supported and cared for, just as we care for our patients.” During the COVID-19 pandemic, she made use of skills picked up from her seamstress mum to sew masks for kids using fabric printed with colourful cartoon characters. “It turned into a little venture of its own, as colleagues came back to me for repeat orders! It was rewarding to see them excited about wearing something I created,” she said. Her greatest fulfillment, however, is in the impact she makes on patients’ lives. “Being there for them during their most vulnerable moments, whether they’re recovering or facing difficult challenges, reinforces why I chose this profession.”

At home, Ms Lee and her radiographer husband enjoy spending quality time with their 10-year-old son and 8-year-old daughter. “We enjoy outdoor activities together, such as picnics, cycling and playing badminton. These moments allow us to bond and create wonderful memories as a family,” she said.

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