KKH children emergency

[Robin]

the last time i reach about 9pm ... waited until 3-4am

touch wood but dont think i'm going back there

[KilluaX]

Mount A now full day parking at 8 dollars. Very easy to find parking lot in the MSCP.

[Watwheels]

I wonder what had happen....

 

http://stomp.straitstimes.com/singapore-seen/kkh-responds-to-stomp-on-couples-fb-posting-claiming-lapses-by-doctor

KKH responds to Stomp on couple's FB posting claiming lapses by doctor

 

 

KK Women's and Children's Hospital (KKH) has responded to a Stomp query regarding a viral Facebook post from a couple complaining that their daughter’s condition was downplayed by an on-duty doctor, attributing her subsequent deterioration to lapses in the doctor's judgement. 

In the Facebook postings of the couple, the enraged parents recounted how they had to wait between three to four hours when they brought their daughter into KKH on the night of Nov 13. 

When they finally met a doctor, Dr Peter Wong, they were told that their daughter’s condition wasn’t serious, and they had to wait a few more hours, as priority would be given to emergency cases. 

However, the girl's condition took a turn for the worse, and around 11am on Nov 14, she became motionless. 

An ambulance was called and she was admitted to the hospital.

Read one of the posts:

“My poor little baby!! 

“Yesterday night came into KKH, waited for three to four hours and the doctor says she’s not (in a) serious condition, called us to wait (for) another two to three hours, (as) emergency cases come first.

“Doctor still said that if we don't want to wait, we can cancel and go (to) another place.

“And today morning at around 11am, this thing happened to my baby.

“Called the ambulance and (the hospital) admitted her.

“Thank god she (still) has a response."

The post also showed the father of the child administering Cardio Pulmonary Resuscitation (CPR) on his daughter.

In an accompanying video to the post, a family member could be heard telling emergency response officer that they were not able to ‘check the breathing’ of the girl. 

The family member was then told to continue CPR on the girl until the ambulance arrives. 

As the girl's father continued administering CPR, the child’s legs started moving, and the member said that she had become ‘responsive’. 

The Facebook postings and videos have since been removed. 

In response to Stomp’s query, KKH issued an official statement on their Facebook page stating that there had been 'no lapses in medical care or patient safety.'

The post which was uploaded on Sunday (Nov 19) read:

“A recent post circulating online mentions our hospital and doctor, Dr Peter Wong, with regard to the KKH Children’s Emergency. 

“We have investigated the matter and are in contact with the child and family.

“The facts are as follows: When the child was first assessed at the Children's Emergency, she was found to have fever, but was otherwise stable. Our attending paediatric consultant, Dr Peter Wong, who is an experienced and well-regarded doctor, acknowledged the inconvenience caused to the family by the wait, and tried to explain to the parent that there were other patients who were more serious that needed to be attended more urgently and that the child would be attended to as soon as possible. 

“The child’s condition was stable and she was not in danger. If her situation had changed or deteriorated, she would have been attended to promptly.

“We understand that the patient then left KKH Children’s Emergency before further medical examination could be conducted. 

“About 12 hours later, the child was again brought to the Children’s Emergency and she was assessed to be stable. 

“She was admitted to the general ward and provided with the necessary care. She was discharged the following day and is now at home.

“We have reviewed the case, and there were no lapses in medical care or patient safety.

“The hospital’s priority is to provide appropriate and timely care to our patients. 

“As such, emergency cases have to be given priority. KKH is committed to improving our patients’ experience, but parents and caregivers have to also play their part to be responsible and considerate to enable our medical professionals to perform their tasks.

“Please share this post.”

 

KKH replies says no lapses found.

https://www.facebook.com/kkh.sg/posts/1523246931045572

 

A recent post circulating online mentions our hospital and doctor, Dr Peter Wong, with regard to the KKH Children’s Emergency. We have investigated the matter and are in contact with the child and family.

