Authors (including presenting author) :
Yau KY(1), Tse HY (1), Cheng CK(1), Leung WY(1), Wu A(1)
Affiliation :
(1) Department of Occupational Therapy, Caritas Medical Centre
Introduction :
Insufficient environmental or care support could be one of the main non-medical reasons of delayed discharge (Giraldo et al., 2012). As patients undergoing major operations are expected to have critical functional decline, discharge planning should be implemented in advance for timely transfer of patients back to community. Under Enhanced Recovery After Surgery Program (ERAS), augmented support from Community Occupational Therapy (COT) was provided to patients before and after surgery so as to promote smooth transition to home.
Objectives :
To evaluate the outcomes of COT service under ERAS program.
Methodology :
Patients recruited into ERAS program who received Occupational Therapy in CMC during October 2021 to September 2022 were reviewed retrospectively. Demographic and statistical data was evaluated between patients with and without COT service.
Result & Outcome :
A total of 141 patients underwent operations during the captioned period. The types of operations included: Total Knee Replacement (55.9%), colorectal resection (26.5%), Total Hip Replacement (6.6%) and hepatic resection (5.9%). COT service coverage was 51.6% that half of the clientele had received home modification or home-based ADL training especially on toileting, dressing and bathing.
Significant reduction in waiting time (63.9%) for home assessment was recorded. Early home modification prior to operation aims to eliminate any potential environmental hurdles for discharge. Initial home assessment was done in average of 2.89 weeks after receiving referral, in contrast to >8 weeks for normal routine. Home assessment was completed 11.3 weeks in advance of the planned operation so as to establish a safer living environment for discharge. The modifications included: handrails installation (63.4%), prescription of aids such as shower chair (48.8%) and bathing area reconstruction (4.9%), etc.
Post-operation home-based ADL training was offered in average of 6.61 days after discharge; particularly to those who are incapable of travelling to hospital at early stage. Timely intervention such as educating ADL precautions helped to prevent complications due to poor handling.
91.8% of the patients underwent major operation could return home. The LOS of COT group was 2.57 days shorter than non-COT group. By Independent-t test, the improvement in Modified Barthel Index was significantly greater in COT group, indicating that patients receiving COT service restored their ADL function more quickly than those did not (p = 0.012).
Conclusion:
Comprehensive community support including early home modification and home-based training were provided under ERAS program. This probably boosted patients and caregivers’ confidence in early discharge after surgery and helped fast restoration of ADL performance at the same time.
