Authors (including presenting author) :
Kwong PY(1),Fan AKH(2),Chan WY(1),Yiu WY(2),Chun HL(2),Tsang CK(2),Cheung KY(1), Kong CY(2), Li P(1),Chan YC(1),Wong NMR(2)
Affiliation :
(1)Accident and Emergency Department, United Christian Hospital (2)Orthopaedic & Traumatology Department, United Christian Hospital
Introduction :
Emergency department (ED) crowding and access block impose an inevitable threat to the core emergency care around the world. With the aging population in our community, escalating service demand and long waiting hours for admission (access block) to various departments, ED crowding has been an issue to our ED. Active interdepartmental collaboration has been made to seek temporary and long term measures to solve this challenging problem. We have identified several categories of patient whose need urgent orthopaedic consultation and treatment that can be discharge within 24 hours after admission. This pilot scheme aims to establish an ambulatory, one-stop care service model for these acute orthopaedic problems. Suitable orthopaedic patients are selected, referred directly from the ED and managed in the Acute Ambulatory Orthopaedic Centre (AAOC). They will be discharged on the same day after appropriate treatment and/or management plan was made by the orthopaedic surgeons. By redesigning the patient flow, we could minimize the unnecessary in-patient stay, and improve the efficiency, clinical outcome and utilization of in-patient care.
Objectives :
(1) To avoid unnecessary in-patient stay in orthopaedic ward and provide safe and effective orthopaedic care; (2) To identify suitable service model and protocol for acute ambulatory orthopaedic care.
Methodology :
Patients who need orthopaedic admission for treatment under current practice in the following diagnostic categories: finger lacerations, fracture of distal radius, fracture of appendix, fracture of lower limbs, simple soft tissue infections, foreign bodies, four limbs laceration, injury of tendon Achilles. The exclusion criteria include unstable vitals, multiple system injury, head injury, confusion, admission of the same complaint within 30 days, non-ambulatory, or age less than 18 years old Patients with suitable criteria were selected and admitted to AAOC from Mondays to Fridays with two morning quotas and two afternoon quotas.
Result & Outcome :
Total 115 cases were referred to AAOC from 13th September, 2021 to 31st December, 2021, 1 case was defaulted and 4 cases were excluded according to exclusion criteria on arrival to AAOC. There were 54 males and 59 females admitted to AAOC. Mean age was: 55.5 (range 2093) years old. Upon the included cases, 32.7% (36) cases are fracture distal radius, 15.5% (17) Finger lacerations, 14.5% (16) appendix fracture, 10.9% (12) foreign body, 10% (11) simple soft tissue infection. Most of these cases (103/110) were discharged within the same AOCC session. There were 103 acute orthopaedic admissions reduced during the period. This pilot scheme received positive feedback by both ED and Orthopaedic Department, and it effectively fasten the orthopedics patients’ journey and minimize the complications arising from orthopedics problems. The interdepartmental collaboration is crucial for easing the tension for admission access block without compromising patient safety and care.
