[AVBC 2025] Reducing Average Length of Stay for Elective Total Hip Replacement Patients
Care Process & Redesign
Appropriate & Value-based Care Conference
National Healthcare Group
5 December 2025
To reduce the average length of stay (ALOS) for elective total hip replacement (eTHR) patients at Tan Tock Seng Hospital. The enhanced eTHR care model achieved its target ALOS of 2.9 days whilst maintaining patient safety and satisfaction.
Year Submitted: 2025
Published Date: 05 December 2025
Tags: Care Process ＆ Redesign, Workflow Redesign, Quality Improvement, Clinical Practice Improvement, Productivity, Cost Saving, Time Saving, Value Based Care, Length Of Stay
About this Content
Aims
To reduce the average length of stay (ALOS) for elective total hip replacement (eTHR) patients at Tan Tock Seng Hospital from 4.8 days to 2.9 days by quarter (Q) 4 2025.
Background
International benchmarking demonstrated that shorter hospital stays for eTHR patients were achievable, with the Netherlands reporting an ALOS of 2.9 days. Local data analysis from July 2019 to October 2022 revealed an ALOS of 4.8 days, highlighting a significant opportunity for improvement.
Methods
Using Clinical Practice Improvement Programme (CPIP) methodology, a multidisciplinary team conducted root cause analysis of delayed discharges. The team implemented a standardised eTHR care model hospital-wide in phases to address the root causes identified. Initial interventions included pre-operative counselling, early mobilisation on post-operative day 0, and early oral intake in the post-anaesthesia care unit (PACU). Subsequent enhancements comprised strengthened pre-operative education with personalised counselling and educational materials (April 2024), establishment of community rehabilitation partnerships (October 2024), and implementation of pre-booking system for community hospital beds (December 2024).
Results
The ALOS from April 2024 to April 2025 was 3.2 days. Further analysis showed the ALOS was 2.9 days from January 2025 to April 2025. Among 82 patients, 60% were discharged home (ALOS 2.8 days) and 40% to community hospitals (ALOS 3.9 days). Process measures demonstrated 100% compliance with early mobilisation and had oral intake at PACU. The improved ALOS yielded 122 bed-days saved annually, generating financial savings of $52,094. Importantly, no 30-day readmissions occurred.
Conclusion
The enhanced eTHR care model achieved its target ALOS of 2.9 days whilst maintaining patient safety and satisfaction. This sustainable model effectively optimised bed utilisation for acute care needs whilst delivering cost savings.
Lessons Learnt
The implementation of a standardised care model and early interventions can significantly reduce the length of stay and improve hospital efficiency.
Keywords
Length of Stay, Elective Surgery, Hip Replacement, Cost Savings
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) | Healthcare Administration |
Applicable Specialty or Discipline | Orthopaedics, Surgery |
Project Lead(s) | Remesh S/O Kunnasegaran |
Project Member(s) | Remesh S/O Kunnasegaran |
Connect with this contributor!
Remesh S/O Kunnasegaran - remesh.kunnasegaran@nhghealth.com.sg
Project Attachment
925_TTSH_AVBC_2025_Reducing_Average_Length_of_Stay_for_Elective_Total_Hip_Replacement_Patients.pdf