[AVBC 2025] Reducing the Incidence of Inadequate Bone Marrow Trephine Samples
Care Process & Redesign
Appropriate & Value-based Care Conference
National Healthcare Group
5 December 2025
The aim of the project is to increase the mean trephine length done by advanced internal medicine residents and general. The interventions show promise for improving trephine quality and efficiency in procedures, resulting in better patient outcomes and.
Year Submitted: 2025
Published Date: 05 December 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Clinical Practice Improvement, Workflow Redesign, Productivity, Cost Saving
About this Content
Aims
The aim of the project is to increase the mean trephine length done by advanced internal medicine residents and general medicine resident physicians from a baseline of 1.0 cm to 1.5 cm over a sustained period.
Background
Bone marrow aspirate and trephine biopsy (BMAT) is an invasive diagnostic procedure for hematological conditions, with an ideal trephine length of 1.5-2.0 cm. Hematology specialists achieve a median trephine length of 1.5 cm with one attempt, while non-hematology specialists obtain only 1.0 cm with two attempts. Baseline data showed General Medicine Senior Residents and Resident Physicians (GMSRs/RPs) averaged 1.0 cm trephine lengths.
Methods
A multidisciplinary team was formed, and the Clinical Practice Improvement Programme (CPIP) methodology was applied. The two primary issues targeted were lack of procedural training and absence of procedural checklists. Interventions included BMAT simulation training (September 2023), implementation of competency checklists (October 2023), and circulation of pre-BMA procedure refresher video for Procedurist and Supervising Doctor (December 2023).
Results
Results demonstrated significant improvement, with mean trephine length increasing from baseline 1.0 cm (January-May 2023) to 1.45 cm post-intervention (September 2023-February 2024), further improving to 1.53 cm by December 2024. Balance measures showed improvements in efficiency with the average number of procedurists per BMAT decreased from 1.23 to 1.06, while average number of attempts per procedure reduced from 1.798 to 1.255, reaching 1.56 by December 2024. Cost analysis revealed potential savings of approximately $10,000 annually by preventing 12 suboptimal trephines, each costing minimum $828, excluding specialized testing costs.
Conclusion
The interventions show promise for improving trephine quality and efficiency in procedures, resulting in better patient outcomes and cost savings.
Lessons Learnt
The systematic approach to improving trephine quality has demonstrated sustainable results, leading to enhanced diagnostic accuracy, improved patient experience, and more efficient resource utilization across the department.
Keywords
Bone Marrow, Trephine, Quality Improvement, Internal Medicine
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) | Medical |
Applicable Specialty or Discipline | Internal Medicine, Haematology |
Project Lead(s) | Fan Bingwen Eugene |
Project Member(s) | Fan Bingwen Eugene |
Connect with this contributor!
Fan Bingwen Eugene - bingwen.eugene.fan@nhghealth.com.sg
Project Attachment
924_TTSH_AVBC_2025_Reducing_the_Incidence_of_Inadequate_Bone_Marrow_Trephine_Samples.pdf