‘21st Century Nurse’, the theme for SingHealth’s Nurses’ Day this year, may sound contemporary, but it truly aptly highlights the significant roles that our nurses have been playing – constantly seeking innovations and improvements to bring about benefits to both patients and staff.

NHCS is proud to have Advanced Practice Nurse (APN) Teo Lee Wah representing the nursing profession in this year’s campus visuals. A veteran nurse of 36 years, APN Teo has been involved in many improvement initiatives, including the successful APN-led Transition Clinic which sees Heart Failure patients within 10 days’ post-discharge.

Our 21st century nurse shares more with us.

Why do you think innovation is important?

Given the limited resources and workforce, adopting innovation helps increase our productivity and improve the quality of care to meet the ever-changing needs and the expectations of our population.

What is your role as an APN?

An APN is a nurse trained in in-depth assessment and understanding of HF, and is an integral member of the HF team in the management of inpatients hospitalised for acute decompensated HF. APN’s primary role is to assess and counsel patients on the condition.

Please tell us more about the APN-led Transition Clinic for heart failure patients post-discharge.

Heart failure is one of the leading causes of hospitalisation. Despite the improvement in medical therapy, the re-admission rate among patients with heart failure remains high. Studies have also shown that early post-discharge review within seven to 10 days by a physician, specialist or advanced practice nurse (APN) reduces the readmission rates for heart failure and mortality.

However, due to the high number of patients seen at physician-led clinics, patients are usually reviewed at the outpatient clinic about 30 to 60 days post-hospitalisation. Hence a quality improvement project was initiated in 2017 to provide early follow-up at the APN-led Transition Clinic to strive to positively impact outcomes of HF patients within 10 days of their discharge. The service is led by an APN trained in HF and assisted by a pharmacist. The goal was to reduce the 30-days readmission rate for heart failure and visits to the emergency department.

What were the results like?

The inclusion criteria for this project comprised adult patients aged 21 and above who were admitted with a diagnosis of acute decompensated HF, and prior history of HF readmission who were under the care of heart failure cardiologists. We then recruited patients during their hospital admission for decompensated HF.

With the APN-led Transition Clinic, the unplanned readmission and visits to the emergency department for HF patients have reduced significantly by 14% as compared to patients who did not participate in the programme. Patients and caregivers were receptive to the initiative, and satisfied with the overall care and services provided at the APN-led Transition Clinic.

What do these results mean for nurses in their work?

The APN-led Transition Clinic provides early access to care such as assessment and intervention to prevent serious complications or lead to hospitalisation. The results have been positive and has brought about better patient outcomes. We hope to roll out the programme to patients who are cared for by other cardiologists from non-heart failure patient service.

What have been some of the challenges faced while working on this project?

The positive and increased take-up/ referral rate to the clinic has inevitably caused an increase in the waiting time. However, it was a happy problem, and to better meet the demands, we implemented an additional clinic session in March 2018.

What are your hopes for the future of nursing?

I chose nursing as my career because it is a rewarding profession. It is a privilege to be part of the patients’ journey and to be able to make a difference in their lives with my skills and knowledge. This profession spurs us to continuously learn, innovate and create solutions so that we can better equipped ourselves for the future and continue to care for our patients.

APN Teo shared that the Clinic spanned from, and is part of the HF Ancillary Clinic which started way back in 2007 to cope with the increasing demand for outpatient HF clinic service. There are various APN-led clinics setup to support and augment physician-led clinics, and these allow patients to be cared for in a timelier manner. Such forward looking attitude and never-ending quest for the ‘next better’ is exactly what makes patient care improve by leaps and bounds.

Thank you to all our 21st century nurses and healthcare workers!


Read more about our nurses, NC Aidila Bte Ismail, Nursing Specialty Care Unit as well as SSN Natasha Choo, Ward 44 and SN Koh Hwee Teng, Ward 56 in the Singapore Health Special Nursing Issue 2021.