Vermont Oxford Network, Our aim is to be in among the best quartile for all serious morbidities and we have achieved this in several of our morbiditie

The Vermont Oxford Network is a non-profit voluntary collaboration of health care professionals. Established in 1987, it is dedicated to improving the quality and safety of medical care for newborn infants and their families. It does this by maintaining two databases that contain information about the care and outcomes of high-risk newborn infants. To date, there are over 600 Neonatal Intensive Care Units in the network from hospitals around the world.

The KK Women’s and Children's Hospital Department of Neonatology has been part of the Vermont Oxford Network since 1998. We participate in the Very Low Birth Weight (VLBW) database, which includes data from all live-born infants whose birth weight is between 401 and 1500grams or whose gestational age is between 22 weeks till 29 weeks and 6 days. We are also currently looking at the health and developmental status at 2 years adjusted age of extremely low birth weight (ELBW) infants born in KKH, who survived until hospital discharge and are benchmarking our outcomes with the Vermont Oxford Network follow-up cohort.

Our aim is to be in among the best quartile for all serious morbidities and we have achieved this in several of our morbidities. For the year 2005, we were in the best quartile for chronic lung disease, severe intraventricular haemorrhage (IVH) and coagulase negative staphylococcal infection. Our mortality rates are also low and in the best quartile for year 2005.

The Vermont Oxford Network data shows that standard of care in KKH Neonatal Intensive Care Unit is high and among the best in the world.

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Clinical Outcome on High Risks Asthma Patients August 2001 to January 2009, Asthma is a severe chronic condition with significant morbidity, mortality

The Singapore National Asthma Programme (SNAP) in KKH was launched in August 2001. All high-risk asthma patients here are identified by the clinicians or asthma resource nurses and are followed up closely by the National Asthma Shared Cared Clinic in KKH.

The primary goal of SNAP is to reduce the frequency of severe asthma attacks and improve the quality of life of patients with asthma.

Satisfactory asthma control improved from 9.4% with the 1st visit to 72% on the 6th visit. Return rate to the Children's Emergency reduced from 69% on the 1st visit to 12% on the 6th visit.

* A database for high-risk asthma patients was developed by KKH Research Center and houses all the data of all high risk patients in KKH
* Recruitment of high-risk asthma patient from August 2001 to Jan 2009, with a total of 3307 patients.

Results after outpatient follow-up

Indictors
Visit1
Visit 2
Visit 3
Visit 4
Visit 5
Visit 6

Absent from school 34.5% 10.2% 9.91% 11.4% 10.4% 9.7%

Parents work loss 15% 4.7% 3.93% 4.08% 4.09% 5.01%

Days with wheeze/cough/SOB 75% 37.% 33% 32% 29.4% 30%

Nights with wheeze/cough/SOB 77.6% 34.4% 30.6% 29% 27% 27.5%

Activity stopped 42% 16% 14% 12% 14.4% 14.3%

Indictors
Visit1 Visit 2
Visit 3
Visit 4
Visit 5
Visit 6

Respiratory infection 89.7% 44.9% 48% 46% 44% 44.7%

Need for acute care 82.9% 22.7% 24% 23% 21% 24%

Visit GP/ OPS 65.8% 19.9% 22 % 22% 18.3% 22.6%

Visit Emergency Department 68.9% 12.3% 11.8% 11.9% 11% 11.9%

Hospitalization 63% 10.% 8.6% 9.4% 8.3% 8.4%

Compliance with Preventer/Controller 17.4% 71.6% 68.6% 69.6% 72.4% 1.4%

Satisfactory asthma control 9.4% 66.9% 68% 69.3% 72% 71.6%



Lymphoma, Neuroblastoma, Sarcoma, Besides malignant and non-malignant blood disorders


KKH’s Children’s Cancer Centre is one of the largest paediatric cancer centers in South-East Asia, treating 70% of childhood cancers in Singapore. Each year, the center sees between 70-90 paediatric cancer cases of which 40% are leukaemia.

