BLAST and CLEAR Catheter in the Community

Year Submitted: 2025
Published Date: 26 December 2025

Tags: Access To Care, Referral Rate, Productivity, Cost Saving, Quality Improvement, Workflow Redesign, Risk Management, Adverse Outcome Reduction, Value Based Care, Safe Care, Care Process ＆ Redesign, Workforce Transformation, Job Redesign, Upskilling

About this Content

Aims

Our project aims to reduce the number of referrals from the National Kidney Foundation (NKF) dialysis centres (DCs) to hospitals due to THC dysfunction by 30%, from a baseline mean of 48 referrals per month.

Background

The majority of patients with End-Stage Kidney Disease (ESKD) in Singapore chose haemodialysis (HD) as their maintenance renal replacement therapy. A significant number of them require tunnelled haemodialysis catheter (THC) to receive life-sustaining HD therapy. However, the use of THC is associated with a relatively high incidence of complications, with catheter occlusion due to thrombosis being one of the most frequent complications.

Methods

The CLEAR and BLAST initiatives were implemented, involving training community dialysis nurses to perform lytic dwells for catheter flow restoration and adopting protocols for preventing THC occlusion. A decision tree model was constructed using TreeAge Pro 2024 to estimate the incremental costs associated with the intervention.

Results

As of 31 December 2024, 117 community dialysis nurses from NKF had been trained. 339 lytic dwell procedures were performed with an 86.4% success rate, averting 292 hospital admissions and saving 584 hospital days. Referrals to public health care institutions were reduced by 77.1% from a median of 48 cases per month to 11 cases per month. The treatments received an average patient feedback score of 4.95/5 per month. Cost analysis showed a cost saving of $258,038 for every 100 patients treated in the community.

Conclusion

The intervention shows promise for improving patient care by reducing hospital referrals and costs while maintaining high patient satisfaction. Collaboration and shared vision among stakeholders were crucial for success.

The project expanded and scaled to cover at least 80% of the HD population in Singapore by December 2024, with a total of 181 community dialysis nurses trained. Acknowledgements were given to Dr. Senanayake Sameera Jayan and Prof Nicholas Graves for their contribution to the cost analysis.

Lessons Learnt

The project illustrated the importance of reviewing existing processes for continuous improvement and empowering nurses in the community to practice at the top of their licenses. Transitioning away from predominantly inpatient care is essential to improve patient outcomes and reduce the burden on the healthcare system.

Additional Information

This project has won National Healthcare Innovation and Productivity Awards 2025 under Excellence Champion category.

Keywords

Catheter, Dialysis, Community Care, Thrombolytics, Nephrology

Innovators' Details

Connect with this contributor!

Ru Yu TAN - tan.ru.yu@singhealth.com.sg

Project Attachment

1061_SGH_NHIP_2025_BLAST_and_CLEAR_Catheter_in_the_Community.pdf