Authors (including presenting author) :
Ng PYT (1), Lui CT (1), Fung HT (1), Lau CL (1)
Affiliation :
(1) Accident and Emergency Department, Tuen Mun Hospital
Introduction :
Referrals from AED are a major source of SOPC referrals. It is difficult for emergency physicians to accurately triage patients to appropriate care facilities for continuity of care based on a single AED attendance.
Objectives :
To establish a service model to provide one-off follow-up care provided by emergency physicians, integrated with PPP investigations.
Methodology :
The service model had been established stepwise in the AED of TMH, with the scope of PPP expanding to cover various imaging studies, echocardiogram, and Holter studies. PPP investigations were gradually included into various departmental guidelines and protocols such as the chest pain protocol. Eligible patients were invited and referred for private investigations through PPP. Follow up at a clinic led by a Fellow of Emergency Medicine was arranged for participating patients. The key investigation would facilitate accurate triage to SOPC, primary care by GP/GOPC or case-closure after exclusion of sinister pathologies. High acuity patients could be identified for priority specialist care while low acuity patients could be handled in primary care setting or case-closed.
We included patients who were handled in the service model from 7-9/2021. Waiting times, clinical problems, PPP investigations, findings, and outcomes were traced.
Result & Outcome :
We identified 78 patients with a total of 83 PPP investigations initiated by an emergency physician. The most common presenting problem is suspected cardiac pathology (39, 50%) and abnormal investigation results (17, 21.8%) CT coronary angiogram was the most commonly ordered investigation (37, 44.6%).
The median waiting time from AED attendance to follow-up was 28 days. 15 (18.1%) were found to have significant investigation findings (e.g. significant stenosis >50% of the coronary arteries, findings suspicious of malignancy, or cord compression).
38 (48.7%) patients were referred to SOPC. Interestingly, a significant proportion of patients were found to have incidental findings that required specialist referral (9, 11.5%), though most were non-major findings. 3 (3.8%) patients required direct admission. Nearly one-third (25, 32.1%) were case-closed and 9 (11.5%) were instructed to FU with their own SOPCs as scheduled.
It is expected that the reduction in SOPC referral would be further enhanced with future strengthening of primary care services and better coordination and collaboration. However, the handling of incidental imaging findings contributed to a significant proportion of SOPC referrals. This service model could be referable for handling of internal referrals by primary care physicians.
