Introduction:
During the COVID-19 pandemic, the social distancing policy and restricted hospital visits have resulted in significant caregiver burden. This is the result of carer's uncertainty of the patients' health status and also lack of awareness of transitional and community care services upon discharge. In view of the unmet care needs and lacking community service provisions amidst the pandemic, we developed the Early Discharge Support Program (EDS) to strengthen the communication with clinical teams and to facilitate the accessibility of social services through community partnership and telecare.
Program Objectives:
It aimed to facilitate the smooth transition of care, reduce caregivers' distress and decrease patients' length of stay in hospital.
Methodology:
Patients who were admitted to the medical stroke or neurosurgical wards of Queen Mary Hospital and their core family members were recruited to join the EDS program from Aug 2021 to Dec 2022. Clinical teams identified specific patients requiring support to join a new online patient orientation program in which caregivers could communicate with clinical staff on disease management and engage with multi-dimensional community support services by online platform. Tele-visit of hospitalized patients and virtual visits of community services were arranged for patients in need and their caregivers. These measures allowed caregivers to gain a better understanding of patients' health conditions and increased awareness of concrete social service provisions in the community. With these supportive measures, the caregivers became more confident in handling discharge arrangements. Quasi-experiment with non-equivalent control group design was adopted. Participants were invited to complete an online questionnaire upon patient admission and one week after patient discharge. Caregiver's distress was measured by the validated Cantonese short version of the Zarit Burden Interview (C-ZBI) and Patient Health Questionnaire - 2 (PHQ-2) respectively. The length of stay of the experimental group and control group was compared.
Results and Outcomes
421 caregivers were recruited during the data collection period. The mean C-ZBI score, reflecting caregiver distress, reduced from 9.37 to 7.44 (p<.0001). The mean PHQ-2 score also dropped from 2.07 to 1.28 (p<0.0001). There were statistically significant reductions in caregiver's distress level. The length of stay of specific patient group was shortened by 13 % and 12.4 % in the medical stroke and neurosurgical wards respectively.
Conclusion:
The program enlightened us on the use of telecare service to support patients and their caregivers on the arrangement of care during transition from hospital to community. By empowering caregivers to be active care masters, they could make good use of online and self-financing community services to facilitate the transition care arrangement efficiently. The discharge planning process could be accelerated through early matching of care needs to appropriate community services. Undoubtedly, the structured telecare workflow, cross-discipline collaboration and shared care with community partners led to the successful implementation of the program.
