Objective: In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. Methods: In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Results: Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Conclusion: Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

In this study, recent trends in the incidence and methods of suicide in Singapore, over the period 1991-2000, were compared with the results of a previous study covering the period 1975-1984 (Tan, 1986). The present study included a total of 3,834 suicidal deaths reported to the coroner and investigated by the Centre for Forensic Medicine of the Health Sciences Authority. The results showed that the crude suicide rate had stabilised over the last decade and that the rate was highest among elderly males. The three most common methods employed were falls from a height (69.3%), hanging (20.7%) and poisoning (5.5%). Comparison of the results of both studies showed that the crude suicide rate had stabilised over the last two decades. However, there was an increase in the suicide rates among males, as compared with the previous study, and a marginal decrease in suicide rates among females over this time. There was also an appreciable change in the methods of suicide employed, in that there was an increase in the proportion of deaths due to falls from a height and corresponding reductions in the proportions of deaths by hanging and poisoning.

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Background Fear of falling (FoF) has far-reaching implications including activity restriction, functional decline and reduced quality of life. It is a common consequence of falls but may be present even in non-fallers. This study aimed to determine the factors associated with FoF in a segment of Singapore’s community-dwelling older adults. Methods This descriptive cross-sectional study recruited a convenience sample of adults aged 65 and above from 4 primary care clinics from September 2020 to March 2021. Data were collected on demographic factors, clinical factors such as multi-morbidity, falls characteristics such as history of falls, injuries, and reasons for falls and frailty as determined by the Clinical Frailty Scale (CFS). FoF was measured using the Short Falls Efficacy Scale–International (Short FES-I), cut-off score of 14 and above indicated high FoF. Logistic regression was used to determine factors associated with high FoF. Results Out of 360 older adults, 78.1% were Chinese and 59.7% females. The mean age was 78.3 years and 76 (21.1%) had a history of falls in the past six months. Almost half (43.1%) were mildly to moderately frail and most (80.6%) had multi-morbidity. The mean FoF score was 15.5 (SD 5.97) and 60.8% reported high FoF. There were statistically significant differences in age, gender, ethnicity, marital status, educational level, use of walking aid, multi-morbidity, frailty status, history of falls within six months and reason for falls between patients who had high FoF versus those who had moderate or low FoF. Logistic regression found that Malay ethnicity (OR = 5.81, 95% CI 1.77–19.13), marital status, use of walking aids (OR = 3.67, 95% CI = 1.54–8.77) and frailty were significant factors associated with high FoF. Compared to those who were never married, the odds of high FoF were significantly higher in married older adults (OR = 6.75, 95% CI 1.39 to 32.76), those who were separated or divorced (OR 10.40, 95% CI 1.13 to 95.76) and those who were widowed (OR = 7.41, 95% CI 1.51 to 36.41). Compared to well older adults, the odds of high FoF were significantly higher in pre frail older adults (OR = 6.87, 95% CI = 2.66–17.37), mildly frail older adults (OR = 18.58, 95% CI = 4.88–70.34) and moderately frail older adults (OR = 144.78, 95% CI = 13.86–1512.60). Conclusions The study found that pre frail to moderately frail older adults as determined by CFS have significantly higher risk of high FoF. The demographic factors such as marital status and ethnicity and falls characteristics associated with FoF in this study will be helpful to develop targeted and tailored interventions for FoF.