SHM Converge Scientific Abstract ePoster Gallery-Ambulatory Care Model for Acute Medical Admissions to Tertiary Care

Pdf Summary

Singapore General Hospital developed an internist-led Acute Ambulatory Care Team (ACT) to address rising emergency department congestion, bed shortages, and increased medical complexity, worsened by the COVID-19 pandemic. The ACT was created by the Department of Internal Medicine to rapidly assess and manage medical patients lodging in the ED, with the goal of identifying those who were acutely unwell and needed inpatient beds, while safely discharging stable patients with ambulatory care-sensitive conditions.<br /><br />Patients with high acuity received prompt treatment and priority for admission, whereas patients with low National Early Warning Scores and stable conditions were treated and discharged within the same or next day, with follow-up in ambulatory or primary care settings. The team also collaborated closely with the Emergency Department, bed management unit, and community family medicine colleagues through a secure communication platform to improve bed allocation and discharge planning.<br /><br />From 1 February to 31 May 2022, the ACT discharged 388 patients. Nearly half were aged 65 or older, with a median age of 64 years; 63% were female, and 80% self-referred to the ED. Most were initially triaged as priority 2. Safety outcomes were favorable: there was one expected death within 30 days, ED re-attendance rates were 3% at 72 hours, 3% at 7 days, and 7% at 30 days, and the 30-day readmission rate was 10%, compared with 13% for medical ward admissions.<br /><br />The common diagnoses included dizziness, chest pain, hypertension, fluid overload, diabetes, and related complications. Overall, the ACT improved resource use, sped up discharge, and supported more efficient and appropriate bed allocation without compromising patient safety.

Asset Subtitle

Wan Tin Lim

Meta Tag

Author List Mei Ling Kang, Shalini Sri Kumaran, Tharmmambal Balakrishnan, Wan Tin Lim

Category Research

Concept Acute Ambulatory Care Team

Concept Emergency Department Boarding

Concept Triage Criteria

Concept Ambulatory Care Sensitive Condition

Concept Medical Admission

Distinguished Non-Finalist

Presenter Organization Singhealth

Presenting Author Wan Tin Lim

Track Other

Keywords

Singapore General Hospital

Acute Ambulatory Care Team

emergency department congestion

bed shortages

internist-led care

COVID-19 pandemic

ambulatory care

patient discharge

bed allocation

medical complexity

Acute Ambulatory Care Team

Emergency Department Boarding

Triage Criteria

Ambulatory Care Sensitive Condition

Medical Admission