[AVBC 2025] Optimising Colorectal Cancer Screening Pathway in TTSH: A Nurse Clinician-led First Visit Clinic
Care Process & Redesign
Workforce Transformation
Appropriate & Value-based Care Conference
National Healthcare Group
3 December 2025
We aimed to upskill our NCs to see FIT+ FV under supervision and meet the referral-to-scope wait time target (90% within 12. A NC-led service can enhance care efficiency by addressing system bottlenecks in CRC screening and is a scalable approach to manage.
Year Submitted: 2025
Published Date: 03 December 2025
Tags: Care Process ＆ Redesign, Workforce Transformation, Quality Improvement, Workflow Redesign, Productivity, Cost Saving, Access To Care, Job Redesign, Upskilling
About this Content
Aims
We aimed to upskill our NCs to see FIT+ FV under supervision and meet the referral-to-scope wait time target (90% within 12 weeks). With the implementation of the NC-led FV clinic, we hoped to improve care access by reducing wait time while maintaining similar standards and patient outcomes from a doctor consultation.
Background
Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality globally. In collaboration with Health Promotion Board (HPB) and Singapore Cancer Society (SCS), the National Colorectal Cancer Screening Programme was launched in 2017 to refer patients testing positive for Faecal Immunochemical Test (FIT+) to PHIs for further assessment. A timely First Visit (FV) leading to early colonoscopy is important as 3-5% of these patients will have CRC. In 2023, the average wait time from referral-to-scope was 17 weeks with only 37% of patients seen within 12 weeks. In view of the increasing referrals, the Department of Gastroenterology & Hepatology (GE) collaborated with Nursing to explore upskilling Nurse Clinicians (NCs) to see FIT+ FVs under supervision of a roving Consultant.
Methods
1. Training: NCs were taught history taking and physical examination, assessment by GE Consultants. 2. Tools: A standardised clerking template was created with guidance for the NCs on which patients to flag up. 3. Authorisation: NCs were granted user access rights to prescribe bowel preparations and list patients for colonoscopy.
Results
Reduction in waiting time with dedicated resource allocation. Referral-to-scope wait time improved from 37% to 73% within 12 weeks.
Conclusion
A NC-led service can enhance care efficiency by addressing system bottlenecks in CRC screening and is a scalable approach to manage increasing demand.
Lessons Learnt
The NC-led service demonstrates the value of workforce transformation by empowering nurses to take on advanced practice roles. Provider's feedback indicates that nurses are well supported by GE doctors and empowered to make clinical judgement. Patients find it easier to ask questions and understand their condition.
Keywords
Colorectal Cancer, Screening, Nurse Clinician, Workflow, Efficiency
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital, Health Promotion Board, Singapore Cancer Society |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Gastroenterology |
Project Lead(s) | Yang Wei Lyn |
Project Member(s) | Lim Wee Chian |
Connect with this contributor!
Yang Wei Lyn - wei.lyn.yang@nhghealth.com.sg