Authors (including presenting author) :
Chan KI(1), Chan SL(1), CheungKM(1), Ko S(1)(2), Cheng SK(1), Leung PS(1), Wong OF(1)
Affiliation :
(1) Accident and Emergency Department, North Lantau Hospital, (2) Honorary Clinical Assistant Professor, Emergency Medicine Unit, Lee Ka Shing Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
As rapid growing of the elderly population in Hong Kong and it is common for the elderlies at the end-of-life stage to access the Accident & Emergency department (AED), the End-of-life (EOL) care in AED is embraced. The EOL care is aimed to promote comfort and preserve dignity of dying patients by controlling symptoms, minimizing invasive or life-prolonging therapies and providing psychological support. Although the importance of EOL care is well informed, it is challenged to promote services under the fast-paced environment in ED while the dominant focus and resources are always diverted to patients with reversible condition.
Despite beset of barriers, the AED in North Lantau Hospital (NLTH) acted as the pioneer to initiate the provision of EOL care services since 2017.
Objectives :
(1) To identify patients being futility in life-sustaining treatment and achieve the “goal of care” with patients
and patient’s families
(2) To prevent unnecessary transportation
(3) To help patients and families to transcend suffering by symptomatic control, spiritual support and social support
(4) To optimize comfort care by introducing multidisciplinary care
Methodology :
The Donabedian’s Model was adopted to evaluate the quality of the EOL care program in AED in NLTH.
Three domains were examined:
(i) “structure”, e.g. facility, equipment, service model;
(ii) “process”, e.g. way to deliver service;
(iii) “outcomes”, e.g. families’ satisfaction
Result & Outcome :
There were 101 patients recruited into the program in 4 years. Service was limited due to the restriction of compassionated visiting during Covid-19 pandemic.
All of the patients were admitted to EMW after “goal of care” was achieved with patients and/or families. Multidisciplinary and individualized are was provided to achieve the patient-centered care. Physiotherapists and Occupational therapists were engaged in all cases to provide the limbs mobilization or splintage application etc. Patient’s families were generally satisfied with the EOL care service provided in view of symptomatic control, facility and spiritual support.
Several improvement areas were identified. Firstly, there were insufficient facilities inside the “Golden Room” and the electronic system for virtual interview was sought after Covid-19 breakout. Besides, variation and insufficient morphine prescription were identified that protocolized of morphine administration may be considered. Structural symptomatic assessment for patients should also be strengthened to ensure the continued of care. Lastly, continuing training was suggested for medical, nursing and allied health workers.
