Right-Siting of Eligible Patients with Poor Prognosis Intracranial Hemorrhage from ED to General Ward
Care Continuum
Care Process & Redesign
National Healthcare Group Quality Improvement
National Healthcare Group
24 December 2025
To increase right siting of eligible patients with poor prognosis intracranial hemorrhage (ICH) presenting to TTSH ED from. Although mission statement goals were not fully achieved, interventions facilitated earlier comfort for dying patients and reduced ICU.
Year Submitted: 2025
Published Date: 24 December 2025
Tags: Care Process ＆ Redesign, Cost Saving, Workflow Redesign, Quality Improvement, Productivity, Care Continuum, Right-Siting, Intermediate and Long Term Care ＆ Community Care
About this Content
Aims
To increase right siting of eligible patients with poor prognosis intracranial hemorrhage (ICH) presenting to TTSH ED from 0% to 100% within 6 months.
Background
The challenge of managing patients with poor prognosis ICH in the emergency department (ED) and ensuring they are right-sited to general wards instead of the ICU.
Methods
Creation of ED terminal extubation workflow, use of ED consult room 5H as an ED EOL room, and communications teaching sessions by Palliative Medicine/Medical Social Worker.
Results
Increase in percentage of eligible patients right-sited away from ICU from 0% to 50% post-implementation, with a reduction in time to compassionate extubation from 39.1 hours to 30 hours.
Conclusion
Although mission statement goals were not fully achieved, interventions facilitated earlier comfort for dying patients and reduced ICU length of stay.
Lessons Learnt
Communications surrounding death remain sensitive, sufficient resources are key for intervention success, and stakeholder belief in the problem's significance is crucial.
Additional Information
Sponsored by Adj Asst Prof Michael Chia Yih Chong, mentored by Dr. Sullivan Troy Daniel.
Keywords
Intracranial Hemorrhage, Right-Siting, Cost Savings, Emergency Medicine, Palliative Care
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | National Healthcare Group Quality Improvement |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Emergency Medicine, Palliative Medicine |
Project Lead(s) | Weng Yanyi |
Project Member(s) | Ou Yong Chee Kit Donovan |
Connect with this contributor!
Group Quality - nhggroup.QRM@nhghealth.com.sg