The facts are as follows: When the child was first assessed at the Children's Emergency, she was found to have fever, but was otherwise stable. Our attending paediatric consultant, Dr Peter Wong, who is an experienced and well-regarded doctor, acknowledged the inconvenience caused to the family by the wait, and tried to explain to the parent that there were other patients who were more serious that needed to be attended more urgently and that the child would be attended to as soon as possible. The child’s condition was stable and she was not in danger. If her situation had changed or deteriorated, she would have been attended to promptly.

We understand that the patient then left KKH Children’s Emergency before further medical examination could be conducted. About 12 hours later, the child was again brought to the Children’s Emergency and she was assessed to be stable. She was admitted to the general ward and provided with the necessary care. She was discharged the following day and is now at home.

We have reviewed the case, and there were no lapses in medical care or patient safety.

The hospital’s priority is to provide appropriate and timely care to our patients. As such, emergency cases have to be given priority. KKH is committed to improving our patients’ experience, but parents and caregivers have to also play their part to be responsible and considerate to enable our medical professionals to perform their tasks.

 

After reading a wall of text also dunno what's wrong with the toddler.

 

 

FYI other dan KKH, NUH aslo got children's emergency dept. For me I go NUH as it's nearer to where I stay. For weekends KKH confirm a lot of ppl go to their emergency. Long wait is expected.

Edited November 19, 2017 by Watwheels

[kdash]

I wonder what had happen....

 

http://stomp.straitstimes.com/singapore-seen/kkh-responds-to-stomp-on-couples-fb-posting-claiming-lapses-by-doctor

KKH responds to Stomp on couple's FB posting claiming lapses by doctor

 

 

KKH replies says no lapses found.

https://www.facebook.com/kkh.sg/posts/1523246931045572

 

After reading a wall of text also dunno what's wrong with the toddler.

 

 

FYI other dan KKH, NUH aslo got children's emergency dept. For me I go NUH as it's nearer to where I stay. For weekends KKH confirm a lot of ppl go to their emergency. Long wait is expected.

 

young kid having fever, even high fever is considered quite low in the list of emergency cases... even if wait up to 4-5 hours to see the doctor, he/she will just give paracetamol and advise to put cold towel on forehead etc... 

 

in this case i guess the doctor thought this was just one of those many cases... 

[Jellandross]

i've never visited KKH during my kid's toddler days as i know the wait time is typically terrible.

 

my kid kena croup one night which freaked us out and we rushed to TMC and got admitted immediately. another time we rushed the kid to raffles hospital A&E due to a fall and got queued to the doc and x-ray pretty fast due to the short queue.

 

if parents have the "life and death" feeling about their kid's condition then the only deciding factor should be which hospital has the shortest waiting time.

Edited November 20, 2017 by Jellandross

[Heartlander]

i've never visited KKH during my kid's toddler days as i know the wait time is typically terrible.

 

my kid kena croup one night which freaked us out and we rushed to TMC and got admitted immediately. another time we rushed the kid to raffles hospital A&E due to a fall and got queued to the doc and x-ray pretty fast due to the short queue.

 

if parents have the "life and death" feeling about their kid's condition then the only deciding factor should be which hospital has the shortest waiting time.

I used to take my kids to TMC when they were young if very sick. Not sure if there is any change since, but TMC does not have any duty doctor on standby at night then. My kids would simply be triaged and admitted into the hospital. The nurse would simply monitor the situation. The doctor will come only in the morning about 8am. 

 

So for really serious case, KKH was still the place to go where treatment would be administered, although quality of doctor at theat hour is a bit hit-and-miss. But as I mention earlier, not sure if situation at TMC has changed.

[Galantspeedz]

 

actually they can just enforce the husband can stay over only ... just like in the delivery room ... my MIL wanted to see how her daughter was doing but was refused entry into the room ... that was after my wife was just admitted into the delivery room ... wife gave birth about 5 hours later only. we already pay so much ... just let us stay over mah ... I also dun want to order their food.

 

personally I dun see it as reasonable ... but can't do anything about it.