Childhood cancer is the second major cause of death among children in Singapore. There are between 130 –150 newly diagnosed cases each year. Acute Lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescent, representing 41% of all childhood cancer causes.

Here at KKH, the outcome for ALL has climbed steadily from 40% in the 80’s to 60% in the 90’s and 80% in 2000’s. Present chemotherapy regime produces more than 80% 5-year survival rates in Singapore. This is comparable with world-renowned children cancer centers. Studies are ongoing to refine protocol to decrease treatment in those with standard risk ALL to minimize late effects of treatment. While those with high risk ALL requires consolidation treatment, which includes allogeneic haemapoietic stem transplant.

5 yrs OS: 83.4% N = 222

Our Children’s Cancer Centre also uses allogenic haematopoietic sten cell transplant as a form of treatment for the following cancers:

Our survival rates for allogeneic haematopoietic stem cell transplant stands at 70%. These are comparable to the best centers in the world.

Our center is one of the participating centers for umbilical cord blood transplant in Eurocord Registry. The Singapore Public Cord Blood Bank is sited in KKH.

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kami telah berhasil mencapai 96% - 99% proporsi penanganan ectopic pregnancy (mengancam kehidupan berhubung dgn ginekologi darurat) oleh laparoscopic

The Minimally Invasive Surgery Unit (MIS Unit) provides endoscopic services, elective laparoscopic and hysteroscopic services to the majority of patients with benign gynaecological conditions. The KK MIS Unit has the largest laparoscopic workload in Singapore and is responsible for the endoscopic training and accreditation of O&G doctors.

With a dedicated team of laparoscopic surgeons providing on call service everyday, we have managed to achieve a 96% - 99% proportion of handling ectopic pregnancy ( a life threatening gynaecological emergency) by laparoscopic keyhole surgery. This has translated to a faster recovery and less pain for all our patients.

Minimally Invasive Gynaecological Surgery
Range of services
* Tertiary level referral centre and consultation services to intra- and inter-hospital referrals from local and overseas clinicians
* 24 hours Laparoscopic Surgeon on call service to provide for Endoscopic Emergencies
* Diagnostic Laparoscopic & Hysteroscopic Procedures
* Therapeutic Laparoscopic & Hysteroscopic Procedures
* One-Stop MIS Centre providing outpatient suites and counseling
* Research, development and evaluation of advanced MIS techniques and instrumentation
* Training and Accreditation of Laparoscopic & Hysteroscopic Procedures for O&G doctors and Nurses
* MIS Unit Fellowship Programme for gynaecologists seeking to advance their laparoscopic and hysteroscopic skills

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KK Urogynaecology, Centre for Advanced Pelvic Floor Reconstruction and Bladder Dysfunction. KK UG Centre, Clinical Outcome of Pelvic Organ Prolapse, C

KK Urogynaecology (UG) Centre is the first urogynaecology centre in Asia to provide one-stop services for the investigation and treatment of female bladder disorders and pelvic floor dysfunction.

The KK UG Centre is equipped with sophisticated equipment to help accurately diagnose urogynaecological problems. Its aim is to provide the best and affordable medical care to patients.

The Centre saw 2,046 new patients and 6,789 follow-up patients in 2006. Currently, it has 3 full-time urogynaecologists, 2 visiting urogynaecologists and 2 urodynamic-trained nurses.

The Centre also conducts training for both local and overseas doctors and is intensively involved in clinical research.

• Clinical Outcome of Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a common condition & 10% of the female population has symptomatic POP.

The surgeries offered by the centre for the treatment of POP are:
• Vaginal Hysterectomy (VH)
• Manchester Operation
• Pelvic Floor Repair
• Sacrocolpopexy
• Sacrospinous Ligament Fixation (SSLF)
• Sacrohysteropexy
• Gynaemesh in Cystourethrocele repair
• Sacrospinous Hysteropexy
• Prolift Mesh system for severe POP

We perform an average of 400 vaginal hysterectomies, 500 pelvic floor repairs and 100 sacrospinous ligament fixations each year for the treatment of pelvic organ prolapse.

