Developing a Nurse-led Paediatric Subacute Inpatient Care Program in Singapore

Year Submitted: 2025
Published Date: 30 January 2026

Tags: Care Continuum, Inpatient Care, Intermediate and Long Term Care ＆ Community Care, Workforce Transformation, Job Redesign, Upskilling

About this Content

Aims

The aims of this programme are to demonstrate that nurse-led care for eligible conditions are: 1) Safe and feasible 2) Able to reduce unnecessary tertiary hospital stay and associated costs 3) Able to improve patient/parental satisfaction.

Background

The current landscape of paediatric inpatient tertiary care necessitates full specialists' involvement regardless of acuity of condition throughout the patients admission process with resources and emphasis on the management of acute conditions. There is also scarcity of paediatric subacute and intermediate long term care facilities. This may result in increased challenges to deliver family-centred care, increased medical cost, prolonged stay in tertiary hospital and overly reliance on specialist resources. The nurse-led paediatric subacute inpatient care program was developed in line with key strategies by Singapore's Ministry of Health (MOH) to meet growing healthcare needs in a cost-effective and sustainable manner.

Methods

Design: Prospective cohort study. Validated questionnaires on patient/parents perceptions of satisfaction with care were used. Ethics approval was obtained from National Healthcare Group (NHG) DSRB.

Results

One hundred and forty patients received the nurse-led paediatric inpatient care over 36 months from January 2021 to December 2023. There was a 13% improvement in parental satisfaction level for those who completed both sets of questionnaires. There was also a 13% improvement in parental perception of the knowledge of the program nurse and 26% improvement in parental perception of the competency of the program nurse. Throughout the duration of this program, there was no mortality. All patients recruited were discharged and there were no unexpected deaths after 3 months post discharge.
The projected cost savings from right-siting 2097 bed days to subacute hospital is $1,342,080. Estimated cost per acute bed day in tertiary hospital is $1,164. Cost of subacute bed day is based on theoretical assumption that it is 45% of the cost of an acute bed day.

Conclusion

The nurse-led paediatric subacute inpatient care program is safe and feasible. It effectively reduces reliance on tertiary and specialist resources, thus reducing unnecessary tertiary hospital stay and associated costs. With the completion of HSDP, there is hope to mainstream this model of care in the tertiary hospital in the interim until the operationalization of the paediatric subacute ILTC ward in Alexandra campus in 2028.

Lessons Learnt

The program is an effective model of care to help reduce reliance on tertiary and specialist resources, thus reducing unnecessary tertiary hospital stay and associated costs. It also shows that nurse-led care is safe and feasible, with reported improvement in parental satisfaction.

Keywords

nurse-led, paediatric, inpatient care, subacute, rehabilitation, cost saving

Innovators' Details

Connect with this contributor!

LIN BINGYUAN JEREMY - jeremy_lin@nuhs.edu.sg

Jeannie Chiam - Jeannie_chiam@nuhs.edu.sg

Project Attachment

436_NUH_NHIP_2024_Developing_a_Nurse_led_Paediatric_Subacute_Inpatient_Care_Program_in_Singapore.pdf