Enhancing Geriatric Emergency Care
As part of the MOH Health Manpower Development Plan (HMDP) Expert Programme, the Section of Geriatric Emergency Medicine (GEM) at NTFGH had the privilege of hosting Prof Christian Hans Nickel from Switzerland. From 24 to 28 February 2025, Prof Nickel visited various Emergency Departments (EDs) across Singapore, joining NTFGH on 25 February for a series of insightful discussions on advancing geriatric emergency care.
About Prof Christian Hans Nickel
Prof. Nickel is a passionate advocate for improving emergency care for older patients. He previously chaired the Section of Geriatric Emergency Medicine of the European Society for Emergency Medicine (EUSEM) for five years and served on the editorial board of the European Journal of Emergency Medicine.
With a strong focus on education, he has contributed to the development of emergency medicine curricula, including a longitudinal Master’s-level programme. His work at the University Hospital Basel (UHBS) ED - in collaboration with nursing, physiotherapy, and social services - led to the first-ever Geriatric Emergency Department Accreditation (GEDA) outside the United States by the American College of Emergency Physicians (ACEP) in June 2024.
Prof Nickel's visit began with a tour of the NTFGH Emergency Department, led by Dr Gary Choa (Head & Senior Consultant, Department of Emergency Medicine, NTFGH) and the ED team. The session brought together participants from local hospitals and international institutions from the region, fostering a dynamic exchange of ideas.
Following the tour, the participants gathered in the auditorium for breakfast and a series of lectures by the Geriatric Emergency Medicine team, led by Dr Colin Ong (Senior Consultant, Emergency Medicine, NTFGH) and NC Kamala (Nurse Clinician, Emergency Department, NTFGH).
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Highlights from the Session
The lecture series began with NC Kamala introducing the CARED (Case Management for At-Risk patients in the ED) programme. This initiative focuses on holistic geriatric care, integrating comprehensive assessments, allied health collaboration, and community partnerships to ensure patients receive the right care in the right setting—transitioning them from hospital to home whenever possible.
Dr Colin Ong then shared the evolution of Geriatric Emergency Medicine (GEM) at NTFGH. Beginning in 2013 with the SAFE programme, GEM has since expanded to include CARED, launched in 2021 during the COVID-19 pandemic to address bed shortages and A&E overcrowding.
Looking ahead, the team outlined their 2025–2027 roadmap, which includes:
✅ Launching a palliative care programme in the Emergency Department
✅ Developing an AI-driven case management tool
✅ Evaluating patient-reported outcomes for CARED patients
n his lecture, “A Systems Approach to Geriatric Emergency Medicine in the A&E,” Prof Nickel provided a comprehensive framework for improving geriatric emergency care. Using a cardiac analogy model, he illustrated the key components of A&E operations—patient influx, emergency processes, and patient disposition.
Key takeaways from his talk included:
🔹 The importance of quick registration, team triage, and frailty assessments
🔹 The implementation of ‘frailty-friendly’ A&E sectors
🔹 The potential of Advanced Practice Nurse-led transitional care models
The session concluded with Dr Colin Ong presenting the ANGEL (Acute Nursing Home General Emergency Line) programme, designed to reduce unnecessary A&E visits and hospital admissions from care homes.
Key features of ANGEL:
📌 Teleconsultation services – Provides remote medical advice
📌 Care protocols – Implements standardised guidelines for managing
acute conditions
📌 Training for care home staff – Equips caregivers with essential skills
📌 Hotline for clinical queries – Offers direct support for urgent concerns
📌 Video consultations – Enables remote medical assessments
📌 On-site visits – Conducted when necessary
📌 Escalation to hospital care – Ensures timely hospital transfers when
required
Currently partnered with several care homes, ANGEL aims to expand its reach to improve resident care while reducing the strain on hospital A&E departments.
This knowledge-sharing session provided valuable insights into the future of geriatric emergency medicine, reinforcing the importance of innovation, collaboration, and system-wide improvements in patient care. With new initiatives on the horizon, the discussions sparked meaningful reflections on how we can continue to enhance care for our ageing population.
Check out more photos below!
