Through the programme, clinicians streamline care delivery to prioritise and improve the comfort, safety, and outcomes for patients.
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At the National University Hospital (NUH), patient-centred care is being re-examined with fresh lens. Doctors and nurses are asking a simple question: Does every test, procedure, or prescription truly benefit the patient?
From fewer blood glucose finger pricks to a gentler approach to end-of-life care, to deprescribing medications which do not add benefit to patients’ health, NUH is rethinking long-established routines to focus on what genuinely improves health, comfort, and dignity. It is resulting in a shift that is changing our culture of care, one conversation, and one patient at a time.
This philosophy underpins NUH’s Appropriate Care (Apt Care) programme, part of a wider, national value-based care movement: Appropriate and Value-Based Care (AVBC). It aims to deliver evidence-based, patient-centred care that maximises health outcomes while using healthcare resources sustainably.
When 48-year-old Mr Noor was admitted to NUH for a heart stent procedure, he anticipated the usual routine: four daily finger pricks to check his blood sugar. But after his condition stabilised, nurses reviewed his readings and reduced testing to twice daily.
It was a small change that made a big difference — less discomfort, better rest, and lower costs.
The adjustment exemplifies NUH’s new workflow for inpatient blood glucose monitoring, a key initiative under the Apt Care programme. Led by Dr Ada Teo, Associate Consultant, Division of Endocrinology, Department of Medicine, NUH, the team introduced clear criteria to guide nurses in safely reducing tests for clinically stable patients.
“This initiative is a true win-win,” says Dr Teo. “By focusing on the right frequency of glucose testing, we can still rely on meaningful data to make informed assessments for our patients’ care plans. Patients who participated reported an improved treatment experience, as it reduced discomfort, pain, and their out-of-pocket costs.”
Over just three months, 87 patients had their average daily glucose checks halved from four to two, without any increase in the rates of hypoglycaemia or hyperglycaemia.
The initiative also empowered nurses to take a more active role in decision-making. A survey found that 85 per cent of nurses involved felt confident implementing the new workflow, and 87 per cent said they felt empowered to reduce unnecessary testing.
“Introducing a clear, evidence-based workflow helps to minimise unnecessary monitoring, allowing for a more appropriate distribution of resources to facilitate patient-centred care,” Dr Teo adds.
For patients nearing the end of life, more treatment does not always equate to better care. Doctors, nurses, and pharmacists at NUH are working together to help terminally ill cancer patients live their final days with less discomfort and greater dignity.
Also under the Apt Care programme, NUH and the National University Cancer Institute, Singapore (NCIS) introduced an end-of-life care pathway that focuses on reducing unnecessary medication and procedures. Each plan is tailored to what matters most to the patient — comfort and quality of life.
Since its launch in October 2024, 108 patients have taken part in the programme. On average, each patient received three fewer oral medications, underwent fewer routine vital-sign checks, and was spared dozens of finger-prick blood glucose tests. Many also needed fewer outpatient appointments, easing the burden of travel, and treatment costs.
“Patients have reported less pain and discomfort as a result of cutting down on non-essential procedures,” says Adjunct Associate Professor Samuel Ow, Senior Consultant, Department of Haematology-Oncology, NCIS, who leads the project. “By limiting consultations to only key ones, patients gain more time to spend meaningfully with their loved ones.”
The benefits have extended to staff as well. Streamlining procedures freed up time for clinical teams to focus on patients’ most pressing needs. “Our nurses have reported greater job satisfaction from being empowered to customise care plans that truly prioritise the needs and well-being of our end-of-life patients,” Adj A/Prof Ow adds.
Beyond these initiatives, the Apt Care philosophy is taking root across NUH. Working with partners across NUHS, NUH is reducing duplicative tests such as glycated haemoglobin (HbA1c), minimising inappropriate or redundant medications and consolidating multiple appointments where possible.
While similar efforts have existed in pockets for years, the Apt Care framework represents a coordinated, hospital-wide effort to formalise and accelerate meaningful change. “This initiative is more than a series of pilots,” says Adjunct Associate Professor Adrian Kee, Head and Senior Consultant, Division of Respiratory & Critical Care Medicine, Department of Medicine, NUH, and Senior Consultant, NCIS, who co-leads the programme. “It brings together doctors, nurses, and pharmacists to embed appropriate evidence-based practices into daily care.”
Adjunct Associate Professor Amelia Santosa, Head and Senior Consultant, Division of Rheumatology and Allergy, Department of Medicine, another co-lead, added that the approach is increasingly essential as Singapore’s population greys. “With more patients managing multiple chronic conditions, purposeful consolidation of tests, medications, and appointments is vital,” she said. “Our ultimate goal is to deliver care that is clinically effective and focused on patient-defined outcomes, while promoting greater healthcare value for everyone — patients, families, and staff alike.”
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