[AVBC 2025] FAST -TKR: Focused Accelerated Surgical Treatment for Total Knee Replacement
Care Process & Redesign
Appropriate & Value-based Care Conference
National University Health System
17 November 2025
To reduce the Average Length of Stay (ALOS) by doubling the number of patients discharged by Post-Operative Day 1 (POD 1) by. The intervention shows promise for improving patient care by reducing hospital stay length, improving patient outcomes, and achieving.
Year Submitted: 2025
Published Date: 17 November 2025
Tags: Care Process ＆ Redesign, Workflow Redesign, Productivity, Cost Saving, Quality Improvement, Access To Care, Length Of Stay, Value Based Care, Discharge Planning
About this Content
Aims
To reduce the Average Length of Stay (ALOS) by doubling the number of patients discharged by Post-Operative Day 1 (POD 1) by 100% in 6 months.
Background
Total knee replacement (TKR) surgeries are rising in Singapore, with projections indicating a 139% increase by 2040 and a 469% increase by 2060, reflecting the countrys aging population. Traditional post-surgery hospital stays pose several challenges, including increased risk of hospital-related complications, poorer outcomes, higher costs, and limited bed availability for more critical patients.
Methods
A novel approach was devised, leveraging multi-disciplinary collaboration to achieve a singular goal with limited resources. Key strategies included pre-admission discharge planning, de-institutionalization of post-operative care, decentralization of outpatient services, and standardization of care protocols.
Results
The mean acute hospital length of stay was reduced from 3.39 days to 2.00 days. POD 1 discharges increased from 11% to 43%. EQ 5D-5L score difference above Minimal Clinically Important Difference (MCID) improved from 32% to 40%. Projected 1-year cost avoidance was SGD$ 613,844.
Conclusion
The intervention shows promise for improving patient care by reducing hospital stay length, improving patient outcomes, and achieving cost savings.
Lessons Learnt
Challenges included ensuring compliance with standardized protocols and effective communication across multiple agencies. The importance of pre-operative education and discharge planning was highlighted.
Keywords
Total Knee Replacement, Surgery, Orthopaedics, Cost Saving, Workflow Redesign
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | National University Hospital, Ng Teng Fong General Hospital, Alexandra Hospital, Ministry of Health Holdings, St. Lukes Hospital, Group Chief Value Office, National University Health System |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Orthopaedics, Surgery |
Project Lead(s) | Harish Sivasubramanian |
Project Member(s) | Barry Tan |
Connect with this contributor!
Harish Sivasubramanian - harish_sivasubra@nuhs.edu.sg
Project Attachment
503_NUH_AVBC_2025_FAST_TKR_Focused_Accelerated_Surgical_Treatment_for_Total_Knee_Replacement.pdf