Authors (including presenting author) :
Chan Y Y (1)(2)(3), Lam T W (1)(2), Hui Y T (1)(2), Wong C T(1)(2), Sze S F(1)(2), Liu HW (1)(2),Lam Y S (1)(2),Lam W H (1)(2), Tso Y K (1) (2), Luk H K (1)(2),Chui T H, Leung F Y (1), Yuen P K (1)(2)(3)
Affiliation :
(1)Department of Medicine,(2)Division of Gastroenterology and Hepatology, Queen Elizabeth Hospital,(3)GI / Hepatology Nurse-led clinic
Introduction :
Many patients with viral hepatitis may develop acute flares and are hospitalized. Hospitalization may be required for monitoring of clinical symptoms and liver function test. This may, however, lead to prolonged hospitalization and wastage of in-patient medical resources. On the other hand, frequent monitoring and follow up (e.g. 2 to 3 time per week) in our overwhelmed specialist outpatient clinic (SOPD) may not be possible.
Objectives :
Hepatitis flare monitoring service can provide a service as an interim follow-up of such patients. This allows early patients discharge from the hospital and avoid overwhelming the busy SOPD. Our Liver team nurse specialist will closely monitor the patients and provide assessment, education, counselling to them. The patients can be followed up by telephone consultation if their condition is stable. It aims to reduce the need for hospitalization, need for early follow up in SOPD, workload of medical specialists and health care expenditure.
Methodology :
The service is delivered according to our pre-defined protocol. The patients are recruited according to the inclusion and exclusion criteria. Viral hepatitis cases will be referred from doctors of the medical gastroenterology team. The monitoring criteria and interval will be made on an individual basis, as decided by the referring doctor. The outcome will be determined by the following factors: Category I : Clinical condition (including, physical condition and biochemical result); Category II : treatment compliance ; Category III health related parameters & psychological concern; Category IV : life style modification and patient satisfactory level.
Result & Outcome :
Over 500 patients were recruited in the viral hepatitis flare monitoring service. The estimated shortening of hospitalization for the 125 cases analyzed included: 42% shortened for 1 weeks, 33% shortened for 2 weeks, 17% shortened for 3 weeks, 8% shortened for 3 days of hospitalization. Besides, the service had reduced unnecessary hospital admissions: decreased unnecessary admission in 11 out of 125 cases. Concerning the clinical progress, around 80% of the cases had improvement in clinical and biochemical parameters. Over 50% of the patients were offered counselling about lifestyle modifications like smoking / alcohol cessation, advice about the use of TCM. Most of patients were satisfied with the nurse clinic service.