Vaginal hysterectomy has an excellent surgical outcome with low post-operative morbidity and can be performed concurrently with other prolapse or continence surgeries.

Depending on the type and severity of vaginal wall prolapse, the pelvic floor repair can be either for the correction of bladder prolapse (cystourethrocele) or rectal prolapse (rectocele). In the past few years, Gynemesh *PS has been used to reinforce the cystourethrocele repair in severe bladder prolapse. This has been superseded recently by the use of the Prolift Mesh system, where the patient can decide to remove or to conserve the womb.

We are the first centre in Asia to start using Gynemesh*PS & the Prolift mesh system in pelvic floor reconstructive surgeries for severe bladder, vault or uterine prolapse.

Pelvic Organ Prolapse One Year Cure Rate*
Pelvic Floor Repair (PFR)
- Cystourethrocele Repair
- Rectocele Repair

83%
96%
Sacrospinous Ligament Fixation (SSLF)
- Severe Uterine Prolapse
- Vault Prolapse

96%
94%
Gynemesh*PS in Cystourethrocele Repair

86%
Anterior Prolift for severe or recurrent Cystourethrocoele
Posterior Prolift for severe Retocoele or Vault Prolapse
Total Prolift for severe Pelvic Organ Prolapse or severe Cystourethrocele
with Vault Prolapse

95%
100%
88%

* The cure rate is defined as the percentage of patients who has undergone the operation successfully without any recurrence.

• Clinical Outcome of Stress Urinary Incontinence (SUI)
Stress Urinary Incontinence affects 12-15% of the women population. For women who are 50 years old and above, the risk of having SUI increases to 1 in 3 women.

The common surgeries for the treatment of SUI are:
• Burch Colposuspension
• Tension-free Vaginal Tape (TVT)
• Tension-free Vaginal Tape-Obturator (TVT-O)

The Burch Colposuspension was formerly the gold standard in the surgical treatment of female SUI. With the invention of TVT in 1996, TVT has revoluntionalised the surgical treatment of female SUI and is now the gold standard. KK UG Centre is proud to be the second centre in Asia to introduce the TVT procedure in late 1998. We have performed more than 1,800 TVT procedures to date.

With the constant advancement in surgical techniques and devices, the operative time and complication rates have been further reduced with the introduction of the TVT-O. In 2004, KK UG Centre was the first in Asia to perform the TVT-O procedure, and since then, it has performed more than 800 TVT-O procedures.

Stress Urinary Incontinence
One Year Outcome*
Cure
Improved
Failure
Burch Colposuspension 90% 10% 0% TVT 94% 4.8% 1.2% TVT-O 95.2%
3.6% 1.2%

* The definition of Cure, Improved & Failure are as follows:
Cure: Symptoms successfully treated and tests were negative
Improvement: Symptoms improved significantly
Failure: Persistent of symptoms

In August 2006, the KK UG Centre has started performing TVT-SECUR procedure which can further reduce the risk & morbidity of surgery. The Centre is once again the first in Asia to start this procedure. The long-term results of TVT-SECUR are still under evaluation.

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Trends of Eclampsia in KKH, significantly to maternal, pre-eclampsia poses substantial risks for the obstetric patient and her baby

As the largest maternity facility in Singapore, and one of the largest in South-East Asia, KKH provides care for over 14,000 women and their babies every year. This amounts to about one-third of the total number of babies born in Singapore.
Perinatal Mortality Rates.

The hospital is recognized for its Integrated Labour Ward Risk Management Programme, a comprehensive risk management programme that features speedy staff mobilization, constant reviews and audits, training as well as a computerized early-warning system. The programme identifies and manages potential risks in the delivery suite, thus helping to improve the safety of women in labour and their newborns.

