[AVBC 2025] Implementing a Nurse-Led Short-Stay Pathway to Enhance Value and Reduce Cost
Care Process & Redesign
Workforce Transformation
Appropriate & Value-based Care Conference
National University Health System
28 November 2025
To evaluate whether the nurse-led Short Stay Ward (SSW) model improves care efficiency by reducing length of stay and cost. The introduction of the SSW pathway for therapeutic abdominal paracentesis has enabled a significant shift toward more efficient and.
Year Submitted: 2025
Published Date: 28 November 2025
Tags: Care Process ＆ Redesign, Workforce Transformation, Quality Improvement, Productivity, Value Based Care, Length Of Stay, Job Redesign, Upskilling
About this Content
Aims
To evaluate whether the nurse-led Short Stay Ward (SSW) model improves care efficiency by reducing length of stay and cost, while maintaining clinical appropriateness for patients undergoing elective ascitic drainage.
Background
Malignant ascites is a common complication in advanced cancer, often requiring repeated drainage via therapeutic abdominal paracentesis (TAP). Traditionally managed via inpatient admission, this contributes to extended hospital stays and higher costs. In 2020, the National University Cancer Institute of Singapore (NCIS) introduced a nurse-led Short Stay Ward (SSW) pathway to provide timely, lower-acuity care for suitable oncology patients.
Methods
A retrospective review of cancer patients who underwent TAP from 2017 to 2024 at NCIS was conducted, with the SSW pathway introduced in 2020. Patients were grouped into three care pathways: Acute Cancer Unit SSW, Inpatient admissions via Emergency Department (ED), and Inpatient admissions via non-ED routes. Administrative data, cost records, and Diagnosis-Related Group (DRG) classifications were analyzed to compare length of stay, relative costs, and clinical groupings across pathways
Results
Since 2020, the SSW pathway has absorbed approximately 40% of all patients requiring ascitic drainage. The SSW pathway incurred costs per episode ranging from 3-5 times lower than non-ED admissions, and 4-7 times lower than ED pathway patients, largely driven by reduced length of stay (1 day vs. 5 and 9 days, respectively).
Conclusion
The introduction of the SSW pathway for therapeutic abdominal paracentesis has enabled a significant shift toward more efficient and cost-effective care delivery, achieving 3-5 fold cost reductions and shorter hospital stays without compromising clinical appropriateness.
Lessons Learnt
The SSW pathway demonstrates how value-based care principles can be translated into operational change, delivering more appropriate care at lower cost and supporting long-term system sustainability.
Keywords
Ascitic Drainage, Short-Stay Pathway, Oncology, Cost Reduction
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | National University Cancer Institute, Singapore, National University Health System, Yong Loo Lin School of Medicine |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Oncology |
Project Lead(s) | Pradeeba Jega |
Project Member(s) | Carol Li Fen Ho |
Connect with this contributor!
Pradeeba Jega - e1373865@u.nus.edu