OPENING REMARKS BY ASSOCIATE PROFESSOR KENNETH MAK, DEPUTY DIRECTOR OF MEDICAL SERVICES, MINISTRY OF HEALTH, AT THE 15TH INTERNATIONAL CONFERENCE ON RAPID RESPONSE SYSTEMS AND MEDICAL EMERGENCY TEAMS

Adjunct Associate Professor Augustine Tee, Organising Chair of the 15th International Conference on Rapid Response Systems and Medical Emergency Teams,

Dr John Welch, President, International Society for Rapid Response Systems,

Distinguished guests, ladies and gentlemen.

1. Good morning and a very warm welcome to Singapore.

2. We are living in a rapidly ageing society. The number of citizens aged 65 and above in Singapore has grown from 340,000 in 2010 to 550,000 in 2018¹ and is expected to grow further. Many of our seniors are likely to have chronic diseases. If not managed well, some may progress to develop serious complications like organ failure and require hospitalisation.

3. When in hospital, the clinical course of a patient can change rapidly. This is particularly the case for frail patients who lack cardiorespiratory and other organ functional reserve. If we fail to appreciate who these at risk patients are, fail to effectively manage the root causes for clinical deterioration, fail to detect early features of deterioration and implement appropriate interventions to reverse this trend, patients may suffer catastrophic outcomes and even death. The early detection and rapid response to patients showing early signs of deterioration can reduce mortality and morbidity. For certain patients, this can also help to reduce unplanned ICU admissions.

4. In my experience as a surgeon providing perioperative care to patients in the ward, I have seen instances where clinical deterioration in patients had been fortuitously recognised and responded to by clinicians, nurses, and allied health professionals, thereby making a difference to patient outcomes. This is an area where Rapid Response or Medical Emergency Teams (MET in short) have critical roles to play, in minimising delays in recognising and responding to patients who are at risk of signs of potential deterioration.

5. In Singapore, several hospitals have implemented MET or similar systems. One such hospital, Changi General Hospital, implemented the MET in 2009 introducing a prompt clinical review of patients with signs of deteriorating vital signs to avert further deterioration, cardiac arrest and death. The hospital found a significant correlation between an increased utilisation of MET with a decrease in incidences of cardiopulmonary arrests. Clearly, the implementation of MET has resulted in better patient outcomes here.

6. A local review of early warning systems showed that while hospitals do place a high priority on reducing failures and delays in initiating a clinical review of patients with clinical deterioration, there is much variation in practice within hospitals in Singapore. As such, there is room to review whether a more harmonised system should be instituted, to standardise clinical processes, share educational resources, and use standard Key Performance Indicators (KPIs). Rapid Response and Medical Emergency Teams are a rich area for Health Services Research. As with all health services, a deeper understanding is needed on how best to structure our clinical services to deliver the best possible patient outcomes.

7. To all experts gathered here this morning, there are lessons and best practices from around the world that we can learn from. I hope that we will continue to share our challenges as well as insights to overcome them and that we will support one another in strengthening this important patient safety initiative to improve patient outcomes.

8. On this note, I wish all delegates a fruitful conference. Thank you.

[1] Source: Population and Population Structure, Singapore Department of Statistics, accessed 11 April 2019.