Paediatric Emergency Medicine in Singapore

Having swapped BST -7 hours for BST +7 hours in the space of 24 hours… which I think means I moved 14 hours ahead of where I was last weekend (although it might have been easier to move 10 hours behind!) its taken me most of the week to work out what planet I’m living on.


I’ve just finished my first week in Singapore – at the KKH Women’s and Children’s Hospital Paediatric Emergency Department. Singapore is an amazing city – really safe, impeccably clean, extremely efficient and very friendly.


The children’s emergency department here is a model of efficiency – and, to be honest, it has to be. The emergency department sees over 170000 children per year – that is just under 500 children per day. To put this into context, the department I work in sees approximately 75 children per day and the busiest single children’s emergency department in the UK sees around 60000 patients per year (about 200 per day). 

So, how do they manage to run a department so busy here in Singapore? The answer to that is an incredibly efficient process with staff having clearly identified roles and responsibilities, everyone being dedicated to ensuring the department functions at an optimum level and a strong educational and research programme to ensure standards are always being advanced.


There is a senior doctor resident on-duty 24 hours a day with sufficient junior medical staff to ensure that patient flow continues and there is strong senior clinical leadership in the Emergency Department to ensure that more junior staff always have access to a senior opinion.

One of the things that particularly impressed me about the functioning of the department was the two-stage triage process and the speed and efficiency with which the nursing staff are able to screen children for potential serious illness or injury (there are four triage nurses at any one time – and the patients are triaged before they register to ensure there is no delay in assessment). The Information Technology system that is used by the Emergency Department was self-designed by the staff there and now contains a database of around 1 million records – making it a fantastic resource for potential research in the future, particularly looking at one of my other areas of interest (the development of early warning or track and trigger scores to assess illness severity in children presenting to emergency departments).

The departmental staff were very welcoming to me and I had the opportunity to speak to many members of the multi-disciplinary team, to teach the medical staff and medical students and spend a significant amount of time in the clinical areas of the department and the resuscitation room (which is very busy!). 

The Head of the Emergency Department and I will both be travelling to Hong Kong in a few weeks time where we will be delivering educational sessions at an International Conference. I feel that this week has been an excellent opportunity to develop the early stages of future collaborative work between the children’s emergency department here in Singapore and the various departments back in the UK and I’m very much looking forward to continuing those discussions in Hong Kong and beyond with the hope that we can set something more formal up in the not too distant future – this can only be of benefit to staff working in emergency medicine as well as the patients and families they treat (both here in Singapore as well as back in the UK).


At the end of this week I had the opportunity to deliver an hour-long presentation at the Ministry of Social and Family Development discussing child protection and how it relates to emergency medicine in the UK as well as how we can change practise to try to ensure that the more subtle cases of child abuse are not missed and are picked up at an earlier stage. After talking for an hour and then taking part in a round-table discussion for over an hour and a half (which basically involved me being questioned by the staff) we had really started to delve into some of the really key issues which are involved in protecting children in Singapore and the parallels, as well as differences, with the UK system were very interesting to explore.

The networking opportunities and multi-agency link-up that this week’s discussions have facilitated are going to be really useful and interesting in the future – I think this is definitely a case of ‘watch this space’ and I’m hopeful that some of the initial discussions we have started this week will continue and become more robust as we continue to explore future channels of communication.

Last night I was treated to a splendid local banquet – of food I’ve never eaten before – so I leave Singapore, albeit it briefly, feeling very full, somewhat sticky from the humidity, and very pleased to have had such a successful week of work.

Today I’m moving on to Malaysia for the first time where I will be spending part of the week in Kuala Lumpur and the remainder of the week in the North in Ipoh. The primary focus of this part of the project is going to be looking at Child Sexual Exploitation, what role emergency medical services can play in the identification of cases and what the barriers are to the identification of children who might be at risk of such harm.

I’ll report back as the week unfolds!


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