The Urgent O&G Centre (UOGC) is Singapore’s referral centre of choice, where patients present with a variety of conditions, including early pregnancy, post-partum, menstrual, urogynaecological, breast and gynaecologic-oncological disorders. An average of 2,210 patients is seen each month. Previously known as the O&G (24-hour) Clinic, the renaming to Urgent O&G Centre emphasises the facility’s focus on managing acute O&G-related issues and dovetails with enhancements to patient care:
1. Round-the-clock Availability of Specialists Consultants or Associate Consultants are present at all times to provide supervisory support to the care team.
2. Adoption of Modified Patient Acuity Category Triage System Under the Modified Patient Acuity Category triage system, all patients are initially triaged by trained nurses into P1/P2/P3 categories by a set of criteria. This allows for acute conditions in the P1 and P2 categories to be attended to in a timelier manner.
To allow for priority critical patients, special personnel are also appointed to screen and re-triage patients in the waiting area as necessary, as conditions may evolve to become more acute.
Patients with non-OG conditions, if stable, will be given a choice to be referred to other hospitals better-equipped to provide them with specialised care for their medical conditions.
3. New Facilities
4. Academic Medical Centre activities in the Urgent O&G Centre The UOGC aims to support the academic centre to promote research and help patients gain access to evidence- based care. Aside from providing clinical services, the UOGC is at the forefront of recruiting patients for various research projects, focusing on developing new diagnostic point-of-care tests and improving urgent care responses.
Work on a Spot Serum Progesterone test, led by Associate Professor Tan Thiam Chye, resulted in a new protocol for the assessment and management of threatened miscarriages in spontaneous pregnancies. This assists the doctors in decision-making, while determining the optimal dosage of pregnancy hormone supplementation in patients presenting with bleeding, which is common during early pregnancy.
Since February 2018, Advanced Practice Nurses (APN) have been attached to the UOGC as part of their accreditation to manage common O&G conditions. The aim is to empower APNs to be pillars of the UOGC, to provide extra support in the clinic and enhance services.
A CORPUS (Course for O&G/Radiologists in Pelvic Ultrasonography) workshop was conducted in May 2018 to train and certify O&G and Radiology trainees to perform early pregnancy scans required to assess common gynaecological conditions such as fibroids and ovarian cysts. The workshop was well-received by attendees.
Looking ahead, the UOGC will continue to review and incorporate up-to-date protocols for common O&G conditions to enhance the management of patients.
In aligning with the hospital’s philosophy of patient-centered care, the UOGC’s multifaceted enhancements aim to improve care, safety and experience for patients.
A specialised area in the UOGC with emergency resuscitation and monitoring equipment caters for patients with significantly abnormal vital signs, who are in critical condition and deemed to be unstable.
Such patients (Triage category P1) will be attended to immediately by registrars and specialists. There is an emergency delivery facility for patients who cannot be transported to the Delivery Suite in time. CODE Blue/Red can be activated from the clinic in case of collapsed patients.
The UOGC will attend to patients who are experiencing bleeding, pain or severe nausea and vomiting in pregnancy (less than 22 weeks’ gestation). Scans are offered by doctors trained to ascertain the location of the pregnancy, and to assess gestational age as well as viability (in order to exclude ectopic pregnancy).
The UOGC has two state-of-the-art ultrasonography machines with excellent resolution, to better aid doctors in management of early pregnancies. In collaboration with the Department of Diagnostic and Interventional Imaging, sonographers will provide expertise and perform urgent scans for unstable patients. Counselling for pregnancy complications such as miscarriages, ectopic and other abnormal pregnancies is also provided. Point-of-care pregnancy blood tests are performed at the clinic and reviewed promptly by on-site doctors to determine further management for patients. Expectant mothers at 22 weeks gestation or more, will continue to be attended to at the Delivery Suite on Level 2, Women’s Tower.
Patients with severe vaginal bleeding or lower abdominal/ pelvic pain will be initially evaluated at the UOGC, and emergency treatment instituted to resolve symptoms as necessary.
Vaginal swabs, biopsies and other diagnostic tests may be performed at the UOGC, if urgently needed, and the management of patients continued at the Specialist Outpatient Clinics as necessary. Again, pelvic imaging is readily available if the need arises.
The UOGC manages patients with breastfeeding issues and other postpartum conditions, such as excessive bleeding, pain or wound complications. 24-hour Lactation Consultant services are available at the clinic.
Fast-track referrals to the Breast Clinic for urgent breast conditions, such as breast abscess, are also available. Patients who are emotionally labile may also be admitted with suicide cautions, for review by the Mental Wellness Service team.
The UOGC is the main portal of follow-up for patients who are experiencing unexpected symptoms after an operation in KKH. These can range from more acute conditions, such as severe bleeding or pain, to less critical ones, such as a urinary tract infection or mild wound infection.
Such a service is especially important for the hospital in promoting patients’ safety and trust in our care.
Not only do we play an essential role in providing medical expertise to evaluate victims for physical injury and prevent sexually transmitted infections, our influence on their psychological recovery as impartial and sensitive first-responders to their trauma cannot be overlooked.
The UOGC attends to pregnant patients, who have been exposed to or have symptoms suggestive of potentially infectious diseases such as chickenpox, in isolation, in order to reduce risk to the many other pregnant patients in the hospital.
These groups of patients are screened and triaged by trained nurses, who then immediately assign them to an isolation area to await consultation by the doctors. Opinions from Infectious Disease specialists can be sought for complex cases. The UOGC was quick to implement a Zika Virus protocol, in collaboration with the Department of Maternal Fetal Medicine.
KK Women’s and Children’s Hospital Women’s Tower, Basement 1 For any enquiries, please call KKH General Enquiries (24-hrs) at +65 6-CALL KKH (+65 6-2255 554).
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