Offering Transcranial Magnetic Stimulation for Treatment-Resistant Depression
Care Process & Redesign
National Healthcare Group Quality Improvement
National Healthcare Group
24 December 2025
To increase the rate at which transcranial magnetic stimulation (TMS) is offered to eligible patients at KTPH Psychological. While TMS is 3 times more likely to be effective than the next antidepressant trial in TRD, not all eligible patients are being.
Year Submitted: 2025
Published Date: 24 December 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Cost Saving, Productivity, Clinical Practice Improvement
About this Content
Aims
To increase the rate at which transcranial magnetic stimulation (TMS) is offered to eligible patients at KTPH Psychological Medicine from 15% to 60% over 6 months.
Background
More than 35% of patients do not respond to 2 trials of antidepressants, defined as treatment-resistant depression (TRD). TMS is a brain stimulation that is evidence-based for TRD.
Methods
The project involved 6 PDSA cycles to increase the offering of TMS to eligible patients.
Results
TMS is being offered to about 86% of eligible patients, a significant increase from 15%. There was a 69% reduction in depression rating scores for patients who complete the TMS course.
Conclusion
While TMS is 3 times more likely to be effective than the next antidepressant trial in TRD, not all eligible patients are being offered TMS.
Lessons Learnt
Inform new psychiatrists and residents on TMS counselling and referral process, conduct twice-yearly reviews and journal clubs on TMS cases at department meetings and CMEs, and obtain feedback to ensure sustainability of TMS counselling service.
Keywords
TMS, depression, treatment-resistant, brain stimulation, quality improvement
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Khoo Teck Puat Hospital, Ministry of Health Holdings |
Platform(s) | National Healthcare Group Quality Improvement |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Psychiatry |
Project Lead(s) | Tay Yi Hang |
Project Member(s) | Ng Kwee Hiang Carol |
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Group Quality - nhggroup.QRM@nhghealth.com.sg