At Changi General Hospital (CGH), patients who require long-term care but are unable to be cared for at home or in their community, are usually referred before discharge to voluntary nursing homes. The average turnaround time for the patient to be transferred to a nursing home was 72 days.

As part of ongoing efforts to improve patient experience across different care settings, a multi-agency team of 25 staff from medical, nursing, inpatient operations, medical social services in CGH, Agency for Integrated Care (AIC), Peacehaven Nursing Home and All Saints Home (Tampines) came together in July 2016 to explore ways to improve turnaround time for nursing home placement.

They first convened a two-day workshop to identify the challenges with the referral process and design the desired future state. Some of the key initiatives that resulted from the workshop include stationing two AIC staff at CGH’s Medical Social Services office to facilitate timely face-to-face discussions with patients and their caregivers, and a “Grab” initiative that allows several nursing homes to receive the referrals simultaneously and accept them.

“Once CGH puts up a referral request, any partner nursing home that has a vacancy and the expertise to care for the patient can ‘grab’ the case. This has significantly reduced the time needed to contact different nursing homes and assess compatibility,” says Yeo Seok Tin, Master Medical Social Worker at CGH.

The team’s initial target was to reduce the turnaround time from 72 to 40 days. Within a year, they exceeded this target and successfully reduced turnaround time to 28 days. In addition to time savings, patients also enjoyed cost savings with the earlier transfer, as charges in a nursing home are lower.

In terms of hospital bed management, CGH saved a total of 17,996 hospital bed days between July 2016 and June 2018. This has allowed patients from the hospital’s Accident and Emergency department who urgently need a bed to be allocated one more quickly.

Since sharing the results, this project has been replicated in other hospitals such as Tan Tock Seng Hospital, Khoo Teck Puat Hospital and Singapore General Hospital with similarly good results.