As part of an extension to all six polyclinics under the National University Polyclinics and 82 general practitioners of the Primary Care Network, the Chest Pain Specialist Clinic at Ng Teng Fong General Hospital looks to cut down waiting time and increase speed of diagnosis of chest pain.
Cardiovascular disease accounts for 30.1 percent of all deaths in Singapore. With increased public awareness, patients more readily alert either their family practitioners (GP) or Emergency Departments (ED) for investigation of new onset chest pain.
In 2018 alone, more than 5,000 patients had attended the ED at Ng Teng Fong General Hospital (NTFGH) for chest pain, accounting for more than 5 percent of ED visits. With link of sudden deaths from chest pain and coronary artery diseases in older adults, a chest pain clinic would prove to be essential for immediate assistance of chest pain patients for comprehensive diagnosis and evaluation.
In what is Asia’s first same-day specialist clinic for chest pain at Ng Teng Fong General Hospital, the Rapid Access Chest Pain Clinic or RACPC for short, was started on 1 July 2018 by Dr Pipin Kojodjojo, the Director and senior consultant of Cardiology at the hospital and Nurse Clinician, Ms Toh Lay Cheng, a cardiac specialist nurse, who had both worked at one of London’s chest pain clinics.
The newly opened chest pain clinic opens every weekday afternoon to respond to same-day polyclinic referrals from the two pilot polyclinics, namely, Jurong and Pioneer polyclinics. Ng Teng Fong General Hospital hopes to scale and extend this tie-up to the rest of the four National University Polyclinics (NUP) and another 82 General Practitioners who are with the Primary Care Network of the National University Health System (NUHS), by June 2021.
“We have created a new care pathway, through Ng Teng Fong General Hospital Rapid Access Chest Pain Clinic (RACPC) that would tackle these problems experienced by many healthcare systems.” Said Dr Pipin.
A patient could be at the polyclinic in the morning and within the same day, his symptoms of chest pain would have been completely evaluated by a specialist in this specialist clinic. This was not possible before, unless the patient was admitted to the emergency department (ED) of a hospital. The RACPC allows the facilitation of GP’s access to cardiologists to manage patients presenting with chest pain. This would help improve patient experience and convenience by allowing consultation and testing to be completed within a single hospital visit.
The clinic hopes to help address and avoid unnecessary hospitalisations for investigation of chest pain as well as provide earlier diagnosis and treatment of coronary artery disease.
When patients are referred to the cardiology specialist outpatient clinic (SOC) for evaluation of chest pain, the time from referral to definitive diagnosis can average 6 to 10 weeks and necessitates several visits to the hospital for consultations and tests. GPs are concerned that such a wait is unduly long for some patients with more alarming symptoms and may recommend that the patient attends the ED immediately. Hence, nearly half of the patients attending the ED with chest pain are referred by GPs. For patients waiting for outpatient tests, this period of uncertainty can cause anxiety and prompt the patient to visit the ED to expedite testing, further straining the already busy ED and increasing healthcare costs.
Increase patient safety, convenience as well as cost savings are some of the goals of implementing the chest pain specialist clinic. The average cost of investigating chest pain in the ED at Ng Teng Fong General Hospital is SGD 1,079 which increases to SGD 2,188 if the patient is admitted to the acute wards. Hence inpatient evaluation of chest pain is expensive and consumes a substantial amount of healthcare resources. With the chest pain specialist clinic, there is a potential 20.7 percent reduction in healthcare expenditure is predicted per patient.
At the Asian Hospital Management Award ceremony held virtually in December 2020, this new specialist clinic came in Second under the category of Patient Experience Improvement. This award now in its 19th year, recognizes and honors hospitals in the Asia Pacific. It is the most prominent hospital management awards in the region.
RACPC was well-accepted by patients with 9 out of 10 RACPC patients highly recommending the service, with a median rating of 8.3 out of 10. [APBN]