Sunday 26 April 2015

National database planned for ICUs in public hospitals

By Salma Khalik, Senior Health Correspondent, The Straits Times, 25 Apr 2015

SINGAPORE will develop a national database of public hospital intensive care units (ICUs) to better understand and manage patients who are critically ill.

Announcing this yesterday, Health Minister Gan Kim Yong said it should lead to better care, improve capacity planning and optimise resources.

"Given the relatively high mortality and costs associated with intensive care, it is important to improve our understanding of the burden of critical illness," he said.

Mr Gan was speaking to intensive care specialists, pharmacists, nurses and other healthcare professionals from Singapore, Australia and New Zealand at the 3rd SG-ANZICS Intensive Care Forum held at Suntec convention centre.

Singapore already has good intensive care outcomes, he said, with the survival of 66 per cent of patients with severe sepsis or blood poisoning, compared with 50 to 70 per cent in other developed countries.

Mr Gan said the newly formed national ICU registry will allow better understanding of the management and outcomes of critical illness and the factors that might influence it.

Dr Jason Phua, vice-chairman of the registry, said there was a three-month pilot programme at the end of last year at three hospitals to work out the information needed, how the data can be collected as well as standardising definitions across hospitals.

The registry will start collecting data from all public hospital ICUs from the middle of this year.

Dr Jonathan Tan, president of the Society of Intensive Care Medicine (Singapore), said the aim is to fill existing gaps and not to compare how hospitals perform - though if one is doing very much better, others should learn from it.

One such gap is the incidence of acute respiratory distress syndrome, which occurs when the lungs fail. When asked how often this is seen in ICUs, none of the intensive care specialists knew.

Associate Professor Loo Shi of Tan Tock Seng Hospital (TTSH) said this is because an ICU is like a "disaster zone" where doctors "just treat, treat, treat", with no time for anything else.

Dr Shahla Siddiqui of TTSH was presented with one of three research awards by the newly formed Society of Intensive Care Medicine (Singapore) to look into acute respiratory distress syndrome.

Dr Zudin Puthucheary of the National University Hospital will study the financial burden of critical care, while Dr T. Suhitharan of Singapore General Hospital will try to determine if the amount of acid in a critically ill patient can be used to predict whether the patient will survive.

Mr Gan said that while it is important to train ICU staff in caring for the sick, it is also important to teach them how to deal with patients who will die despite the best available care.

"It requires understanding when intensive care will not benefit patients, how best to communicate with families or surrogates, guiding and supporting them on making decisions on clinical care, and finally to ensure that patients' and their families' views are respected," he said.

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