[AVBC 2025] Optimising Stroke Care Pathway: Implementation of Nurse-Led Holter Monitoring Using Novel Tech
Care Process & Redesign
Technology
Appropriate & Value-based Care Conference
National University Health System
21 November 2025
To reduce the waiting time from test order to test initiation of holter monitoring in the Acute Stroke Unit by 50% within 6. Integration of user-friendly cardiac monitoring technology with nurse-led initiation demonstrated significant enhancement in care.
Year Submitted: 2025
Published Date: 21 November 2025
Tags: Care Process ＆ Redesign, Technology, Quality Improvement, Workflow Redesign, Productivity, Cost Saving, Time Saving, Access To Care, Waiting Time, Assistive Technology, Digitalisation, Digital Platforms
About this Content
Aims
To reduce the waiting time from test order to test initiation of holter monitoring in the Acute Stroke Unit by 50% within 6 months.
Background
Long term ECG (holter) monitoring is used to detect paroxysmal atrial fibrillation as a potential cardioembolic source in patients with ischaemic stroke. Traditionally, this procedure requires setup and management by cardiac technologists from the cardiology department, leading to delays due to scheduling conflicts, limited availability of technologists, and restricted access to devices.
Methods
The team collaborated with the National Heart Centre Cardiac Laboratory to explore the use of an alternative holter monitoring device, MyPatch , which can be managed by trained Ward 74 nurses, reducing dependency on cardiac technologists.
Results
Mean waiting time decreased from 2.9 (SD=3.0) days for the pre-intervention cohort (N=438) to 2.5 (SD=3.0) days (p=0.105) in the post-intervention cohort (N=349). Within the post-intervention cohort, mean waiting time for conventional holter (N=158) was 3.0 (SD=3.4) days while MyPatch (N=191) was 2.2 (SD=2.7) days (p=0.008). Estimated cost avoidance was S$1000 per MyPatch holter done, based on length of stay saved.
Conclusion
Integration of user-friendly cardiac monitoring technology with nurse-led initiation demonstrated significant enhancement in care delivery efficiency and clinical responsiveness, optimizing healthcare resource utilization and associated expenditures while enhancing patient and staff experience.
Lessons Learnt
The implementation of MyPatch holter monitoring effectively reduces the time between test ordering and initiation, offering enhanced flexibility for nurses and allowing device attachment at convenient times, including during night shifts.
Keywords
Holter Monitoring, Stroke, Neurology, Cardiac Monitoring, MyPatch
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | Singapore General Hospital, National Heart Centre, National Neuroscience Institute |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Nursing |
Applicable Specialty or Discipline | Neurology, Cardiology |
Project Lead(s) | Chew Jing Si |
Project Member(s) | Shahidah Bte Roslan |
Connect with this contributor!
Chew Jing Si - chew.jing.si@sgh.com.sg