[AVBC 2025] Improving Fluid Intake Compliance in Subacute Frailty Patients: A Quality Improvement Initiative
Care Process & Redesign
Appropriate & Value-based Care Conference
National Healthcare Group
10 November 2025
To increase the percentage of daily compliance for fluid intake from 35% to 75% (stretch goal 80%) for subacute patients. Systemic change was achieved with streamlined Doctors order workflow and formalized and standardized fluid intake tally in the EPIC.
Year Submitted: 2025
Published Date: 10 November 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Productivity, Cost Saving, Value Based Care, Adherence Rate, Safe Care
About this Content
Aims
To increase the percentage of daily compliance for fluid intake from 35% to 75% (stretch goal 80%) for subacute patients admitted to ICH Ward 11G in 6 months (from September 2024 - February 2025).
Background
Dehydration in older adults is a significant health concern associated with increased length of hospital stay, higher mortality risks, increased healthcare costs, and many other consequences. Baseline data showed only 35% of subacute patients were meeting at least 3/4 of their target fluid intake.
Methods
Root cause analysis was conducted using CPIP principles, brainstorming, affinity table, and fishbone analysis. A 2-phased intervention was designed and Plan-Do-Study-Act (PDSA) cycles were conducted.
Results
The median daily compliance increased from a pre-intervention baseline of 35% to a post-intervention level of 72%. There was a reduction in total number of IV fluid hydration days ordered from 30 days pre-intervention to 17 days post-intervention.
Conclusion
Systemic change was achieved with streamlined Doctors order workflow and formalized and standardized fluid intake tally in the EPIC system.
Lessons Learnt
Lack of routine fluid check & tally and staff proactivity were identified as the top root causes of non-compliance. Increased awareness and better compliance with documentation were achieved.
Keywords
Fluid Intake, Compliance, Geriatric Medicine, Quality Improvement
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Geriatric Medicine |
Project Lead(s) | Khin Khin Win |
Project Member(s) | Goh Cheng Jee |
Connect with this contributor!
Goh Cheng Jee - cheng_jee_goh@ttsh.com.sg