Exploring Pre-hospital Emergency Care Challenges and Interventions in Singapore: A Qualitative Environmental Scan.

ObjectiveEmergency Departments in Singapore face increasing demands for acute care. Possibly due to factors such as an ageing population with increasing burden of complex chronic illnesses. However, a significant proportion of ED attendances are potentially avoidable cases which may not require emergent care. It is timely to consider approaches for Pre-hospital Emergency Care (PEC) redesign that direct patients towards the most appropriate care settings, thereby mitigating demand for emergency care. By gathering stakeholders' perspectives, findings of this study could help to propose and evaluate suitable PEC interventions and enablers that could be explored in Singapore and similar healthcare systems globally.MethodsThis qualitative study gathered the perceptions of participants through semi-structured interviews. Participants recruited were PEC stakeholders, including emergency consultants, paramedics and administrative leaders of various government organisations involved in PEC. Inductive thematic analysis was conducted, and findings were reported with references to the Consolidated Criteria for Reporting Qualitative Research.ResultsTwenty-one participants were interviewed, and three main themes were identified: (1) patient profile and factors influencing help-seeking behaviour, (2) the advantages, limitations and considerations of different interventions, (3) implementation enablers and policy levers for interventions. Key findings include the significance of Alternative Care Service Pathways, with supporting enablers, such as appropriate subsidy and insurance coverage for primary care, that could work in tandem to complement one another within the PEC network.ConclusionChallenges identified ranged from patient-to policy-related factors, suggesting that a multifaceted approach could be needed. Most interventions explored aim to manage ED demand by serving as alternative pathways, along with enablers that could help integrate novel interventions into the overall PEC system. We gathered that some crucial ways to better manage ED demand include, expanding primary care capabilities for multidisciplinary care, enhancing accessibility to community resources, and revising medical insurance coverage for Singapore's current population healthcare needs.