Authors (including presenting author) :
Lai KPL(1), Wong SN(1), Chan PF(1), Yim CW(2), Tsang WC(2)
Affiliation :
(1) Department of Family Medicine and Primary Health Care, Kowloon East Cluster, (2) Department of Medicine, Tseung Kwan O Hospital
Introduction :
With an aim to alleviate the long waiting time of Specialist Out-patient Clinic (SOPC), a pilot Family Medicine Triage Clinic - Medicine was established in a General Out-patient Clinic (GOPC) of Tseung Kwan O Hospital (TKOH) from January to March 2022 to manage patients with predefined medical conditions which would otherwise require referrals to Medical SOPC. Collaboration between the Department of Family Medicine and Primary Health Care and Department of Medicine of TKOH included setting up mutually agreed medical conditions and their triage criteria, knowledge transfer by sharing on updated clinical approach to different medical conditions and criteria for referring to secondary care, facilitation on arrangement of special investigations including echocardiography, holter study, treadmill exercise test, oesophago-gastro-duodenoscopy and liver elastography (fibroscan) in the triage clinic and establishment of fast tract refer back mechanism
Objectives :
To evaluate the outcomes of patients managed in the medical triage clinic with focus on effectiveness of patient discharge
Methodology :
Relevant clinical information of all patients referred to the medical triage clinic from 1 January 2022 to 1 March 2022 in Clinical Management System was reviewed.
Result & Outcome :
61 patients were triaged from 2 GOPCs to the triage clinic within the study period. Mean age of patients was 63.8 years old (range 38-86). 67.2% were female. Mean waiting time was 17.2 days (range: 1-39 days). The commonest reasons for referral included deranged liver function (37.7%), chest pain (21.3%), palpitation (9.8%), deranged renal function (8.2%) and epigastric pain (6.6%). 45 special investigations were ordered in which 55.5% (including ultrasound abdomen, echocardiography and CT coronary angiography) were performed in private. The mean no. of consultations for each patient was 2.4 (range 1-6). 16.4% of patients attended the triage clinic once only. More than half of the patients (52.5%) were discharged in which 31.2% was discharged without the need of follow up and 21.3% was discharged to GOPC. Only 26.2% of cases required referral to Medical SOPC. The default rate was 11.5% and 9.8% of patients were still being followed up in the clinic. Among the patients referred to Medical SOPC, 2 patients were found to have severe coronary artery disease with percutaneous coronary intervention subsequently performed. 2 patients with hepatitis B (one was found to have liver cirrhosis) were started with anti-viral treatment. Conclusion: In collaboration with the Department of Medicine, family physicians led medical triage clinic could provide appropriate and timely management to patients requiring referral to Medical SOPC. The triage clinic also shared some burden of Medical SOPC routine new cases.
