On 20 March 2020, after Singapore reported 345 confirmed cases of COVID-19, SGH began operating a Fever Screening Area (FSA) out of the Multi-Storey Car Park at Macalister Road. The FSA manages suspect cases sent from GP Clinics and other institutions in dedicated ambulances, who need swabs taken for testing.
“We see patients who are ambulatory and look generally well, but with mild respiratory symptoms. That first weekend, we operated for just four hours. This was to give us time to put our plans into action and allow us to iron out any teething issues,” recalled Dr Fua Tzay-Ping from the Department of Emergency Medicine (DEM) who runs the FSA.
“With more manpower, we started to receive patients from 8am to 5pm. We then operated from 8am to 8pm, daily. Currently, we operate from 8am to 8pm for new arrivals, and 24 hours as a holding area for patients who are waiting for the results or waiting to be transferred to other facilities. To help reduce crowding in the SGH Emergency Department (ED), we also see suitable patients sent from the ED in a special shuttle bus,” said Dr Fua.
Occasionally, the team will see patients on quarantine orders who become symptomatic and need to be tested. These patients are also conveyed by designated vehicles. Walk-in patients are not accepted.
Initially, patients are swabbed and discharged home to await their test results. “The hospital will call these patients with their results, or they can check for themselves through our Health Buddy mobile app or the government’s Health Hub portal. This way, we’re able to see more patients and patients don’t have to be kept in the FSA for hours on end."
However, when more migrant workers were sent to FSA for testing, FSA’s operations changed, to become a holding area for both positive cases awaiting admissions and for foreign workers who were tested negative to be transported to a safe location for alternate housing.
“By then, my DEM colleague Dr Lim Chin Siah who was helping to run FSA, was also deployed out to lead the Mobile Swab Teams that test workers at the bigger dormitories,” said Dr Fua.
A swab booth, the SGH ‘SAFE’, where swabs are taken. This foldable swab screen system developed by SGH doctors allows double the number of swab tests to be done, without putting staff at increased risk. Read more about it here.
The FSA at the car park was first conceptualised to deal with a flu outbreak. In 2015, the plan was materialised with the first of many exercises to work out the logistics and workflow. When COVID-19 struck, SGH closed the car park in early February and started preparing to activate the plan, more than a month before the hospital was given the green light to begin operations.
With IT Support to ensure stable network connections, the FSA team can access the electronic records medical system.
Dr Fua has been involved in the pre-planning and exercises from the start. “I am definitely impressed that the Preparedness and Response Department and the rest of our Operations Division managed to retrofit an existing parking facility into a functional clinical space! The demarcation of ‘clean’ and 'dirty' clinical areas was well thought out; like the central clean clinical staircase for staff to move between decks without any patient encounter, the staff pantry and gender-specific toilets with showering facilities. We even have an in-house X-Ray service right here!” she said.
Radiographers are on-site at the FSA.
With the facility in place, getting adequate manpower was key to operationalising the FSA.
“It is an additional medical facility, and we had to deploy staff to work in a new area at short notice,” said Dr Shen Yuzeng from DEM who is helping to plan the FSA roster for clinicians. Challenges included getting staff orientated in time, making sure they were safely mask-fitted and addressing their unique needs and concerns.
“The FSA started with three doctors per team. We ramped up staffing to as many as 10 doctors per team at the peak of operations, to meet the increased patient load. It was possible with reinforcement from all clinical divisions within SGH and also from institutions on SGH Campus, like NCCS, NHCS, SNEC and OCH.
Recently, we have had Allied Health colleagues who volunteered for swabbing duties too,” added Dr Shen.
Doctors from SGH and SNEC take a moment to pose for the records
Nursing also sent more staff for certain areas like the visual triage station, and to man the swab stations. Allied Health colleagues like Radiographers and Pharmacy Technicians are deployed as originally planned, to provide X-ray services and to dispense medication.
Both Dr Fua and Dr Shen shared how moved they are, by the SGH spirit. Dr Fua was particularly struck by how everyone from Medical Officers to Senior Consultants and even Heads of Departments, took on the same role to see patients in the FSA.
“We have the privilege of having swab specialists from Otolaryngology, Anaesthesiology and Head & Neck Surgery to help us take swabs!” said Dr Fua.
“Most had some apprehensions but yet were giving their very best in their given roles, as some clinicians had not 'clerked' a patient in years! Infectious Diseases physicians are especially deep in the trenches with us in refining the clinical workflows every day. Iwas particularly touched when people came back voluntarily on their off-duty days to work or stayed late beyond their shift hours in the FSA when the need arose,” she added.
Dr Fua also marvelled at the FSA nurses led by DEM Nursing. “Together with nurses deployed from other departments, they work tirelessly and can remain amazingly cheerful despite the hard work!”
Nurses taking a break, to enjoy drinks sponsored by the appreciative public
Similarly, Dr Shen was extremely inspired to see colleagues from different parts of the system rise to the occasion and come together as one during this trying period to face the unknown.
“It’s amazing to see how the hospital system has mobilised across departmental and institutional lines to meet this COVID-19 challenge. That we are seeing a whole-of-health-system team at the frontlines rapidly deployed speaks volumes about what our people are made of, the value of having an integrated health system, and the tireless efforts of many people in the background,” remarked Dr Shen.
“The ground requirements may change as the situation evolves over time, but I'm pretty sure SGH (and SingHealth) will continue to have Singapore's back, because (in the words of one of the Senior Consultants rostered at FSA) – We are one SGH!’ said Dr Shen emphatically.
FSA is made possible by staff from: Admitting ServicesCommunicationsDivision of Radiological SciencesDivision of MedicineDivision of NursingEmergency MedicineEnvironmental Services Facilities Management & Engineering Food ServicesGeneral ServicesInfection Prevention and EpidemiologyIT SupportMaterials Management DepartmentPreparedness & Response PharmacySecurity
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