Authors (including presenting author) :
Cheng PL(3), Kan KC(1), Lam KL(1), Wong HL(3), Ho SKS(1), Po MY(3), Siu TS(3), Chin MT(2), Chau YM(2), Wan MC(1), Kong HL(1), Leung CP(2), Kan PG(2), Kng PLC(1)
Affiliation :
(1) Division of Geriatrics, Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospital (2) Accident and Emergency Department (AED), Ruttonjee and Tang Shiu Kin Hospital. (3) Community Healthcare Service, HKEC
Introduction :
The corporate steering program – Enhancing Geriatric Support to Elderly Patient Attending AED was commenced in October 2020 at Ruttonjee and Tang Shiu Kin Hospitals, together with 4 other HA hospitals. This collaborative program between AED and M&G Department provides early detection of geriatric syndromes and support of clients with multi-dimensional discharge care planning. A 3-year pilot was implemented in RTSKH during previous Winter Surge Period. This paper is to share outcomes of the Program.
Objectives :
1. To minimize unnecessary hospitalization through better mobilizing non-inpatient resources of hospital and community social support service. 2. To meet the health and social needs of elderly patient for wellness in places. 3. To evaluate the outcome and forecast future development.
Methodology :
Methods: Patients aged >= 65 years attending AED with category 3 or 4, or belonged to specific programs for high risk patients would be screened by Link Nurse in AED using structured screening form with validated Clinical Frailty Scale (CFS). Designated geriatric nurse would conduct further workup with the tailor-made tool “Focused Geriatric Assessment” (FGA) for patients. A conjoint discharge plan was suggested for mobilizing all available access of non-inpatient services (e.g. fast track, GDH) and community resources (e.g. CNS, CGAT, ICDS, HST, GOPC etc.) to targeted elderly. Proactive phone follow-up and tracing of AED attendances / admission within 28 days after index discharge would be performed to follow-up patient’s needs and outcomes. The group of fall cases was analyzed in more details as it was the largest group.
Result & Outcome :
Result and Outcome: Among 1568 patients being recruited from Oct 2020 to Sept 2021, 2 cases refused service. 645(41.1%) were male, mean age 79 (range 60-104), 360(23%) were living alone or daytime alone. The CFS revealed 76.7% (1203) patients being vulnerable to moderately frail within which 710 being vulnerable, 322 mildly frail and 171 moderately frail. The commonest 3 reasons of attending AED were Fall (348, 22.2%), Musculoskeletal pain (316, 20.2%) and Dizziness/Syncope (129, 8.2%). 73.6% (256) fall patients were discharged by AED doctors and a wide range of proactive discharge plan were arranged, including GDH and fall prevention clinic (50, 14.4%), ICDS (43, 12.4%) and CNS (18, 5.2%). Phone follow-up has been provided to over 71.6% (249) of fall patients. On completion of 28-day discharge support services, 89.9% (313) fall patients had no AED re-attendance nor hospital readmission. Only 2.8% (10) patients attended AED due to repeated fall within 28 days. While comparing outcomes of previous pilot during Winter Surge period 2017 - 2021, the AED 28day re-attendance rate improved from a mean of 19% per year from 2018 - 2020 to 13.6% in 2021, while the re-admission rate in 28day reduced from 11.5% (mean of 018- 2020) to 9.9% in 2021. Conclusions: Proactive discharge planning for mild to moderate elderly patients on their first steps in AED or hospital could help in early discharge via quick, precise screening and assessment of both AED and Geriatric Nurse, optimal discharge support with seamless communication between AED, Geriatric Team and community partners. After the 3-year pilot for reforming and 1-year roll-out, skill set were established as showed improving trend of hospitalization. Further development in enhancing e-documentation of FGS for efficiency in assessment planning and collection of patient experience survey for service evaluation are highly suggested.