So successful is the programme in ensuring patient safety that KKH’s perinatal mortality rate for 2005 is 4.92 per 1,000 births – one of the lowest in the world.

Eclampsia Rates

Pre-eclampsia and eclampsia are diseases in pregnancy, which contribute significantly to maternal and foetal mortality and morbidity. Severe pre-eclampsia poses substantial risks for the obstetric patient and her baby. Utero-placental perfusion is severely compromised, which puts the fetus at high risk for problems such as preterm birth and perinatal mortality. It may also lead to severe maternal hypertension and multi-systemic organ dysfunction and damage, including eclampsia and abruption placentae.

The incidence of eclampsia in KKH has dropped significantly from 101.3 per 100,000 births in 1995 to 6.9 per 100,000 deliveries in 2004. This rate is likely to be the lowest for a tertiary maternity hospital. The implementation of improvement strategies for the reduction of eclampsia, and an introduction of regular medical education for doctors involved in antenatal care of pre-eclampsia, have led to this low rate.

Trends of Eclampsia in KKH

Period 1955 1957 1968 1981 1990-1993 1994-1999 1999-2003

Incidence per 100,000 deliveries 337.5 288.4 140 33.1 45.3 67.2 16.2

Risk of Eclampsia 1:296 1:348 1:715 1:3025 1:2270 1:1489 1:6160

Maternal Mortality – (%) 7.8 - - - 3.7 1.6 0

Perinatal Mortality – (%) 26 - - - - 9.7 - 0


Cesarean Section in KKH


KKH's Cesarean section rate in 2005 was 27%, lower than most hospitals in Singapore.

In 1995, the Royal College of Obstetrics and Gynaecology published an organisational standard for maternity service in which they proposed a maximum 30-min interval time between the decision and time of delivery for urgent Caesarean sections.

In 1997, KKH established a protocol named for extremely urgent Caesarean section (“crash” CS). Once the decision for “crash” CS was made, a public announcement system was used to activate the obstetrician, the anaesthetist, the neonatologist as well as the operating theatre staff that a “crash” CS was required.

Following this protocol, an internal audit was conducted by the hospital from Feb 2003 – Feb 2004 and it revealed that the hospital was able to achieve 100% of deliveries within 30mins with the protocol, reliably achieving the standards laid down by the Royal College of Obstetrics and Gynaecology.

1998 (1 year audit) 2003 (6 months audit)

Total no. of deliveries 16,267 7,512

Total no. of caesarean sections 3,367 1,728

Crash Caesarean 113 45

Mean Delivery Time (mins) 14.9 7.5

Patients delivered < 30 mins 112/113 45/45



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KK Gynaecological Cancer Centre, HPV Vaccine Trial - FUTURE II Study, papilloma virus, cervical cancer, Cancer of the Cervix, Cancer of the Uterus

The mission of the KK Gynaecological Cancer Centre (GCC) is to provide an excellent, efficient and compassionate service to our patients through better care made possible with the highest ethical standards and professionalism.
KK Gynaecological Cancer Centre is the only centre in Singapore and Asia to participate in the HPV Vaccine Trial - FUTURE II Study. This is a worldwide trial on a vaccine to protect women against the human papilloma virus (HPV), which causes cervical cancer.

We are the only treatment center in Singapore to offer this HPV vaccine to the women of Singapore.

Cancer of the Cervix

In its earliest stages, cervical cancers are highly curable. Early detection is therefore the key to improving survival.

Here at KKH, our 5 year survival rate for Cervix cancer is:-

Stage 1a 98%
Stage 1b 84%
Stage 2a 71%
Stage 2b 50%


Cancer of the Uterus
Cancer of the uterus is the third commonest cancer of the female genital tract in Singapore. It usually affects the endometrium (lining of the uterus). If treated early, the cure rate is very good.

Here at KKH, our 5 year survival rate for Uterus cancer is:-

Stage 1 92%
Stage 2 90%

Ovarian Cancer

Epithelia cell cancers of the ovary are more common than germ cell cancers. Names of different types of epithelia ovarian cancers include mucinous or serous cystadenocarcinoma, clear cell carcinoma and endometrioid carcinoma of the ovary.