 

if they allow MIL then how about DIL, how about grandparents, how about other kids if they have, etc etc..... can hold party liao.... maybe allow BBQ also...lol

[Tkseah]

The kkh doctor advised them to wait or go other hospital... But the parents decided to go home?

[mersaylee]

I was a frequent user of KKH children A&E when my elder child was very young till 2+. Never come across lousy duty Doctors or Nurses there. Most of the time sent to go straight through the red door...follow up at the wards or during reviews after discharge were equally prompt and professional.

 

A relative from overseas was highly impressed by their professionalism when he needed immediate medical attention for his child...cited he won’t get that kind of service unless he pays a premium to go to the premium hospital in his country.

[Ysc3]

if they allow MIL then how about DIL, how about grandparents, how about other kids if they have, etc etc..... can hold party liao.... maybe allow BBQ also...lol

wow ... that was 2 years ago ... I don't remember what was it about already ....  

[Kb27]

we always complain about doctors, especially if it's "our baby" not being attended to at the highest priority.

 

heck care about other people dying or real emergencies.

 

Let us salute the doctors and nurses who have to make the hard decision on who gets to be treated first.

[Windwaver]

https://www.channelnewsasia.com/singapore/newborn-baby-died-brain-injury-breathing-difficulty-kkh-reviewing-procedures-monitor-3229896

KKH considering continuously monitoring newborn's vital signs after 11-day-old baby dies: Coroner

SINGAPORE: KK Women's and Children's Hospital (KKH) is reviewing its procedures to consider continuous documentation of a newborn’s vital signs, after a baby died of a type of injury that stems from a decrease in oxygen or blood flow to the brain.

State Coroner Adam Nakhoda encouraged the hospital to implement this practice, after finding that the lack of continuous documentation of the baby's vital signs "was not ideal". He made this note in a set of findings into the death of the baby made available over the weekend.

The 11-day-old baby died on Apr 12, 2021 of natural disease causes, and the case was referred to the coroner after the hospital alerted the police about the baby’s death. 

He was born via emergency Caesarean, with his mother on general anaesthesia, after vaginal delivery by vacuum and forceps was unsuccessful and a slow foetal heart rate was detected for eight minutes.

His mother had been admitted to KKH at 39+1 weeks of pregnancy, and had gestational diabetes mellitus during her pregnancy as well as a prior history of Graves’ disease - an immune system disorder that affects the thyroid gland.

However, her thyroid function tests were normal during pregnancy, as well as her antenatal ultrasound scan.

The boy was born with three tight loops of umbilical cord around his neck. The cord was cleared and he was noted to have a "fair cry" when delivered.

POST-BIRTH EVENTS

KKH's neonatal resuscitation team immediately attended to the baby after birth and placed him on a resuscitator.

His initial heart rate was low, and he had borderline oxygen saturation, so he was given continuous positive airway pressure (CPAP) via nasal prongs until his condition improved.

The CPAP was discontinued at six minutes post-delivery, with the baby observed to be vigorous and have a "good cry". The rest of the examination findings were normal.

At about 5am, the doctors at the operating theatre were called away to attend to a Code Blue activation, referring to a medical emergency.

The baby remained in the operating theatre in the care of a senior staff nurse named only as SSN KJ in court documents. He was to be transferred to the special care nursery ward for observation.

SSN KJ weighed and measured the baby before placing him back on the resuscitator. According to her, measurements of the baby's oxygen saturation and heart rate via a probe attached to his palm were normal. However, she noted that his cry was "quite weak" and contacted the special care nursery ward for his transfer.

She then took him out of the resuscitator, placed him on a transport cot and took him to the viewing room for his father to look at him.

The baby's father took a video of his child, who was giving out weak cries, said the coroner. About four minutes into the video recording, the baby's father observed that the child was quiet, sleepy and responding slowly. 

He asked SSN KJ if the baby was still sleeping. The nurse did not reply, instead uncovering the baby's swaddle and appearing to be monitoring him.

