Appropriate Care: An Unexpected Strategy for Greener Healthcare

Singapore, 9 March 2026 – As patients or caregivers ourselves, how many of us have requested for additional medical tests “just in case”? It’s not an uncommon request, and it’s equally common to hear physicians offer us these options for our peace of mind. But are these tests really necessary?

Between 2023 and 2024, approximately 1,600 unnecessary chest X-rays (CXRs) were avoided following the launch of the Choosing Wisely movement led by Associate Professor Hairil Rizal Abdullah, Clinical Director at the Office of Value Based Healthcare, Singapore General Hospital.

Choosing Wisely, first implemented in 2012 by the American Board of Internal Medicine, was developed to champion a culture of appropriate care. It refers to intentional care that is evidence-based, aligned with patient needs and values, and delivered at the right time. It is not simply about cutting tests or treatments simply to save costs or resources.

“When healthcare is delivered appropriately, low-value interventions are naturally reduced. Beyond the resulting economic and social gains, this also generates a positive environmental impact. Together, these outcomes represent the three pillars of sustainability. Most importantly, these outcomes arise not because sustainability was the primary goal, but as a natural consequence of doing what is right for the patient,” shared Associate Professor Hairil.

By avoiding approximately 1,600 unnecessary CXRs, the initiative achieved significant cost savings of approximately $154,000 across patients and hospital operations, including 330 man-hours for Radiology. The initiative also avoided approximately 1,280kg of CO2 equivalent emissions.

Beyond eliminating nonessential CXRs, the appropriateness of repeated urine cultures was also examined. Guided by a de-implementation framework that promotes value-based care, the team found that more than half of repeated urine cultures were performed within seven days of the previous test. In a single month, this accounted for nearly 60% of urine microscopy and urine culture requests. This translates to an estimated resource impact totalling approximately $18,500, including 1,000 man-hours, and greenhouse gas emissions equivalent to driving a petrol-powered car for about 130 km.

Moving forward, SGH plans to scale up initiatives that have demonstrated significant results and will be launching new projects across different departments to further embed this culture of appropriate care hospital-wide.