SPECIALTIES & SERVICES
Acute and Emergency Care
The Acute and Emergency Care Centre serves as an entry point for the critically ill & major trauma patients, in addition to a wide range of non-traumatic conditions for the northern sector of Singapore. We serve as a referral centre for specialist care in KTPH. To fulfill these needs, the centre is designed with:
- Resuscitation suites
- Emergency care area with 28 trolley bays
- Acute care area for walk-in patients
- Procedure rooms for minor surgery
- X-ray suites
- CT scanner
An emergency nurse will perform the initial assessment and triage (assigning a priority grade) of the patient. Stable patients with urgent problems are seen in the consultation rooms of the acute care area while those of greater severity are transferred to the emergency care area.
In resuscitation and major trauma management, the centre adopts a “pit-stop” approach where our emergency staff works with the in-patient specialists as a team to provide timely and expedient care. For the other patients, we strive to provide solutions to their medical problems with the minimal hassle and wait.
Our emergency nurses conduct a telephone after-care review for all patients who received minor procedures or surgeries in the centre.
The A&E is open 24 hours and accepts all patients without the need for an appointment. As the need for emergency service is high, all patients will be prioritized and seen in turn according to the severity of their problems.
In accordance to rhythm of work-life activities of the population, the two peak periods of the centre is 10am to 3pm and 8pm to 11pm. During these periods, surge in patient volume is great and the waiting time to see a doctor will be much longer than expected. The busier days of the week are Monday, post-lunch period on Saturday and Sunday evenings. A web-linked queue viewer is installed in the centre to give timely update on the crowd situation and estimated waiting time.
Some activities take time and the approximate turn-around time (time needed for the process) are:
- X-rays
- Procedures /minor surgery
- Laboratory tests
- Observation
- Admission to wards
- 20 mins
- 30 - 45 mins
- 60 mins
- 1 - 4 hours
- 1 - 2 hours
The Acute & Emergency Care Centre attends to a wide variety of patients. Because the resources are finite, there is a need to prioritise patients upon arrival to receive emergency medical care. Acuity (or severity) would naturally form the basis for such prioritisation.
The assessment of patient with the aim of prioritizing is called Triage and this is carried out by a triage nurse. After getting information about the patient's problems and initial assessment of the vital signs, the triage nurse will assign a PACS (or simply, P) status:
The 4-point Singapore Patient Acuity Category Scale (PACS) is as follows :
| PACS Classification | |
|---|---|
| PAC Scale 1 | These are patients who are either already in a state of cardiovascular collapse or in imminent danger of collapse and would therefore be required to be attended to without a moment's delay. They would likely require the maximum allocation of staff and equipment resources for initial management. e.g. Acute Myocardial Infarction, Cardiac Arrest, Major Trauma |
| PAC Scale 2 | These patients are ill and non-ambulant and in various forms of severe distress. They would appear to be in a stable state on initial cardiovascular examination and are not in danger of imminent collapse. The severity of their symptoms requires very early attention, failing which early deterioration of their medical status is likely. e.g. Stroke, Long Bone Fractures, Asthma |
| PAC Scale 3 | These patients have acute symptoms, but are ambulant, have mild to moderate symptoms and require acute treatment which will result in resolution of symptoms over time. e.g. Cuts with bleeding, Mild to moderate injury, High Fever |
| PAC Scale 4 | These are non-emergency patients. They should not be presenting to Acute & Emergency Care in the first place and should more appropriately be managed in a primary health care setting such as in family practice or public polyclinics. They may have an old injury or condition that has been present for a long time. They do not require immediate treatment. There is no immediate threat to their life or limb. e.g. Chronic Low Back Pain, High Cholesterol, Acne |
