Tan Tock Seng Hospital’s Rapid Testing Smart Ward Previews the Future State of Inpatient Care

​Mere minutes and seconds can make a difference in our care team being able to deliver crucial interventions to save lives and prevent complications.
To anticipate falls, sensors and AI technologies are embedded in the ward with our multi award-winning PreSAGE bed-exit Prediction and Prevention system co-developed by CoNEX Healthcare and TTSH.

Using thermography, machine learning, predictive algorithms, and image processing techniques, PreSAGE® is powered by artificial intelligence to detect and predict bed-exits which allows a 15-second pre-exit lead time for staff to intervene before patient assumes a standing position from the bed. Patients’ conditions can be monitored and even predicted remotely by these digital enablers for earlier interventions.
During evaluation, PreSAGE achieved a sensitivity score of 100% for bed-exit prediction. There was a 34% reduction in falls rate, and a 67% saving in manpower hours.

Since its implementation, PreSAGE® has been scaled to all single-bed and isolation rooms in TTSH which comprise a total of more than 100 beds. The next phase of evaluation will be to test-bed this system in TTSH Smart Ward’s cubicle room of 6 beds. As well as, to explore advanced contactless sensors that will monitor patients’ parameters such as respiratory rate, temperature, behavioural and emotional state to predict deterioration of condition for early intervention.

PreSAGE® has also been adopted by other hospitals and nursing homes in Singapore after the successful pilot at TTSH.

It assists the nurses in the wards to bedbound turn patients every two hourly to prevent bed sores caused by laying on one side of the body for too long. Reduces the need for labour intensive turning and staff injury.

The Doctors, Nurses and Allied Health Professionals (DNA) hands-free communication technology can empower clinicians to make timely and informed decisions. Virtual ward rounds will be the norm where care team members can dial in anytime and anywhere, even off-campus, for care plan discussions.

For instance, a doctor who needs to update on the patient’s condition or obtain input from other clinicians to define the patient’s care plan together can use this hands-free wearable technology. The device allows clinicians to issue voice commands, such as “Call Patient ABC’s Care Team”, to contact the relevant personnel for virtual discussions.

Its voice-to-text command function also enable nurses to treat a wound and document the clinical procedure hands-free. Especially relevant in today’s context during the COVID-19 pandemic where members of the care team have to gown and de-gown Personal Protective Equipment (PPE) to check on each patient, take his or her vital signs and administer medications periodically in an isolation room. With this technology, it can minimise material wastage.

Still on trial, the voice activated communication wearable can potentially save up to 8 seconds as compared to using a smartphone for calling another care team member. The additional step to search for phone directory reduces the calling time.

Activated patients are empowered to take charge of their own health.

Each patient in the Smart Ward will have a SMART Device (iPAD) at their bedside. It will allow patients to have real time access to their care team, personal health data as well as educational information.

Patients can find out more about their well-being and take charge of their own health, through their personal health data such as vital signs, as well as check for the schedules of their next medical and/or therapy sessions.

Patients and caregivers can also learn more about their conditions and be equipped with the necessary skills to better manage their care in the community when they are discharged.

The current ward has work counters in the middle of the ward to facilitate documentation by staff. As we have transited to electronic medical records and digitisation of records, and documentation mainly at the decentralised counters, the space can now be re-purposed as a healing space in the inpatient ward.

With the space redesign, it caters as a multi-purpose space for optimised for patient engagement, team interactions, virtual team conferencing and future evolving needs. Thus, creating more space to empower patients to partner with their care team in caring for their own health.

Practising good hand hygiene is important to serve as protection surveillance to patients, staff, and visitors themselves.

The use of voice prompts is to remind staff and visitors to carry out hand hygiene when they enter the wards.

It is a ground up initiative by the nurses. With the implementation of the Hand Hygiene Reminder, there has been 50% more hand hygiene completed when staff and visitors enter the ward.

A multi-functional chair with reclining function that can be converted from chair-to-bench for more visitors to sit on, as well as a chair-to-bed for caregivers to rest at night.

An innovation co-designed from scratch by TTSH’s multidisciplinary team of nurses, allied health professionals and representatives from the Infection Control, and Kaizen offices, to meet patients’ needs.

The usability test show that more than 90% of the users (staff, patients and their next-of-kins) found the prototype to be intuitive.

(FuSA stands for Function and Safety meets Aesthetics)

 

The assisted shower device supports nurses in showering patients who are functionally dependent and at risk of fall. There are smart water jet spray and self-shampooing capsule to bathe the patient.

With this shower device, one nurse nstead of the usual two nurses is now needed to assist the patient. It reduces the time for patients to shower, from 10 mins to 4 mins, improving nurses’ productivity by 60% so that they can do more value-added work.

Patients feedback that the device’s showering process is thorough and complete. With patient safety and privacy ensured, this device has since scaled within the hospital.

Allows nurses to draw out electronic accessories and clinical consumables as and when required to replace faulty items faster without needing to raise purchasing orders.

It helps with reducing the downtime of ward equipment from a week to just 5 minutes, and minimising patient care disruption. Improving work processes and nurses’ productivity.

Allows for safely disposal of single use pulp consumables such as bedpans and urinals that contains human excreta. Compared to bedpan sanitizers, the macerator is able to significantly reduce the risk of cross contamination to meet higher infection control standards, especially critical during an outbreak.

It is environmentally friendly, improves hygiene and saves the need for nurses and health care attendants to wash the consumables.

​Co-designed with Cadi Scientific and TTSH, RTLS provides the foundational locating technology, that allows us to locate patients and equipment in real-time. The RTLS will enable the tracking of patients, visitors and staff, for rapid and reliable contact tracing so that necessary actions can be taken quickly to curb onward transmission.

RTLS was implemented in National Centre for Infectious Diseases (NCID) in 2019 and has scaled to the TTSH’s main ward block in 2023. TTSH Smart Ward also redesigned the process for patient abscondment leveraging on RTLS. For example, in the event of patient abscondment, staff can locate patient immediately to ensure patients’ safety.
RTLS provides us the capability of real time location tracking and contact tracing which allowed us to:

• Improved operational efficiency
• IOptimised asset management
  
• Enhanced and expedited contact tracing