Authors (including presenting author) :
Chiu SH(1), Tong FH(1), Mak CO(1), Tang WH(1), Yik WM Jessica(1)
Affiliation :
(1)Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
Introduction :
n the past 3 decades, Coronary Care Unit (CCU) in Princess Margaret Hospital (PMH) has been playing a pivotal role in providing care to patients suffering from acute coronary and cardiac diseases. Although the number of CCU beds has increased to 10, only 40% of ST-elevation myocardial infarction (STEMI) patients could be directly admitted to CCU. There was no space for expansion in existing CCU location. Moreover, CCU / Cardiac Ward & Cardiac Catheterization Laboratory (CCL) in PMH were located in different blocks causing ineffective patient flow and inefficient workflow
In response to the Kowloon West Cluster (KWC) clinical service plan (CSP) in 2019, PMH will serve as a referral center to provide primary PCI on a 24-hour basis to all eligible STEMI patients in the cluster. PMH CCU will be the command center and plays a vital role in the management for post-primary PCI patients.
For the full benefit of STEMI patients requiring emergency PCI service, improved systems are urgently needed.
Objectives :
1)To enhance CCU beds to provide high dependent unit (HDU) care to the increasing cases and complexity of cardiac patients
2)To enhance safe & efficient patient flow, to optimize prognosis of STEMI patients receiving primary PCI
Methodology :
In 2019, Dental Unit (under Department of Health) was suggested and supported by high management to vacate space for CCU and Cardiac Ward relocation and expansion. After that CCU, Cardiac Ward and CCL are located on the same floor with 4 additional CCU beds added by phases
To maximize patient safety, workflow efficiency, reduce staff workload and keep abreast with the advances in medical technology, our new CCU contains multiple new innovative smart features and highlighted as below:
-Replacement the patient monitoring and clinical information system (CIS) with the integration related features to Hospital Authority Clinical Management System (CMS).
-Interface Inpatient Medication Entry (IPMOE) and medical devices, such as ventilator and bipap machine, intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO) machine to the CIS
-Creation of the smart booking and scheduling system of cardiac procedures to the Cardiovascular Information System (CVIS), so that the real time patient tracing could be displayed in the dashboard. Patient identification in “Time out” and “Sign in” were performed by use of barcode scanning
-Installation of E-whiteboard to facilitate the real time display of CCU bed situation. E.g. patient status, length of stay, coming up investigation and safety precaution, duty assignment for doctors and nurses, etc.
-Installation of smart bed panel which has been interfaced with CMS for Corp. alert, electronic patient assessment form (ePAF) and self-defined important information
-Installation of self-help smart patient locker for temporary patients’ property storage who underwent cardiac procedure. it’s safe and easy operated by use of patient’s wrist band barcode scanning. CCU staff no more need to counter check patients’ property before storage.
-Installation of electrocardiogram (ECG) telemetry monitoring to cover both CCU and cardiac ward provides continuous monitoring of patients’ rhythm and ST level. Effective treatment can be timely delivered.
Result & Outcome :
Relocation of CCU and cardiac ward to close proximity to CCL greatly speeds up the transport of STEMI patients for primary PCI from 10 minutes to less than 1 minute. The added CCU beds coupled with installation of a series of smart features in CCU will certainly enhance the workflow and optimize the delivery of care to our cardiac patients.