The baby appeared limp and was not showing any spontaneous limb movements. The nurse later said the baby was not breathing spontaneously and swaddled him again at 5 min 19 sec into the recording, before taking him back to the operating theatre.

In the operating theatre, the nurse put the baby back on the resuscitator and attached a probe to him. He did not appear to be breathing spontaneously, so the nurse administered intermittent positive pressure ventilation using a resuscitator, before activating a neonatal code blue emergency at 5.22am.

A team comprising an on-call consultant, an on-call senior resident and two on-call junior residents went to attend to the baby.

He was showing no response to stimulation at 5.25am, so he was intubated and given manual ventilation before being transferred to the neonatal intensive care unit (NICU). His fraction of inspired oxygen had decreased to 21 per cent.

He reached the NICU at 5.36am and was connected to a ventilator. At about 8.30am, he began developing clinical seizures including breath-holding, followed by rapid breathing and movement of his upper limbs. 

He was treated for the seizures and referred to the neurology team for co-management, but later was found to have copious amounts of fresh blood in his mouth.

Between the second and fifth day of his life, the baby's condition remained largely unchanged, with no discernible change in the neurological findings.

A magnetic resonance imaging (MRI) of the child’s brain revealed, among other things, swelling and bleeding.

The baby remained on low ventilator settings but did not show any spontaneous movements or spontaneous respiratory effort, with his pupils remaining fixed and dilated. 

The findings were communicated to the baby's parents, and they agreed after consideration on day six to actively withdraw care, with provision for sedation and pain medications.

He was pronounced dead on Apr 12, 2021.

An autopsy found the cause of death to be hypoxic ischaemic encephalopathy (HIE). This is a type of brain dysfunction or injury that occurs when the brain experiences a decrease in oxygen or blood flow.

The HIE was possibly related to Long QT Syndrome - a heart signalling disorder that can cause fast, chaotic heartbeats or arrhythmias - with an abnormally low foetal heart rate. Forensic pathologists said the cause of death was probably due to a natural disease process.

THE FATHER’S QUESTION

During the coroner's inquiry, the baby's father asked why the child was not put on a ventilator to assist his breathing after he was noted to have breathing difficulties.

A consultant at KKH who wrote the medical report for the case said the baby was born limp with a slow heart rate, and the medical team had to go through the standard resuscitation process.

Six minutes after birth, he was deemed to be breathing sufficiently well and CPAP was discontinued. According to KKH's protocol, he was to be transferred to the special care nursery as he had been subject to resuscitation.

The baby was hooked up to a probe that would have recorded his oxygen saturation and heart rate, but there was no electronic record of these readings as they were not captured by KKH's electronic medical records system.

The only vital sign recordings noted were the ones at the sixth and seventh minute after birth. When he was placed in the transport cot and brought to the viewing room, the probe was disconnected.

There was no objective evidence to establish the baby's condition prior to his transfer to the viewing room, said the coroner.

A further medical report by KKH stated that there was no documentation of continuous monitoring of the baby's vital signs considering his initial stable status.

The KKH representative said that after reviewing this aspect, the hospital is working to ensure documentation of a newborn's vital signs is kept until the newborn is handed over to medical teams at the respective clinical areas.

It was emphasised to the neonatology teams that they should ensure that any newborn babies who require oxygen supplementation should be accompanied by medical personnel.

State Coroner Adam Nakhoda found no foul play in the baby's death and returned a finding of death by natural causes.

However, he noted that the baby's vital signs were not recorded from the seventh minute after birth, until he was taken back to the operating theatre.

"I found that the lack of continuous documentation of (the baby's) vital signs was not ideal. I am heartened by the fact that KKH is reviewing its procedures to consider continuous documentation of a newborn’s vital signs and I would encourage the hospital to implement this," he said.

However, he said the nurse's actions were otherwise appropriate.

The coroner said it is not known what exactly caused the baby to stop breathing when he was in the viewing room, but investigations later revealed he had a KNCQ1 missense variant and that mutations in the KNCQ1 gene have been known to cause arrhythmias or chaotic heartbeats.

