SINGAPORE: It is a conspicuous addition to Singapore General Hospital’s (SGH’s) landscape, though it looks little more than a large canvas tent, with a long ramp leading to a set of double doors.
“From the outside, no one’s going to know what it looks like inside,” said nurse clinician Thurgathavi P Vellasamy.
That was also her first thought that sprang to mind the first time she set foot in the site meant to be the hospital’s newest isolation ward. “What’s this going to look like?” she wondered.
In mid-May, it was an open-air car park. But in 50 days, it was transformed into a full-fledged ward capable of housing up to 50 suspected and confirmed COVID-19 cases.
Before construction began in mid-May, this was what the space looked like.
With its opening on July 15, the hospital’s isolation capacity has doubled. Prior to this, SGH had a total of 51 beds in Ward 68, its isolation ward comprising 35 single rooms and 16 beds in shared rooms.
A gust of air conditioning and a brightly lit interior greet staff and patients who now enter the doors of the new ward.
From the wide reception space, two aisles lead to 50 purpose-built container rooms, each outfitted with a single bed, en-suite bathroom, desk and chair as well as negative pressure, so air does not flow out when people enter or leave.
The ward, named Ward@Bowyer for its proximity to the hospital’s Bowyer block, also includes facilities that feature in any other hospital ward: Nurses’ stations, a rest area and changing rooms for staff and on-call rooms for doctors.
Each unit has en-suite toilet and shower facilities. (Photo: Hanidah Amin)
“It’s amazingly nicely done,” said Ms Thurgathavi, the nurse clinician in charge of the ward.
NO MORE CALL BELLS
What also stands out inside, however, is what does not feature in regular hospital wards, for example wearable biosensors.
Patients are each given a biosensor to wear on their wrists. It wirelessly transmits their heart rate, respiration rate and oxygen saturation readings to a mobile app, which allows staff to monitor their well-being continuously and remotely.
Patients themselves can access the data through an in-room smartphone, a device they can also use to call for the assistance of their care team via video conferencing or through an app called MyCare Lite.
This allows doctors or nurses to assess patients in the room without bringing additional equipment.
The in-room smartphone. (Photo: Hanidah Amin)
“It reduces the turnaround time for nurses to meet patients’ requests,” said assistant nurse clinician Esther Fan, who estimated that it could save 10 minutes per trip.
“Previously they’d have to press a call bell, and the nurse would have to come into the room, ask them what they need and then go out to gather the necessary items.
“It also reduces the time the staff are exposed to the virus.”
Within the facility, there is also an X-ray unit housed in its own customised container.
Designed by SGH’s diagnostic radiology department, it features a booth separating the patient from the radiographer. This means the radiographer need only wear an N95 mask instead of full personal protective equipment (PPE).
The X-ray unit.
Given the ward’s design and features, it is best placed for patients who are generally more stable, ambulant and can take care of themselves, said SGH’s medical board chairman, Associate Professor Ruban Poopalalingam.
It serves a different function, however, from community care facilities such as the Changi Exhibition Centre, which are for those who “don’t really need to be in a hospital”.
“It’s not the same as what we have here,” said Assoc Prof Poopalalingam. “These are patients who still need to be admitted to hospital, but they need isolation facilities, with the appropriate care.”
The 3,200-square-metre ward is also different from the medical posts set up for foreign workers at their dormitories, which he likened to “an HDB block with a GP clinic at the bottom”.
“If they’re unwell, they can come down and see the doctors there,” he said.
“The team there would then decide what they need to do … Should (they) send (the workers) to the hospital or … give them simple medications and they can go back to the dormitory?”
HOW IT BEGAN
The story behind the ward began one Sunday in mid-April, when SGH chief operating officer Tan Jack Thian received an email from the Ministry of Health (MOH), asking if the hospital would be interested to take on the project.
It took him all of two days to decide.
“Of course I asked my colleagues … Are we able to get it up?” he recalled. “When they came in and said, yes, we can do it, I had full confidence in them.”
