Characteristics of unplanned hospitalisations among cancer patients in Singapore

Introduction: Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as “gate-keepers” to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. Methods: Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. Results: Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger (P=0.010), had lower National Early Warning Scores (NEWS) (P=0.006), and had a lower proportion of gastrointestinal and hepatobiliary cancers (P=0.005). Among short admissions, common presenting medical problems were infections (n=144, 36.3%), pain (n=116, 29.2%), gastrointestinal complaints (n=85, 21.4%) and respiratory complaints (n=76, 19.1%). These admissions required investigations and treatments already available at the ED. Conclusion: Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs. Keywords: Emergency medicine, healthcare use, oncology, palliative care, unplanned cancer admission

Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits

Introduction: Foreign workers (FWs) on work permit face unique health challenges and potential barriers to healthcare. We aimed to examine the epidemiology, attendance patterns, disposition, and adherence to follow-up, by FWs on work permit to two emergency departments (EDs) in Singapore. Methods: In this retrospective observational study, we included consecutive FWs on work permit who registered at the EDs of two public restructured hospitals from 1 May 2016 to 31 October 2016. Data obtained from electronic medical records included patient demographics, triage acuity, disposition, ED diagnoses and bill information. Results: There were 6,429 individual FWs on work permit who contributed to 7,157 ED visits over the 6-month study period, with male predominance (72.7%, 4672/6429), and median age of 31 (interquartile range 26 to 38) years. A high proportion of these FWs were triaged to low-acuity status compared to the general ED population (66.9% versus 45.9%, P<0.001). Trauma-related injuries contributed to 34.4% of their visits, and were more likely to result in admission compared to non-trauma-related conditions (18.7% vs 15.2%, P<0.001). FWs engaged in shipyard, construction and process industries were more likely to be discharged “against medical advice” (14.8% vs 3.2%, P<0.001), and default their specialist outpatient follow-up (50.1% vs 34.2%, P<0.001) for non-trauma-related conditions compared to trauma-related injuries. Conclusion: In Singapore, the EDs of public restructured hospitals provide healthcare safety nets to FWs on work permit. These workers made more low-acuity visits compared to the general population during the study period and may face potential barriers to admission and follow-up. Keywords: Emergency medicine, epidemiology, migrant workers, occupational medicine, public health

Pre-Hospital Care: The New Perspective in the International Rotational Program of Emergency Medicine Residents

Background: Cooperation between Japan (Tsukuba University), Laos (The University of Health Sciences), and Thailand (Khon Kaen University) had been established in order that the teaching of doctors in the Emergency Medicine Training Program in Laos could be developed so that these doctors could have the opportunity to be the observers of EMS in Thailand. However, as of this time, no studies related to the pre-hospital care perspective in the International Rotational Program for residents of Emergency Medicine have been conducted. Objective: To survey the perspectives of pre-hospital care for residents from Laos, who were participating in the International Rotational Program of Emergency Medicine. Materials and Methods: This was a retrospective cross-sectional study conducted between January and March 2020 with thirdyear residents in Emergency Medicine from Laos, who had come to gain practice at the EMS of Srinagarind Hospital in Thailand. Before starting the session, data was collected from all participants, which consisted of responses to a multiple-choice test, demographic data, and satisfaction surveys. Results: A total of eight emergency medicine residents were enrolled and were then divided into three groups. Under normal conditions, the EMS duration time was thirty-two hours for each group. During the first week of the course, knowledge was disseminated through lectures. During the second week, the participants were placed on duty. After that, they received calls from the 1669 center and were dispatched with the EMS operation team. Finally, over the duration of a two-week period, they were placed in the role of being observers on ambulance duty. When comparing the Pre-test and Post-test assessment of their EMS knowledge, a significant increase in their scores from 3.4 to 8.5 (p = 0.010) was found. In addition, the medical oversight had increased from 2.4 to 8.4 (p = 0.005), while the EMS systems had significantly increased from 4.2 to 8.6 (p = 0.014). Conclusion: The International Rotational Program for Emergency Medicine residents, which had focused on the EMS aspects with EMS knowledge, Medical Oversight, and on the EMS systems, was found to be successful for the doctors from Laos. Keywords: Emergency medicine, Internship and Residency, Emergency Medical Services, Learning