[AVBC 2025] Advanced Practice Nurse (APN) Led Interventions, Improving Outcomes, Indwelling Pleural Catheters
Care Continuum
Care Process & Redesign
Appropriate & Value-based Care Conference
National Healthcare Group
21 November 2025
To review outcomes of patients with Indwelling Pleural Catheters (IPC) and assess its impact on overall healthcare cost and. The project demonstrated that APN-led interventions, along with the involvement of a home-based care network such as community.
Year Submitted: 2025
Published Date: 21 November 2025
Tags: Care Process ＆ Redesign, Care Continuum, Quality Improvement, Workflow Redesign, Functional Outcome, Productivity, Cost Saving, Value Based Care, Safe Care, Adverse Outcome Reduction, Intermediate and Long Term Care ＆ Community Care, Home Care
About this Content
Aims
To review outcomes of patients with Indwelling Pleural Catheters (IPC) and assess its impact on overall healthcare cost and resource utilization.
Background
Malignant pleural effusions (MPEs) cause significant symptoms and often require repeated hospital admissions. Indwelling Pleural Catheters (IPCs) are increasingly used for managing symptomatic MPEs as they allow drainage at home. However, self-care of IPCs poses a challenge for patients and caregivers, often resulting in delayed discharge and repeated healthcare visits.
Methods
Multiple nurse-led interventions were designed to address issues related to IPC care. The pleural APN conducted training for community nurses, standardized patient education and caregiver training with pamphlets and videos, and developed a workflow for escalation protocol if early signs of infection were identified. The IPC trained community nurses began their first visit in January 2022 through the Hospital to Home (H2H) Programme.
Results
26 patients out of the 50 IPC insertions were enrolled in the H2H programme. The empyema rate decreased from 22.7% pre-intervention to 3.5% post-intervention. The average length of catheter-days related to catheter care issues decreased from 257 days pre-intervention to 152 days post-intervention. The median number of IPC related visits in 90 days following IPC insertion decreased from 3.5 to 2 post-intervention, while unplanned ED visits in 30 days decreased from 45% to 25%.
Conclusion
The project demonstrated that APN-led interventions, along with the involvement of a home-based care network such as community nursing, can improve outcomes in patients with IPC. These interventions should be sustained and potentially adapted for future projects to enhance patient outcomes.
Lessons Learnt
APN-led interventions improved outcomes by ensuring continuity of care, with the APN as the first and constant point of contact during patients' IPC journey. Early follow-up and close monitoring by community nurses reduced complications and healthcare utilization significantly.
Keywords
Advanced Practice Nurse, Indwelling Pleural Catheters, Healthcare Utilization, Patient Outcomes
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Changi General Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Respiratory Therapy, Pulmonology |
Project Lead(s) | Marnie Tamayo Gutierrez |
Project Member(s) | Lee Wai Kit |
Connect with this contributor!
Marnie Tamayo Gutierrez - marnie_gutierrez@cgh.com.sg