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SPECIALTIES & SERVICES

Acute and Emergency Care


KTPH Acute and Emergency (A&E) Care Centre has been in operation since 2010 and sees over 138,000 patients a year. 

The Centre has an urgent care section which receives all walk-in patients and an acute care area which sees the critically ill and trauma.   
  
The Centre adopts a team approach towards the management of acute resuscitation and major trauma, with the participation of in-house surgical and medical specialists. This contributes to the smooth and expedient management of all ill patients.  
  
The A&E is active in academic programmes, clinical innovation and participation in hospital and national level activities:   
  
Academic Programme   
Regular in-house training programme include the weekly Emergency Medicine Conference,  Course for Emergency Nursing Triage and Medical Students Teaching programme.   
Our specialists also regularly contributes  to external programmes  such as Paramedic training programme, Advanced Trauma Life Support Course, Advanced Cardiac Life Support Course, Advanced Diploma in Emergency Nursing and Emergency Medicine Residency Teaching Programme.  
  
Emergency Ultrasound  
We are the frontrunner in the adoption and practise of emergency point-of-care ultrasound to aid diagnosis and assessment of patient's condition.  
  
Disaster Medical Support  
The A&E constantly prepares itself to provide medical support for disaster mitigation efforts at the hospital and national level.


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

The A&E, through the support of other departments, provides the following 24/7 services:

Diagnostic Services   X-rays, CT scans and laboratory services

Percutaneous Coronary Intervention (PCI) for acute myocardial infarction (heart attack)

Thrombolysis for Acute Stroke

Trauma Team for major trauma

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 prioritised 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
  • 20 mins
  • 30 - 45 mins
  • 60 mins
  • 1 - 4 hours

 

 

 

Our wards are very full due to high patient volume. Please expect a longer waiting time for admission.


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