SGH chief operating officer Tan Jack Thian.
He also drew confidence from the hospital’s experience in setting up a similar “container city” during the Severe Acute Respiratory Syndrome period.
“A lot of our staff involved in the project had the experience and expertise,” he said, adding that the new ward incorporates several “design concepts” of the container city.
He and his team were determined to complete the project as quickly as possible. But there were challenges and delays, which stretched the construction process from its intended 40 days to 50.
The biggest challenge, he said, was a manpower shortage, as the project was implemented during the “circuit breaker” and foreign workers were unable to leave their dormitories.
“We were quite fortunate that our contractors managed to get Singaporeans and permanent residents to come and help us,” he said. “It was only towards the last two weeks of the project that we managed to get some foreign workers.”
He added that contractors also had problems getting construction supplies in owing to supply chain issues, and thunderstorms on some afternoons forced them to suspend work, which added to the delays.
LOOKING FOR CREATIVE SOLUTIONS
While construction was ongoing, other teams sprang into action with planning and meetings involving staff from all over the hospital. They came together to adapt processes for the new ward.
“We started with lots and lots of meetings with all the stakeholders,” said Ms Thurgathavi.
“Though I worked here for 22 years, I didn’t know a lot of people. Now, I’ve got to know a lot more people, especially those from the facilities department.”
With staff from many departments and specialities, like oncology, being deployed to the ward, she said orientation was a priority in order to familiarise them with infection control practices.
“We wanted to make sure they were well-trained before we started,” she added, citing a week-long induction programme that all staff assigned to the ward had to complete.
She herself came from a colorectal surgery ward. “Nursing isolation patients is very different from nursing patients in a general ward,” she noted.
“You have to don the full PPE, and you need to have a lot of isolation processes at your fingertips.”
Creative solutions also had to be found for situations they previously took for granted, such as carrying out a Code Blue — resuscitating a patient. “There were so many possible solutions and recommendations that came up,” she recalled.
In normal wards, she said, staff can resuscitate and intubate patients in the room and send them to the intensive care unit. But the isolation rooms in the new ward are smaller and narrower, so they now use scoop stretchers.
“Ambulances would use this, but we’ve never had to do this in the wards, because we just need to push the whole bed,” she said.
“We need to scoop the patient onto the stretcher, bring the patient out of the room and place him or her on a long trolley, then push the patient all the way to the resuscitation bay to continue the resuscitation.”
Simulations of the process took a week, she added. “The nurses trained so many times, and we did so many drills.”
All this work, she stressed, is to ensure that patient care is not compromised. “Patients here will receive the same care they receive in the main SGH block,” she said. “The processes, protocols and guidelines are still the same.”
USING THE WARD FOR AS LONG AS POSSIBLE
While the ward may not be a permanent addition, Assoc Prof Poopalalingam hopes that it will continue to be used even as the COVID-19 patient load goes down. Indeed, it is built to last “a few years”.
“It’ll take care of the COVID-19 pandemic at this point but will also be useful for other infectious diseases,” he said.
This is why patients with infectious diseases like tuberculosis and whooping cough, besides COVID-19, can be cared for at the ward. “We’ll continue to use it for as long as we are able to,” he added.
Meanwhile, as the ward begins to fill with patients, Mr Tan cannot help but look back at how it began with that Sunday email and, most of all, the belief in his team’s ability to bring the project to fruition.
The past few months were by no means all plain sailing. But his most satisfying moment came when he saw the first container unit being lifted and placed on the ward platform.
“We’d crossed the first hurdle,” he said. “Then it was just a matter of time to complete the project.”
He also remembers feeling excited, and even comforted, the first time he walked through the completed ward, which was already starting to buzz with activity before its first patient was admitted.
“I just felt so good about this whole project,” he said. “Our teams got together, and you really get to see the teamwork at SGH.
“It’s an excellent feeling.”
