Authors (including presenting author) :
CHAN SK(1), KO WC(1), WONG KL(1), WONG YN(1) , LAU LW(1), CHENG PPP(2), MO KK(2,)YAU TL(3), YUEN YY(3)
Affiliation :
(1)Community Nursing Service, (2)Department of Medicine, (3)Accident & Emergency Department
Introduction :
High occupancy rate in acute hospital is commonly seen during winter. There were total 7720 Cat 3 & Cat 4 elderly patients attended at YCH A&E (10/2020- 8/2021). The discharge is hindered by limitation of expertise for managing frail elders with complex needs, inadequate support and coordination to utilize post-discharge resources. Therefore, the funded enhancement program can strengthen the collaboration between A&E and Geriatric teams to demonstrate safe discharge and minimize hospital admission.
Objectives :
Provides better liaison support between A&E, Emergency Medical ward(EMW)and general medical service in hospital Minimizes hospitalization by early targeted assessment of patient needs accompany with co-joint care plan Provides better utilization of hospital resources and coordinate community social support services.
Methodology :
A workgroup on Collaboration between A&E and Geriatrics formed and regular meeting for communication enhancement & outcome evaluation. Geriatric team provided Geriatric assessment training to A&E team and newly developed 4 care protocols (DM, Heart failure, Fall & dizziness and HT) for Geriatric care enhancement. A&E team performed Frailty screening & Geriatric syndromes assessment to refer selected patients aged ≥65 of Category 3 and 4 with low medical acuity. Geriatric team performed Focused Comprehensive Assessment to identify their Geriatric problems and developed co-jointed care plan, facilitated a range of community and ambulatory resources. For individual special needs, Geriatric team would coordinate with community stakeholder & referred existing community outreach services and phone consultations for extra support. Besides, empowerment on using HA Go app for Government Outpatient Clinic appointment booking.
Result & Outcome :
From 6/10/2020 to 30/11/2022, 3,150 Focused Geriatric Assessments performed. 1414 (44.9%) discharged from A&E, 828 (26.3%) discharged from EMW and 908 (28.8%) admitted to hospital. Enhancement services for discharge support included Integrated Care & Discharge Support 523 (35%), Community Nursing Service 223 (15%), Community Geriatric Assessment Service 237 (16%), other Non-Governmental Organization services 148 (10%) and 292 Tel-consultations. 2,242 category 3 & 4 cases with safe discharge from A&E/EMW. 1670 (74.5%) minimize utilization of A&E service and 1891 (84.3%) readmission within 28 days. Strengthen the collaboration between A&E and Geriatric teams facilitated safe discharge with enhancement services support and enhanced necessary medical follow up to minimize A&E attendance and hospitalization.
