Authors (including presenting author) :
SY Man(1)(2), KH Lee(1), WK Lo(1), LK Chuk(1), PC Hon(1), YH Fan(1), WF Chan(1), SS Hau(1), NH Chu(1)(2), KB Wong(1)(2), CY Lai(1)(2), YS Ong(1)(2), KR Rotheray(1)(2), HY Cheung(1)(2), CL Tsui(1)(2), YK Wong(1)(2), NS Yeung(1)(2), KH Cheung(1)(2), NK Cheung(1)(2), C Graham(1)(2), CH Cheng(1)(2)
Affiliation :
(1)Trauma and Emergency Centre, Prince of Wales Hospital,(2)Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong
Introduction :
An Emergency ambulatory care (EAC) unit was set up in July 2021 in the A&E department of Prince of Wales Hospital and has been providing service since 1 August 2021. The EAC unit provides emergency care without traditional hospital bed-based management through streaming to the EAC unit and supporting early discharge. Several studies from 2012 to 2020 concluded that a structured clinical pathway could safely identify low-risk ambulatory care-sensitive conditions for outpatient care.
Objectives :
To evaluate the effect of EAC service in an A&E department on reducing medical admission in a tertiary hospital.
Methodology :
According to clinical protocols, an emergency medicine specialist recruited appropriate patients pending hospital admissions at the A&E department into the EAC unit for outpatient care.
Result & Outcome :
The EAC unit has provided 170 eight-hour EAC sessions from 1 August 2021 to 31 December 2021. 408 patients initially planned for hospital admission in the A&E department were recruited into the EAC unit for care with ages ranging from 18 to 102, mean 64.2; 196 (48%) were male; 365 (89.5%) patients were successfully discharged via EAC, 43 (10.5%) patients required hospital admission. Of those discharged patients, 144 (39.5%) were referred to fast-track clinics or specialist outpatient departments, 50 (13.7%) with EAC follow-up arranged, and 14 (3.8%) required community nursing support. 307 (75.2%) were medical cases, and 101 (24.8%) were surgical and orthopaedic cases. The five most common clinical diagnoses recruited were chest pain (13.7%), congestive heart failure (10.0%), abdominal pain (10.0%), hypertensive urgency (8.6%) and syncope (8.3%). The mean length of stay in the EAC unit was 1.33 days. The 30-day all-cause mortality was 4 (0.98%), and the unscheduled A&E re-attendance within seven days after discharge was 18 (4.93%). For each EAC session, an average of 1.83 patients were recruited from 24.64 patients pending medical admission, reducing the medical admission by 7.4%.
Conclusion: EAC service can safely reduce medical admission
