[AVBC 2025] Delivering Appropriate Care in Laboratory Utilisation: Curbing unnecessary repeated HbA1c orders
Care Process & Redesign
Appropriate & Value-based Care Conference
National University Health System
28 November 2025
To optimize resource utilization and improve patient experience by curbing unnecessary repeated HbA1c orders. The multi-faceted approach, leveraging data analytics, education, and specialist recommendations shown potential for cost savings and.
Year Submitted: 2025
Published Date: 28 November 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Operational Management, Value Based Care, Patient Satisfaction, Patient Reported Outcome Measures
About this Content
Aims
To optimize resource utilization and improve patient experience by curbing unnecessary repeated HbA1c orders.
Background
HbA1c testing is important for monitoring diabetes, but inappropriate testing leads to unnecessary costs and patient inconvenience. Guidelines typically recommend HbA1c testing every 3-6 months for most people with diabetes. In 2023, over 17,000 HbA1c tests were performed within a short interval of 75-days at the National University Health System (NUHS), representing potentially avoidable, unintended duplications
Methods
A root cause analysis (RCA) was conducted. Clinical workflows were reviewed, ordering behaviours were assessed on Electronic Medical Record (EMR), and clinician feedback was gathered for reasons behind repeated HbA1c testing. Interventions included education, specialist recommendations for appropriate testing intervals, and cross-cluster EMR enhancements.
Results
Current EMR prompts with HbA1c duplicate orders within 30 days. Post educational interventions, duplicative HbA1c orders within 30-days dropped by 59% from August 2024 to May 2025, compared to January -July 2024.
Conclusion
The multi-faceted approach, leveraging data analytics, education, and specialist recommendations shown potential for cost savings and improved patient experience. With ongoing EMR enhancements, the aim is to optimize appropriate HbA1c testing levels with 75-day impact, balancing necessary monitoring with resource efficiency.
Lessons Learnt
The consistent month-over-month decrease suggested sustainable change in clinician ordering patterns, demonstrating significant progress towards appropriate, value-based care.
Keywords
HbA1c, diabetes, testing, resource utilization, patient experience
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | National University Health System, National University Hospital, Alexandra Hospital, National University Polyclinic, Ng Teng Fong General Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Healthcare Administration |
Applicable Specialty or Discipline | Endocrinology, Medical ＆ Laboratory Technology |
Project Lead(s) | Esther Huiyun Lin |
Project Member(s) | Ong Lizhen |
Connect with this contributor!
Esther Huiyun Lin - lin_esther@nuhs.edu.sg