Special Session 6 - Striving for Clinical Excellence in HKUMed

3D printed patient specific metal implants are becoming increasingly accepted for reconstruction of complex and rare bone and joint pathologies. The aim is to improve patient outcomes. In this talk we discuss the indications, design and manufacturing principles, pitfalls, and safety regulations regarding their use. To illustrate the above we present a few highlight cases performed in Hong Kong along with a literature review.

Rare bone diseases, including many skeletal dysplasia and metabolic bone diseases, can cause significant disabilities to the patients due to abnormal bone development.  Unfortunately, many of the rare bone diseases are poorly understood and definitive cure is lacking.  Even if treatments are available, the cost is usually very high and most patients cannot afford it.  Rare diseases are poorly understood by the patients and the public.  As a result, patients do not seek medical attention and the diagnosis may be delayed.  Patients may sometimes need to consult different hospitals before their diagnosis are made and proper treatments are given.   Apart from the skeletal abnormalities, these rare diseases may affect multiple organs.  Many of the rare bone disease patients usually require multidisciplinary teams and multiple hospital visits in treating their medical problems.
The University of Hong Kong - Shenzhen Hospital has established a multidisciplinary platform for patients with rare bone diseases since 2015. Through the one-stop service, their multidisciplinary team can provide a comprehensive care including diagnostics, medical treatments, surgical interventions, rehabilitations, genetic counselling and other various supports by different disciplines for the patients with rare bone diseases.  The hospital is an important referral center for patients with osteogenesis imperfecta (OI).  OI is one of the 400 types of skeletal dysplasia that lacks curative treatment.  OI is a rare genetic disease at which the mutation causes abnormal collagen formation leading bone fragility, long bone deformities and scoliosis.  Individuals with OI also have dental, hearing, vision and various medical problems requiring comprehensive holistic care.
Through online public education and patient forums, the hospital plays a very active role in educating the public and patients about rare bone diseases.  We also establish hospital referral network for rare bone diseases in the southern part of China so that the patients can be treated promptly.

The development of telemedicine has accelerated during the COVID-19 pandemic. Applications in the emergency department (ED) include pre-ED evaluation and screening, minimising staff exposure to infected patients, post-ED discharge monitoring and treatment, staff education, and coordinating resources and transfer.1 Telemedicine has the potential to revolutionise healthcare by shifting care from hospitals to homes and mobile devices.2 From systematic reviews on different modes of delivery, real-time videoconferencing tends to be the best mode of care in the ED setting.3
The 24-hour Outpatient and Emergency Department of Gleneagles Hospital Hong Kong (GHK) under the Hong Kong University Health System is one of the first EDs in Hong Kong that provides telemedicine service to patients. The telemedicine programme is a joint venture between GHK and a leading telecommunication company in Hong Kong. The programme enables real-time videoconferencing, and direct delivery of medication and medical documents to the clients’ home. After pilot testing in May 2020, the programme has been commercialised since November 2020. In parallel, GHK has set up an in-house telemedicine platform for patients who are not subscribing to the telecommunication company platform. During the COVID-19 pandemic, the telemedicine service was extended to COVID-19 patients to improve access to timely medical assessment and antiviral therapy. 
In this talk, we will discuss our experience in pioneering telemedicine service in a private ED, based on the Cochrane Effective Practice and Organisation of Care (EPOC) framework, and the challenges in integrating telemedicine with regular clinical services in the private healthcare sector. A roadmap for possible future development is also presented. Our experience shows that telemedicine is feasible in local private ED settings for low-acuity conditions, highlighting the importance of case selection. It has the potential for improving access to health care at times when public and private EDs are overwhelmed in future pandemics.

Drug allergy is a common problem in Hong Kong, with up to 7% of the entire population’s medical records documented with a suspected drug allergy label. The most common labels are to penicillin or beta-lactam antibiotics, with 1 in every 50 people in Hong Kong are labelled with suspected “allergies” to these drugs. Unfortunately, the majority of these “allergy” labels are incorrect and more than 85% of patients found to be tolerant and able to take penicillins again after allergy workup. 
The consequences of incorrect drug allergy labels are an overwhelming and a serious threat to patient safety. For example, incorrect penicillin labels are known to be associated with higher healthcare costs, as well as a myriad of negative clinical consequences – such as development of multi-drug resistant organisms and even increased patient mortality! More recently, there has also been massive public attention and fear to the potential of COVID19 vaccine associated allergies. Suspected cases of vaccine allergy have been detrimental to the vaccination campaign. The safe delabelling of such incorrect drug allergy labels are therefore of enormous public interest.
Drug allergy evaluation and delabelling of incorrect allergies are therefore crucial to patient safety. Despite this, expertise and specialist care for Immunology & Allergy remains extremely limited with only one Specialist in Immunology & Allergy working in the Hospital Authority. Given the lack of expertise but constantly-growing Immunology Clinic queues, strategic utilization of such precious resources are needed. Novel strategies have been designed and led by HKUMed to tackle this urgent health issue.
In this session, the feasibility, effectiveness and safety of a novel nurse-led, protocol-driven drug allergy delabelling strategy will be shared. The strategy has now been implemented as the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI) across various Hospital Authority clusters as a “Hub and Spoke” model to more effectively tackle low-risk drug allergy delabelling. This “Hub and Spoke” model has been internationally recognized and now being implemented both across Hong Kong and other countries in the Asia Pacific region. The long term benefits of delabelling and effectiveness in other countries of HK-DADI await further prospective studies.