[AVBC 2025] Establishing a Dental Referral Workflow for Paediatric Hematology-Oncology Patients
Care Process & Redesign
Workforce Transformation
Appropriate & Value-based Care Conference
National Healthcare Group
National University Health System
17 November 2025
To improve dental referral rates by 100% for paediatric hematology-oncology patients over 6 months in a tertiary hospital. A structured, nurse-led model and interdisciplinary collaboration significantly improved early dental screenings and referral rates.
Year Submitted: 2025
Published Date: 17 November 2025
Tags: Care Process ＆ Redesign, Workforce Transformation, Quality Improvement, Workflow Redesign, Productivity, Time Saving, Access To Care, Referral Rate, Waiting Time, Risk Management, Job Redesign, Inter-Disciplinary
About this Content
Aims
To improve dental referral rates by 100% for paediatric hematology-oncology patients over 6 months in a tertiary hospital.
Background
The oral cavity harbours a diverse array of microorganisms and serves as a reservoir and potential entry point for systemic infections, particularly in immunocompromised patients. In 2023, only 10.5% of patients were referred for dental care, mainly for emergency reasons such as neutropenic fever or dental pain, indicating missed opportunities for preventive oral health management.
Methods
A QI initiative was implemented in May 2024 with a structured referral workflow between paediatric haematology-oncology and paediatric dental services at NUCOHS. Nurses were trained to conduct basic oral screenings at cancer diagnosis, and dental caries risk stratification was used to guide the urgency of dental referral.
Results
Pre-intervention: 27.3% referred with a 109.3 days lead time. Post-intervention: 77.8% referred, 100% in the final 3 months. Lead time reduced to 3.955.0 days, reflecting a 61% reduction in wait time. 85% of nurses correctly stratified risk in clinical scenarios.
Conclusion
A structured, nurse-led model and interdisciplinary collaboration significantly improved early dental screenings and referral rates, enabling timely integration of oral health into paediatric hematology-oncology care pathways.
Lessons Learnt
Feedback supported the nurse-led protocols acceptability and sustainability within existing workflows.
Keywords
Dental Referral, Paediatric Oncology, Quality Improvement
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System, National Healthcare Group |
Organization(s) Involved | National University Centre for Oral Health Singapore, Khoo Teck Puat National University Childrens Medical Institute |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Paediatrics, Dental / Dentistry, Oncology |
Project Lead(s) | Ruth Choe Wei |
Project Member(s) | Sim Chien Joo |
Connect with this contributor!
Ruth Choe Wei - ruth_choe@nuhs.edu.sg