He accepted the forensic pathologist's opinion that the HIE was not caused as a result of traumatic or unnatural circumstances, and found instead that his death was consistent as being a result of a natural disease process.

The coroner said losing a child is always a devastating event, perhaps more so when the child is a newborn, and extended his condolences to the baby's parents.

[Atonchia]

23 minutes ago, Windwaver said:

https://www.channelnewsasia.com/singapore/newborn-baby-died-brain-injury-breathing-difficulty-kkh-reviewing-procedures-monitor-3229896

KKH considering continuously monitoring newborn's vital signs after 11-day-old baby dies: Coroner

SINGAPORE: KK Women's and Children's Hospital (KKH) is reviewing its procedures to consider continuous documentation of a newborn’s vital signs, after a baby died of a type of injury that stems from a decrease in oxygen or blood flow to the brain.

State Coroner Adam Nakhoda encouraged the hospital to implement this practice, after finding that the lack of continuous documentation of the baby's vital signs "was not ideal". He made this note in a set of findings into the death of the baby made available over the weekend.

The 11-day-old baby died on Apr 12, 2021 of natural disease causes, and the case was referred to the coroner after the hospital alerted the police about the baby’s death. 

He was born via emergency Caesarean, with his mother on general anaesthesia, after vaginal delivery by vacuum and forceps was unsuccessful and a slow foetal heart rate was detected for eight minutes.

His mother had been admitted to KKH at 39+1 weeks of pregnancy, and had gestational diabetes mellitus during her pregnancy as well as a prior history of Graves’ disease - an immune system disorder that affects the thyroid gland.

However, her thyroid function tests were normal during pregnancy, as well as her antenatal ultrasound scan.

The boy was born with three tight loops of umbilical cord around his neck. The cord was cleared and he was noted to have a "fair cry" when delivered.

POST-BIRTH EVENTS

KKH's neonatal resuscitation team immediately attended to the baby after birth and placed him on a resuscitator.

His initial heart rate was low, and he had borderline oxygen saturation, so he was given continuous positive airway pressure (CPAP) via nasal prongs until his condition improved.

The CPAP was discontinued at six minutes post-delivery, with the baby observed to be vigorous and have a "good cry". The rest of the examination findings were normal.

At about 5am, the doctors at the operating theatre were called away to attend to a Code Blue activation, referring to a medical emergency.

The baby remained in the operating theatre in the care of a senior staff nurse named only as SSN KJ in court documents. He was to be transferred to the special care nursery ward for observation.

SSN KJ weighed and measured the baby before placing him back on the resuscitator. According to her, measurements of the baby's oxygen saturation and heart rate via a probe attached to his palm were normal. However, she noted that his cry was "quite weak" and contacted the special care nursery ward for his transfer.

She then took him out of the resuscitator, placed him on a transport cot and took him to the viewing room for his father to look at him.

The baby's father took a video of his child, who was giving out weak cries, said the coroner. About four minutes into the video recording, the baby's father observed that the child was quiet, sleepy and responding slowly. 

He asked SSN KJ if the baby was still sleeping. The nurse did not reply, instead uncovering the baby's swaddle and appearing to be monitoring him.

The baby appeared limp and was not showing any spontaneous limb movements. The nurse later said the baby was not breathing spontaneously and swaddled him again at 5 min 19 sec into the recording, before taking him back to the operating theatre.

In the operating theatre, the nurse put the baby back on the resuscitator and attached a probe to him. He did not appear to be breathing spontaneously, so the nurse administered intermittent positive pressure ventilation using a resuscitator, before activating a neonatal code blue emergency at 5.22am.

A team comprising an on-call consultant, an on-call senior resident and two on-call junior residents went to attend to the baby.

He was showing no response to stimulation at 5.25am, so he was intubated and given manual ventilation before being transferred to the neonatal intensive care unit (NICU). His fraction of inspired oxygen had decreased to 21 per cent.

