Authors (including presenting author) :
Hui TM(1), Liu OYA(2), Lau MT(1), Wong OF(1), Shih YN(1)(2)
Affiliation :
(1)Accident and Emergency Department, North Lantau Hospital
(2)Accident and Emergency Department, Princess Margaret Hospital
Introduction :
Emergency Medicine Ward (EMW) of North Lantau Hospital is currently the only local acute ward providing inpatient service. The population of Tung Chung is growing and aging. It is anticipated that an increasing number of geriatric patients will be admitted to the EMW. The management of geriatric patients presents the healthcare team with multiple challenges including multiple comorbidities, polypharmacy, and subtle and atypical presentations of illnesses. Geriatric patients management is further complicated with the problem of frailty. Frailty is prevalent among geriatric patients and it contributes to morbidity and mortality. However it is potential preventable and reversible at an early stage with the appropriate interventions. A geriatric patient can be identified as frail by using a frailty index, e.g. Clinical Frailty Scale. The frail geriatric patient should be managed by a multi-disciplinary team to address the complexities of geriatric illnesses, and to come up with a care plan that addresses the individual's needs.
Objectives :
The aim of Geriatric Emergency Medicine (GEM) Program is to enhance the geriatric care in EMW by implementing a multi-disciplinary care plan to target group of patients and to facilitate an early discharge or disposal plan.
Methodology :
All patients who are aged 65 years or above with any one of the following principal diagnoses (1) Fall (2) Musculoskeletal pain (3) Decreased general condition/deconditioning/ weakness (4) Inpatient optimization of pre-existing medical conditions (e.g., Hypertension, Diabetes Mellitus and electrolytes disturbance) (5) Dizziness (6) Caring problem/carer stress and without any exclusion criteria, will be rated on Clinical Frailty Scale (CFS) score by Registered Nurse on admission. Exclusion criteria are patients who are critically ill, managed under end-of-life care, Old Age Home (OAH) or Institution residents and those admitted for post-operative care after elective surgery. Selected patients with CFS scored 4-7 will be recruited into the program. The Geriatric Emergency Medicine (GEM) team consists of EM ward Nurse-In-Charge, Physiotherapist, Occupational Therapist, and Dietitian. Nurse-in-charge will perform comprehensive frailty assessment of recruited patients using the Edmonton Frail Scale. Further assessment will be done by Physiotherapist, Occupational Therapist and Dietitian on the same day or next working day. Patient with additional needs will be referred to psychiatric team, speech therapist, or medical social worker. Daily case conference will be conducted by Nurse-In- Charge, Physiotherapist and Occupational Therapist. Disposal plan is expected to be formulated within 3-5 days.
Result & Outcome :
From September to November 2021, 23 patients were served and the mean age was 82 years (ranged from age 64-92 years). All of them had disposal plan decided within 4 days of recruitment. Average length of stay in EMW was 6.4 days. The majority (43%) of them were discharged home home with community physiotherapy or occupational therapy service. 17% of patients stayed in EMW for short course of rehabilitation (within one week). 13% of patients were referred to Day Rehabilitation Center after consultation with medical team. 4.3% of patients were taken over medical team to Extended Care beds in NLTH for anticipated prolonged hospitalization. 13% of patients were discharged to OAH. There were only 2 patients with re-admission within one month for other diagnoses and 2 patients were excluded from the program due to clinical reason.
In conclusion, The GEM Program is structured with a well-defined protocol to guide care for geriatric patients in EMW. The multi-disciplinary team in GEM program helps to identify frail elderlies and provides the appropriate interventions to address their special needs.
