Page 90 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Special Topics

T4.1 Training in Emergency Medicine 13:15 Convention Hall C

Tuesday, 3 May Team-based Learning — a Way to Integrated Patient Centric Care
Quek LS
Emergency Department, Ng Teng Fong General Hospital, Singapore

The “Symptom – Diagnosis Gap”

History of medicine over past decades shows increasing specialisation and increasing opportunities for diagnosis and
treatment.

This created a dilemma:
Specialty-based hospital care system being “diagnosis-based”, but, patients seeking care being “symptom-based”.

Diagnosis-based care is silo units, non-interactive and often leads to disjointed care for the patient.

Symptom-based care requires a team-based approach, considering multiple diagnosis, specialty team members participating
in the care to address the patient’s symptoms. A multi-professional approach, working in teams, understand group dynamics
and be involved in dialogue.

In this session, some of the clinical care and service initiatives Jurong Health Singapore piloted will be shared, leveraging on
team and motor skills simulation training, applied to complex, high stakes teams in the hospital environment and new care
models in the community — to close the gap.

T4.2 Training in Emergency Medicine 13:15 Convention Hall C

Emergency Physicians’ Journey to Achieve Better Toxicology Service
Tsui SH 1, Fung J 2
1Accident and Emergency Department, Queen Mary Hospital, 2Accident and Emergency Department, Pok Oi Hospital,
Hong Kong

In early era of emergency medicine, the mainstay of care provided by emergency physicians was mostly confined to
resuscitation. The management of other clinical categories was far from either in-depth or in breadth, and that of toxicology
was no different at all. Actually, appropriate management or specific treatment are crucial to the very first phase of caring
toxicology patients. Besides, toxicology patients are very suitable to be managed in the Emergency Medicine Ward or a
comparable setting. About a decade ago, a group of passionate emergency physicians, in response to these favourable
factors, started their journey to sub-specialise and to improve the toxicology service in the Hospital Authority (HA).

To support an up-to-standard toxicology service, training is indispensable. Many Accident and Emergency Departments
(A&Es) started organising inhouse courses and clinical meetings. Some A&Es hold inter-departmental meetings that serve
additional purposes of enhancing understanding and collaboration between various stakeholders. At another level, the Hong
Kong College of Emergency Medicine and Hong Kong Poison Information Centre hold structured courses at various levels,
from basic to diploma, that open to all interested clinical staff (not limited to A&Es) within and outside the HA.

A toxicology team can form when a critical mass of trained emergency physicians and nurses accumulates in a particular
hospital. As years passed, now a number of A&Es with toxicology teams have taken up the duty of care of toxicology patients
presented to the hospitals from presentation to medical clearance. Emergency Medicine Ward is the hub for the care of such
patients. Post-discharge followup are provided as required. Some departments have even set up toxicology outpatient clinic
for outside referrals. Toxicology team members are also enthusiastic on research and knowledge sharing. In the past decade,
the output to medical journals, from case reports to prospective trials, has been growing fast. Some reports are the first
worldwide while some have widespread implications to clinical practice.

The changed paradigm of toxicology service provision illustrates how passionate clinicians have improved patient service by
making self-advancement and implementing changes within the established system.

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