He reached the NICU at 5.36am and was connected to a ventilator. At about 8.30am, he began developing clinical seizures including breath-holding, followed by rapid breathing and movement of his upper limbs. 

He was treated for the seizures and referred to the neurology team for co-management, but later was found to have copious amounts of fresh blood in his mouth.

Between the second and fifth day of his life, the baby's condition remained largely unchanged, with no discernible change in the neurological findings.

A magnetic resonance imaging (MRI) of the child’s brain revealed, among other things, swelling and bleeding.

The baby remained on low ventilator settings but did not show any spontaneous movements or spontaneous respiratory effort, with his pupils remaining fixed and dilated. 

The findings were communicated to the baby's parents, and they agreed after consideration on day six to actively withdraw care, with provision for sedation and pain medications.

He was pronounced dead on Apr 12, 2021.

An autopsy found the cause of death to be hypoxic ischaemic encephalopathy (HIE). This is a type of brain dysfunction or injury that occurs when the brain experiences a decrease in oxygen or blood flow.

The HIE was possibly related to Long QT Syndrome - a heart signalling disorder that can cause fast, chaotic heartbeats or arrhythmias - with an abnormally low foetal heart rate. Forensic pathologists said the cause of death was probably due to a natural disease process.

THE FATHER’S QUESTION

During the coroner's inquiry, the baby's father asked why the child was not put on a ventilator to assist his breathing after he was noted to have breathing difficulties.

A consultant at KKH who wrote the medical report for the case said the baby was born limp with a slow heart rate, and the medical team had to go through the standard resuscitation process.

Six minutes after birth, he was deemed to be breathing sufficiently well and CPAP was discontinued. According to KKH's protocol, he was to be transferred to the special care nursery as he had been subject to resuscitation.

The baby was hooked up to a probe that would have recorded his oxygen saturation and heart rate, but there was no electronic record of these readings as they were not captured by KKH's electronic medical records system.

The only vital sign recordings noted were the ones at the sixth and seventh minute after birth. When he was placed in the transport cot and brought to the viewing room, the probe was disconnected.

There was no objective evidence to establish the baby's condition prior to his transfer to the viewing room, said the coroner.

A further medical report by KKH stated that there was no documentation of continuous monitoring of the baby's vital signs considering his initial stable status.

The KKH representative said that after reviewing this aspect, the hospital is working to ensure documentation of a newborn's vital signs is kept until the newborn is handed over to medical teams at the respective clinical areas.

It was emphasised to the neonatology teams that they should ensure that any newborn babies who require oxygen supplementation should be accompanied by medical personnel.

State Coroner Adam Nakhoda found no foul play in the baby's death and returned a finding of death by natural causes.

However, he noted that the baby's vital signs were not recorded from the seventh minute after birth, until he was taken back to the operating theatre.

"I found that the lack of continuous documentation of (the baby's) vital signs was not ideal. I am heartened by the fact that KKH is reviewing its procedures to consider continuous documentation of a newborn’s vital signs and I would encourage the hospital to implement this," he said.

However, he said the nurse's actions were otherwise appropriate.

The coroner said it is not known what exactly caused the baby to stop breathing when he was in the viewing room, but investigations later revealed he had a KNCQ1 missense variant and that mutations in the KNCQ1 gene have been known to cause arrhythmias or chaotic heartbeats.

He accepted the forensic pathologist's opinion that the HIE was not caused as a result of traumatic or unnatural circumstances, and found instead that his death was consistent as being a result of a natural disease process.

The coroner said losing a child is always a devastating event, perhaps more so when the child is a newborn, and extended his condolences to the baby's parents.

39+1 week is full term already.

Think gynae will recommend induce labour at 38 week. 

My 1st born also 40 week...wanted natural birth and rejected induced labour. Had a crash C sect due to placenta abruption, immediately place to NICU after birth for 2 days to monitor any lack of oxygen. 

Luckily all ok. 

Sometimes adult decisions can also contribute to unwanted circumstances.