[AVBC 2025] Driving Appropriate Care in a Tertiary Hospital: Reducing Unnecessary Blood Glucose Monitoring
Care Process & Redesign
Appropriate & Value-based Care Conference
National University Health System
27 November 2025
To reduce inappropriate point-of-care testing (POCT) blood glucose monitoring (BGM) among inpatients in a tertiary hospital. Excessive POCT BGM represents a common yet frequently overlooked practice in hospital care.
Year Submitted: 2025
Published Date: 27 November 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Productivity, Cost Saving, Time Saving, Manhour Saving
About this Content
Aims
To reduce inappropriate point-of-care testing (POCT) blood glucose monitoring (BGM) among inpatients in a tertiary hospital.
Background
POCT BGM is commonly initiated by junior admitting physicians, often without regular re-assessment by the managing team. This leads to wide practice variation and frequent, unnecessary testing. A 2015 quality improvement initiative at New York Methodist Hospital demonstrated that educating teams to reduce fingerprick testing to twice-daily in stable patients led to a significant reduction in POCT BGM from 275,000 to 238,000 tests annually resulting in substantial manpower and cost savings.
Methods
A root-cause analysis was conducted with key stakeholders in a tertiary hospital (doctors and nurses) to understand local drivers of over-use. Findings revealed a lack of awareness, variable confidence among physicians, and absence of a standardised workflow. Cost implications of excessive testing were also under-recognised. As a result, a simplified and standardised inpatient POCT BGM workflow was developed. This included clear inclusion and exclusion criteria for reduced monitoring frequency, tailored for general ward patients who were clinically stable and not requiring active insulin titration. Nurses were educated and empowered to actively reduce unnecessary POCT BGM monitoring based on this workflow - this was piloted in two wards in National University Hospital (NUH).
Results
Preliminary data over the first six months shows a 5% reduction in POCT glucose utilization in the surgical ward (p=0.08). Rates of hypoglycemia and hyperglycemia remained relatively stable pre- and post-intervention.
Conclusion
Excessive POCT BGM represents a common yet frequently overlooked practice in hospital care. There is value in expanding this to more wards and over a longer time-frame. Introducing a clear, evidence-based workflow may help to minimise unnecessary monitoring, allowing for more appropriate redistribution of resources. This in turn empowers nurses to deliver more patient-centred and cost-effective care.
Lessons Learnt
The initiative highlighted the importance of standardised workflows and education in reducing unnecessary medical practices. Empowering nurses and involving key stakeholders were crucial steps.
Keywords
POCT, BGM, workflow, monitoring, cost-effective
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | National University Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Healthcare Administration |
Applicable Specialty or Discipline | General Medicine |
Project Lead(s) | Ada Teo Ee Der |
Project Member(s) | Esther Lin |
Connect with this contributor!
Ada Teo Ee Der - ada.teo@mohh.com.sg