Anaesthesia Clinical Evaluation (ACE) Clinic: a nurse-led preoperative assessment clinic
Care Process & Redesign
Workforce Transformation
National Healthcare Innovation and Productivity Medals
SingHealth
26 December 2025
To establish an in-house nurse-led preoperative clinic, ACE clinic, to assess patients undergoing general anaesthesia (GA). The ACE clinic has proven to be efficient and cost-effective, ensuring better patient care and resource utilization.
Year Submitted: 2025
Published Date: 26 December 2025
Tags: Care Process ＆ Redesign, Workforce Transformation, Productivity, Cost Saving, Job Redesign, Upskilling, Operational Management, Resource Allocation
About this Content
Aims
To establish an in-house nurse-led preoperative clinic, ACE clinic, to assess patients undergoing general anaesthesia (GA) and sedation with significant comorbidities, thereby optimizing preoperative assessment and freeing up appointment slots at SGH PAC for more complex cases
Background
SNEC performs approximately 20,000 ophthalmic surgeries annually. Previously, preoperative assessments for patients undergoing GA and sedation were not standardized, leading to unnecessary referrals, surgery postponements, and increased costs.
Methods
The ACE clinic was proposed as a nurse-led initiative to assess less complex cases in-house. A structured screening questionnaire was designed, and nurses underwent a structured training program. The clinic opened in April 2023 and expanded in phases.
Results
The implementation led to reduced surgical cancellations, unnecessary investigations, and specialist referrals, resulting in substantial cost savings. There was a 57% reduction in cardiac referrals and potential cost savings of approximately $740,000 per year.
Conclusion
The ACE clinic has proven to be efficient and cost-effective, ensuring better patient care and resource utilization. It has the potential to be scaled up to other sites.
Lessons Learnt
Effective communication with stakeholders is crucial. Transitioning training from doctor-led to nurse-led is challenging. Training a larger group of nurses initially could have mitigated attrition issues.
Keywords
preoperative, assessment, clinic, nurse-led, optimization, surgery, anaesthesiology
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | SingHealth |
Organization(s) Involved | Singapore National Eye Centre, Singapore General Hospital |
Platform(s) | National Healthcare Innovation and Productivity Medals |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Anaesthesiology |
Project Lead(s) | Charlene Kwa |
Project Member(s) | Chau Keen Chong |
Connect with this contributor!
Charlene Kwa - charlene.kwa.x.w@singhealth.com.sg