Changing models of care for emergency surgical and trauma patients in Singapore

Abstract

The last 15 years have seen changing patterns of injury in emergency surgery and trauma patients. The ability to diagnose, treat and manage these patients nonoperatively has led to a decline in interest in trauma surgery as a career. In addition, healthcare systems face multiple challenges, including limited resources, an ageing population and increasing subspecialisation of medical care, while maintaining government-directed standards and managing public expectations. In the West, these challenges have led to the emergence of a new subspecialty, 'acute care surgery', with some models of care providing dedicated acute surgical units or separating acute and elective streams with the existing manpower resources. The outcomes for emergency surgery patients and efficiency gains are promising. In Singapore, Khoo Teck Puat Hospital has implemented its first dedicated acute surgical unit. This article outlines the evolution of acute care surgery and its relevance to Asia.

General Surgeons Australia's 12‐point plan for emergency general surgery

“…Koea et al ., in their systematic review, made use of the 12‐point plan to critically analyse the function of seven ASU in Australia as well as European models of care . Local and international units have also appraised their ASU based on the 12‐point plan …”

“…2 Local and international units have also appraised their ASU based on the 12-point plan. 7,[11][12][13] This study aims to provide a descriptive review on the relevance of the 12-point plan to the ASU model and review the current available evidence to support this framework.…”

Development of an Extended Acute Care Surgery Service in Response to the Covid-19 Global Pandemic: Assessment of Clinical Patient Outcomes and Staff Psychological Well-being

“…eACS clinical and e ciency outcomes ACS models of care have consistently shown improved outcomes including LOS, costs, reduced complications and mortality [14][15][16][17][18]. Our eACS model reduced LOS further with signi cant cost savings to the institution in just 2-months.…”

Cohort study on emergency general surgery patients and an observation unit

“…This was occurring to a lesser degree in the pre‐RAMS period using interim orders. Although a shorter time to admission has been shown to decrease patient discomfort, fasting, risk of deterioration and overall LOS, these patients experienced significant delay in their review; which may have jeopardized their care . The RAMS unit provided an avenue for earlier patient movement and review to occur.…”

“…The access to senior surgical staff, during daylight hours allows for more teaching opportunities. Though there was not allocated theatre time, all hospitals have cancellations and close communication between theatre staff and the surgical team allows for prioritization of cases and discussion of alternative arrangements when the system is under pressure . In this manner, the RAMS unit provided the opportunity for simple cases to be completed by an unaccredited registrar within hours, again increasing the training, supervision and teaching.…”