SPEECH BY DR KOH POH KOON, SENIOR MINISTER OF STATE FOR HEALTH, FOR THE OFFICIAL OPENING OF CHANGI GENERAL HOSPITAL’S WOUND HEALING CENTRE

Mr Cheng Wai Keung, Chairman, SingHealth
 
Prof Ng Wai Hoe, CEO, Changi General Hospital

Mr Koh Choon Hui, Chairman, Celligenics

Mr Kurt Wee, CEO, Celligenics

Ladies and gentlemen,

1.     Good afternoon. It is my pleasure to join you at the Official Opening of the Wound Healing Centre (WHC) by Changi General Hospital (CGH). 

Growing number of chronic wound patients in Singapore

2.     Chronic wounds are a common problem, especially among the elderly with underlying health conditions such as diabetes, cardiovascular and peripheral vascular diseases, and reduced mobility. Chronic wounds bring pain and emotional stress to those who are affected. Studies have shown that about 2 percent of the population will experience a chronic wound during their lifetime in developed countries¹. 

3.     In Singapore, we are seeing a rising prevalence of chronic medical conditions that are associated with the development of chronic wounds. Amongst these conditions, diabetes mellitus predisposes patients to chronic wounds from injuries related to diabetic peripheral neuropathy as well as poor wound healing that results from arterial insufficiency or peripheral vascular disease.  A study showed that diabetes contributed to 87 percent² of the arterial insufficiency ulcers in our local population. Another study showed that the length of stay for a patient with a chronic wound is likely to take 2.4 times longer than the average length of stay (ALOS) of all admissions within the same institution³. Recurring chronic wounds consume healthcare resources, reduce productivity, and increase caregiver burden. 

4.     Chronic wounds that heal poorly may have multiple aetiologies where the underlying causes may not be obvious without further investigations. For example, Madam Talisa is a patient with diabetes and chronic renal failure on dialysis support, who had a blister on her toe one month ago. She was referred to an orthopaedic specialist for evaluation. An early scan revealed critical narrowing of the blood vessel supplying the foot and vascular surgery was performed to re-establish blood flow to the ischemic area. However, the blister became infected, and a decision was made to amputate the toe to prevent further infection and a greater loss of her lower limb. Others who may not have early detection of the underlying causes of their chronic wounds could encounter more severe consequences. 

5.     The healthcare challenges associated with chronic wounds are multi-faceted and requires a reframing of our approach to patients at risk of chronic wounds. In addition to managing tertiary acute episodic care of salvaging end stage complications, we need to move upstream to enhance our efforts to avoid complications that may lead to potential   loss of limb and life. For example, primary and secondary prevention aim to prevent chronic conditions from developing or to improve the management of chronic conditions to prevent progression to complications over time. Regular surveillance of at-risk patients as part of tertiary prevention such as our diabetic foot screening programme aims to diagnose and treat complications early to mitigate the long-lasting impact of the complications if left uncontrolled. These prevention efforts cannot be done in isolation, and requires the cooperation of many different stakeholders, including specialists, and those in allied health, nursing, and primary care.  

One-stop, multi-disciplinary outpatient care for chronic wounds

6.     To improve and streamline care for patients with chronic wounds, Changi General Hospital (CGH) has set up the Wound Healing Centre (WHC), which officially opens today. The WHC is a patient-centric one-stop outpatient facility focusing on early intervention and fast-tracked treatment of chronic wounds, helmed by a multidisciplinary team of specialists and nurses from the Vascular Surgery, Orthopaedic Surgery, and Plastics, Reconstructive & Aesthetic Surgery. These integrative services work with other relevant specialists looking after the concurrent medical conditions to provide the holistic care that would achieve the best outcomes for our patients with chronic wounds. 

7.     Patients are now able to receive a suite of services ranging from diagnostic tests, assessments, and treatments within the same day. At steady state, the WHC aims to provide an average of 1,000 wound-related consultations and procedures each month. Timely access to outpatient treatment would help reduce avoidable Emergency Department attendances, hospitalisation and readmissions. 

8.     Nurses play an integral role in wound care management as they journey with patients on the road to recovery. At WHC, wound care nurses, together with vascular and geriatric Advanced Practice Nurses, manage extensive and complex wounds that require close monitoring. Nurse Clinician Ong Ling, who is part of the team of wound care nurses, performs advanced wound care procedures on patients and educates caregivers on wound dressing techniques as well as identification of wound deterioration. More than that, she is also a listener, cheerleader and health and wellness educator.

Advancing wound care through digital health, research and innovation

9.     Apart from keeping up with research and clinical trials updates, it is also very important to take a proactive approach to leverage new technology to improve patient outcomes for wound care. 

10.     I am happy to share that CGH Wound Healing Centre will work with Celligenics on studies to explore the role of stem cell treatments in wound healing. It is hoped that this may reduce the incidence of infections and associated complications with chronic wounds to improve the quality of life of the patients. The Memorandum of Understanding (MOU) will be signed today, and CGH will act as a testbed for the development of the technologies.

11.     The advancement of chronic wound care will improve the quality of life for individuals and bring cost savings to the healthcare system in Singapore and patients around the world. 

Closing

12.     I wish CGH success in the care of patients with the set up of the Wound Healing Centre. Thank you.

¹ Gottrup F. A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. Am J Surg. 2004;187(5):S38–S43. doi: 10.1016/S0002-9610(03)00303-9.

² Goh OQ, Ganesan G, Graves N, et al. Incidence of chronic wounds in Singapore, a multiethnic Asian country, between 2000 and 2017: a retrospective cohort study using a nationwide claims database. BMJ Open 2020;10:e039411. doi:10.1136/ bmjopen-2020-039411

³ Lo ZJ, Lim X, Eng D, Car J, Hong Q, Yong E, Zhang L, Chandrasekar S, Tan GWL, Chan YM, Sim SC, Oei CW, Zhang X, Dharmawan A, Ng YZ, Harding K, Upton Z, Yap CW, Heng BH. Clinical and economic burden of wound care in the tropics: a 5-year institutional population health review. Int Wound J. 2020 Jun;17(3):790-803. doi: 10.1111/iwj.13333. Epub 2020 Mar 9. PMID: 32149471; PMCID: PMC7948834.