Breaking Barriers Through Integration: Singapore's Pioneering Hospital-Community Model Dramatically Reduces Dialysis Catheter-Related Hospital Referrals

 

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Breaking Barriers Through Integration: Singapore's Pioneering Hospital-Community Model Dramatically Reduces Dialysis Catheter-Related Hospital Referrals

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Li Choo Michelle
Ng
Li Choo Michelle Ng michelle_lcng@yahoo.com,.sg Singapore General Hospital Renal Medicine Singapore Singapore *
Ru Yu Tan tan.ru.yu@singhealth.com.sg Singapore General Hospital Renal Medicine Singapore Singapore -
Suh Chien Pang pang.suh.chien@singhealth.com.sg Singapore General Hospital Renal Medicine Singapore Singapore -
Ren Kwang Alvin Tng alvin.tng.r.k@singhealth.com.sg Singapore General Hospital Renal Medicine Singapore Singapore -
Chee Wooi Tan tan.chee.wooi@singhealth.com.sg Singapore General Hospital Renal Medicine Singapore Singapore -
Pauline Tan pauline.tan@nkfs.org NKF Singapore Nursing Singapore Singapore -
Mei Hua Lu meihua.lu@nkfs.org NKF Singapore Nursing Singapore Singapore -
Maynard Urmatan maynard.urmantan@nkfs.org NKF Singapore Nursing Singapore Singapore -
Zhilin Zhang zhang.zhilin@sgh.com.sg Singapore General Hospital Emergency Medicine Singapore Singapore -
Yu An Genevieve Marie Ng genevieve.marie.ng.y.a@sgh.com.sg Singapore General Hospital Emergency Medicine Singapore Singapore -
Song Sue Raphael Nyoe raphael.nyoe.s.s@sgh.com.sg Singapore General Hospital Emergency Medicine Singapore Singapore -
Jing Jing Chan chan.jing.jing@singhealth.com.sg Singapore General Hospital Emergency Medicine Singapore Singapore -
Wei Wei Lydia Lim lydia.lim.w.w@sgh.com.sg Singapore General Hospital Renal Medicine Singapore Singapore -
Jason Chon Jun Choo jason.choo@nkfs.com.sg NKF Singapore Medical Singapore Singapore -
Chien Suai Tan tan.chieh.suai@singhealth.com.sg Singapore General Hospital Renal Medicine Singapore Singapore -

Dialysis catheter dysfunction significantly impacts patient outcomes and healthcare resources. Traditional management required hospital referrals, creating care fragmentation and system inefficiencies. To revolutionise dialysis catheter management through innovative multidisciplinary protocols spanning hospital and community settings whilst enhancing nursing practice capabilities.

The Catheter Care Champions implemented a comprehensive two-phase initiative across Singapore. Phase 1 targeted Emergency Department (ED) catheter interventions through workflow redesign and nurse champion training. Phase 2 established community-based catheter restoration programmes (CLEAR/BLAST protocols) across dialysis centres, training nurses in advanced catheter management techniques. Standardised protocols, competency frameworks, and quality assurance measures ensured consistent care delivery.

Phase 1 achieved remarkable ED improvements: 25% reduction in length of stay (4.3 to 3.2 days), increased success rates from 62.1% to 72.6%, and S$48,000 annual cost avoidance. Seven nursing champions were trained with sustained improvements through August 2025.

Phase 2 demonstrated exceptional community outcomes: 87.9% success rate across 181 interventions, 70% reduction in hospital referrals (48 to 14.5 monthly cases), and S$412,861 cost savings. One hundred and four nurses across 42 centres were trained with zero adverse events reported.

Sustainability initiatives expanded training to additional dialysis centres, achieving 70% coverage across Singapore's community dialysis facilities.

This pioneering multidisciplinary approach successfully transformed catheter management through innovative hospital-community integration, empowering nursing practice whilst achieving substantial clinical and economic benefits with exemplary safety standards.

Earlier phases of this initiative were shared individually at the Kidney Care Conference 2023, Singapore Society of Nephrology Annual Scientific Meeting 2024, and SingHealth Nursing Conference 2025.

 

Kewords