For very early stage disease and non-aggressive types, further treatment may not be required. For the more advance and aggressive types of cancers, often chemotherapy is the treatment of choice.

Here at KKH, our 5 year survival rate for Ovarian cancer is:-

Stage 1 90%
Stage 2 55%




KKIVF Centre, infertility, diagnostic, frozen embryo transfer of 22

IVF Success Rate

KKIVF Centre is a leading infertility center in South-East Asia, offering a comprehensive range of diagnostic and treatment procedures for infertility related services.



The center has:-

* Performed more than 800 cycles in 2005
* Achieved a consistently good clinical pregnancy rate between 34% to 40% over the past four years
* Achieved clinical pregnancy rate per frozen embryo transfer of 22%

In 2001, KKIVF achieved the 1st Laser Assisted Hatching pregnancy in Singapore, which resulted in a live birth in May 2002.

Improvements in clinical techniques, embryo culture techniques and embryo selection have also led to a rise in success rates & a reduction in the risks of multiple pregnancies. Over the last 3 years, our elective double embryo transfer cycle (hence, avoided the risk of triple pregnancies) achieved an average of 42% success per embryo transfer.
Asia’s first IVF (In-Vitro fertilization) baby was born in KKH on 19 May 1983.

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Hospitals in the Asia-Pacific, Paediatric Surgery, Vermont Oxford Network , Transplant and Leukemia survival rates, High Risk Asthma Outcomes, Women’s

As a leading hospital for women and children, we constantly strive to achieve a higher standard in clinical care through the use of Clinical Indicators across all medical departments. Clinical Indicators also allow patients the ability to make choice decisions for their treatment.

International Reputation
1. We are the first hospital in Asia Pacific to receive the prestigious Asian Hospital Management Award (AHMA) for measures taken to improve the safety of women in labour and their newborns.
2. KKH has gained accreditation from the US-based Joint Commission International (JCI) in 2005, which affirmed the quality of our patient care and safety.

Local Reputation

1. Spring Singapore (previously the Productivity and Standards Board) awarded KKH the coveted People Developer award in 2000. This award recognizes the hospital’s investment in a comprehensive system for developing our people and to bring out the best in them.
2. In 2005 KKH achieved the Singapore Quality Class Award. It is conferred by SPRING Singapore to selected organization which have demonstrated commitment to business excellence, measured in the following dimensions – Leadership, Planning, Information, People, Process.

Medical Reputation
1. KKH is the accredited center with the Royal College of Obstetrics & Gynaecology (UK) in obstetric ultrasound.
2. KKH's Department of Diagnostic Imaging is accredited as a training centre for paediatric radiology by the Royal Australian and New Zealand College of Radiologists (RANZCR).
3. KKH’s Gynaecological Cancer Centre is accredited as a recognised training centre for fellows pursuing the Certificate/Diploma in Gynaecological Oncology of the Royal Australian-New Zealand College of Obstetrics & Gynaecology (RANZCOG).

Some of our hospital’s progresses in clinical excellence are:

Women’s Services

* Gynaecological Cancer Centre
- 5 year survival rate for Cervix Cancer
- 5 year survival rate for Uterus Cancer
- 5 year survival rate for Ovarian Cancer

* KK IVF Centre
- IVF Success Rates

* Obstetrics
- Perinatal Mortality Rates
- Eclampsia Rates
- C-Section Rates

* KK Urogynaecology Centre
* KK Minimally Invasive Surgery Unit


Children’s Services

* High Risk Asthma Outcomes
* Transplant and Leukemia survival rates
* Vermont Oxford Network
* Paediatric Surgery
- Laparoscopic Surgery for Appendicitis Outcomes - Updated
- Post-Tonsillectomy and post-adenoidectomy Hemorrhage in Children

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