Research at NICQ

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CalSense: Real-Time AI-Driven Detection and Triage of Hypercalcaemia

The challenge: Hypercalcaemia (high blood calcium levels) is often underdiagnosed, leading to delayed treatment and potential complications.

Our solution: National University Health System (NUHS) developed CalSense, an AI-powered tool for smarter calcium monitoring.

How it works:

1. AI detects patients with significant hypercalcaemia
2. Care coordinators follow up on identified cases
3. Physicians take timely action
4. Patients are expedited to appropriate specialists within 4-8 weeks

Impact:

• Up to 80% detection of all hypercalcaemia cases across NUHS
• Improved patient safety and streamlined clinician workflows

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Healing Patients While Healing the World

The challenge: Under the Singapore Green Plan, there's a national aim to reach net zero carbon emissions by 2050 (public sector by 2045). The NUHS Green Target is to reduce all controllable emissions by 25% by 2030. There was a gap in nurses' awareness and understanding of environmental knowledge.

Our solution: National University Hospital (NUH) Nursing established the Nursing Sustainability Committee (NSC) to embark on a journey towards building a greener healthcare environment.

How it works:

• Established NSC in March 2024 with a 5-member core team and 53 Green Champions from all Nursing areas to support and share new/existing green initiatives
• Adopted a 4R Strategy: Refuse, Reduce, Reuse, Recycle
• Collaborated closely with Group Hospitality for initiatives like "Bring Your Own Food (BYOF)" and Sort-At-Source
• Implemented specific initiatives such as refurbishing patient cabinets
  

Results:

• Achieved an increase of 231% for plastic recycling and 47% for paper recycling through the Sort-At-Source pilot
• Refused disposal of 30 old cabinets (38kg/unit), which led to cost savings of $18,524
• Plan to refurbish 130 more units in 2025, which will achieve cost savings of $73,000 and reduce waste by 4,940kg

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Optimising Care for Patients with Cellulitis: A Combined Educational and Clinical Decision Rule Approach

The challenge: Patients admitted with cellulitis frequently experience hospital stays that exceed the expected length of stay, increasing their risk for hospital-acquired infections and contributing to bed shortages. Additionally, there is notable overuse of low-yield investigations such as routine blood cultures, which add to unnecessary cost and resource utilisation.

Our solution:  The healthcare team implemented a combined educational and clinical decision rule approach to optimise care for cellulitis patients.

How it works:

• Developed a clinical decision support tool for appropriate blood culture use
• Implemented streamlined discharge workflows
• Educated clinicians on proper test indications and discharge options
• Created a smart phrase to optimise blood culture orders and discharge planning 

Results:

• Appropriate blood culture use increased from 6% to 98%
• Early discharge (within 3 days) rose from 48% to over 80%
• Cost savings of about SGD $1,000 per patient
• Improved bed utilisation
• Enhanced patient experience with fewer unnecessary tests

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Water-Less ICU Innovation – Eliminating Waterborne Infection Risks Through Infrastructure Redesign and Workflow Innovation

The challenge: Persistent late-onset sepsis (LOS) in very low birth weight (VLBW) infants despite strict hygiene protocols. Water-based sources (sink traps and faucet aerators) were identified as reservoirs of multidrug-resistant bacteria.

Our solution: The healthcare team implemented a "Water-Less ICU" model in the Neonatal Intensive Care Unit (NICU) at National University Hospital, Singapore, combining infrastructure redesign with innovative workflows.

How it works:

1. Removed/closed bedside sinks and implemented water-free protocols
2. Introduced sterile wipes and irrigated bottled water as alternatives for routine baths
3. Implemented electric milk warmers and UV sterilisers for milk preparation
   
4. Trained staff and oriented families on new water-free practices

Results:

• Sink contamination dropped from 69.4% to near-zero
• Significant bioburden reduced 11-fold (from 16.34 to 1.49 CFU/mL)
  
• LOS in VLBW infants reduced from 14.8% (2014-2016) to 3.8-6.6% (2021-2024)
  
• Reduced plumbing costs
  

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Automated Code Red Alerts (ACRA) & ICU Outreach Nursing (ICUORN)

The challenge: In general wards, patients can sometimes get worse quickly without anyone noticing in time.

Our solution: Ng Teng Fong General Hospital in Singapore created two tools:

• ACRA: A smart alarm system that constantly monitors vital signs parameters of which ACRA will monitor six physiological parameters for patient health evaluation.
• ICUORN: ICU Specialised nurses ready to respond 24/7 when ACRA raises an alert.

How it works:
ACRA automatically detects when a patient's health is declining, using pre-set thresholds from NEWS2 and hospital policy.

ACRA immediately alerts the ICU Outreach Nurses, ward nurse in charge and relevant doctor, if the parameters reach the threshold criteria.

Nurses quickly assess the patient and escalates if needed.

Results:

• Escalation Care to the Right Clinicians
• Reduction in Incidence of In-Hospital Cardiac Arrest (IHCA) from 1.42-1.45 (2020-2021) to 1.17 (2023)
• Early intervention that leads to reduced ICU / HD Admission
• Efficiency and Resource Opitmization with ICUORN

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Decreasing Length of Stay in Ortho-Geriatric Patients: A Cost-effective and Comprehensive Care Model 

The challenge: Older adults with hip fractures often have prolonged stay in the hospital, leading to poor outcomes and high healthcare costs.

Our solution: National University Hospital implemented a comprehensive care model for ortho-geriatric patients (older adults with fragility fractures).

How it works:

• A multidisciplinary team approach with multiple targeted interventions (Eg. Visibility of community hospital beds, enhance coordinated discharge plan)
• Fast-track workflow to a dedicated rehabilitation facility
• More inclusive updates for patient and their family or carers

Results:

• Reduced median length of hospital stay by 20%
• Benefited 226 patients over 8 months
• Saved more than SGD$850K in healthcare costs over 8 months and projected to save over SGD$1 million over a year

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Improving Patient Experience in the Emergency Medicine Department

The challenge: Patient satisfaction scores in the Emergency Department were declining, indicating issues with patient experience particularly for non-urgent cases.

Our solution: National University Hospital implemented a comprehensive series of non-clinical interventions to enhance patient experience in the Emergency Medicine Department.

How it works:

• Conducted surveys and interviews to identify pain points
• Formed a multi-disciplinary team to develop strategies
• Implemented targeted interventions, including:
  1. Service Ambassadors for non-clinical support
  2. Amenities Corner for blankets and water
  3. Power Bank Kiosks for phone charging
  4. EPIC Wait Time Dashboards for accurate wait information
  5. Redesigned wall murals for better wayfinding

Results:

• Significant improvement in patient experience scores (75% in 2022 to 90% 2024)
• Reduction in negative patient feedback (46% in 2022 to 30% in 2024)
• Enhanced process efficiency
• Improved staff job satisfaction