Singapore Medicine -- Healthcare Quality Where It Counts

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Singapore Medicine, a department of the Singapore Tourism Board, announces that Singapore has achieved a quality score in healthcare that puts it well on par with the most medically advanced countries worldwide.

Singapore's medical infrastructure has been well designed and our medical training is rigorous. Also, we have a medical audit system that helps us track our progress in various areas. This ensures that we constantly review our standards

Measuring quality in healthcare has always been difficult. To go beyond mere platitudes, accolades and hygiene factors means getting into specific clinical indicators.

In both the private and public sectors, Singapore's hospitals and medical centers have achieved outcomes that equal and even surpass those in the developed West.

The numbers speak for themselves, numbers that made Singapore Asia's Leading Medical Hub.

"There are several indicators used worldwide to benchmark the quality of hospital care, such as MRSA infection rate and the time lag for commencement of antibiotic therapy," explains Dr S. Thanasekaran, Chief Medical Officer at ParkwayHealth, one of Singapore's premier private healthcare groups.

The "superbug" MRSA (Methicillin Resistant Staphylococcus Aureus) is a highly dangerous and drug resistant bacterium known to cause hospital-acquired infections. A low MRSA rate indicates greater effectiveness of infection control measures being implemented.

"For the first half of 2008, we have consistently achieved lower-than-target MRSA rate of 0.33 in our hospitals. This compares very favorably to the US national average of around 2.4 percent, as published in the American Journal of Infection Control," says Dr Thanasekaran.

Another indicator often used as a pointer for good hospital care is response time for the administration of emergency medication. The timely use of antibiotics in cases of pneumonia caused by bacteria, for example, can lower the mortality rate by as much as 15 percent.

"The current standard internationally is for antibiotic therapy to begin within four hours after admission. We have successfully kept above the 90th percentile mark even as we aim for 100 percent compliance. Again, this compares well to the US national average of around 80 percent," says Dr Thanasekaran.

An even sharper contrast can be seen for Ventilator-Associated Pneumonias. Patients cared for in Intensive Care Units often required artificial ventilation, which introduces the risk of ICU-acquired chest infections. These patients are seriously ill and additional hospital-acquired infections compromise their condition further. It has been estimated that between 15% and 40% of patients on mechanical ventilation for more than 48 hours develop pneumonia.

In 2005, the average Ventilator-Associated Pneumonia rate in coronary care units in Singapore was 2.53 per 1000 ventilator days, compared to the pooled mean of 4.4 and pooled median of 4.0 respectively in the US National Nosocomial Infection Surveillance Report 2004.

Singapore's good showing is not limited to its private healthcare providers. The nation's public hospitals, too, have left their marks in such specialized fields as cardiology, gynecology and obstetrics.

The National University Hospital, one of the region's top teaching and medical research hospitals, has consistently garnered good reviews backed by statistics for its cardiology program.
Recently published indicators showed that NUH has up to 75 percent fewer heart failure mortalities within a 30-day period compared to its peers. Their re-hospitalization rate for heart failure patients, too, is significantly lower than the international standard.

Over at the KK Women's and Children's Hospital (KKH) -- Singapore's largest maternity facility -- the perinatal mortality rate for fetuses 24 weeks and above stands at just 5.38 per 1,000 births -- one of the lowest in the world. This compares to eight in the UK and 10 in Australia.

"We have moved well beyond international benchmarks in some areas. For example, the current standard as set by the United Kingdom's Royal College of Obstetrics and Gynecology for emergency Caesarean sections is 30 minutes' interval time between the decision and time of delivery. Here at KKH, we have cut that lag time down to a mere seven to eight minutes," says A/Prof Tan Kok Hian, Chairman of KKH's O & G Division.

A member of the Vermont Oxford Network which collates information about the care and outcome of high-risk newborns, KKH's neonatal department is now placed in the best quartile amongst 600 neonatal intensive care units worldwide.

Singapore's steady climb up the medical ranks is no accident. Currently ranked sixth best in the world and best in Asia by the World Health Organization, the tiny nation-state has worked hard for its string of successes.

"Singapore's medical infrastructure has been well designed and our medical training is rigorous. Also, we have a medical audit system that helps us track our progress in various areas. This ensures that we constantly review our standards," shares A/Prof Tan.

This sentiment is echoed by Dr Thanasekaran of ParkwayHealth, "Our hospitals are committed to continuously quality improvement. We aim to exceed globally recognized benchmarks in order to offer all our patients the best possible care."

For more information download a personal copy of 'Patients Beyond Borders Singapore Edition'.


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