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Sepsis Value-Driven Outcomes (VDO) in National University Hospital (NUH)

Case study


  • Community-acquired sepsis incurs high morbidity and mortality
  • In 2019, there were 1,985 cases of sepsis in NUH, resulting in inpatient mortality rate of 13%
  • Sepsis VDO project launched in 2017


Encourage continuous improvement of "Value of Care" through:

  • Increasing quality of care while reducing cost
  • Minimising variation in care delivered to patients


Conceptualisation of Sepsis VDO (Emergency Department, Department of Medicine, Medical Informatics Team, Finance team), literature review, determined quality indicators and costs to be measured​
​Cascaded downstream by training of ground teams (simulation sessions)
​Sepsis management concepts and processes implemented and introduced to junior doctors during orientation
E​nhanced "Trigger Programme" initiative
​Reinforcement of key clinical concepts through intensive and remote education efforts; feedback loops with clinical departments


Quality Indicators

  • No inpatient mortality
  • No emergency readmissions ≤ 30 days (same cause)
  • Blood cultures (within 3 hours from triage)
  • Antibiotics (within 3 hours from triage)
  • Intravenous fluids (within 3 hours from triage)


  • Increase in Clinical Quality Index (CQI) driven by decreasing cost and increasing quality
  • An absolute decrease of 12% points in mean total cost per patient from 2019 to 2021


  • Antibiotics administration within 3 hours of triage. Increase of 7% to 51% in 2021.
  • In 2021, 32% of patients experience Perfect Quality of Care compared to 25% in 2019. (Increase of 7%)
  • Rate of appropriate de-escalation of antibiotics. Increase of 1% to 95% in 2021 when compared to 2019
  • Average length of stay. Decrease of 3 days from 17 days in 2019 to 14 days in 2021.
  • Stable inpatient mortality between 11% and 13% (compares favourably to 18.3% in ANZ)



Improvements in CQI and minimising variation in care achieved and sustained without compromise in mortality, despite challenges posed during COVID-19 pandemic in 2020 and 2021.

Team members
  • Dr See Kay Choong, Head & Senior Consultant, Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital
  • Dr Kuan Win Sen, Senior Consultant, Emergency Medicine Department, National University Hospital
  1. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395:200-211.
  2. See KC. Management of sepsis in acute care. Singapore Med J. 2022;63:5-9.
  3. Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372:1629-38.
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