Authors (including presenting author) :
Chan YYF (1), Chan CC (1) Lui CT (1), Fung HT (1), Lau CL (1,2,3)
Affiliation :
(1) Department of Accident and Emergency, Tuen Mun Hospital
(2) Department of Accident and Emergency, Pok Oi Hospital
(3) Department of Accident and Emergency, Tin Shui Wai Hospital
Introduction :
With a growing healthcare service need, there is an increase in demand of specialty outpatient clinic (SOPC) service and lengthening of appointment waiting time. From a previous review, more than 10% of SOPC referrals were from Accident and Emergency Department (A&E) within Hospital Authority.
Public-Private-Interface (PPI) is one of the corporate key strategies and service direction. Investigations through PPI had been piloted for years but lacked an integrated A&E protocol for streamlined referral. A program to enhance doctors’ and patients’ awareness and usage of private sector services, together with a standardized A&E pathway and follow-up plan targeting to reduce SOPC referral has been piloted in 2019.
Objectives :
To conduct a service improvement program to revise standardized management protocol and logistic workflow for patients suitable and eligible for private investigation referral.
Methodology :
The proposed service model identifies suitable, eligible patients for investigations in private sector, with an A&E follow-up to further triage and assess the need for SOPC referral. Indicated patients were referred SOPC, with fast-track priority referral for patients with identified pathology according to SOPC triage system.
A&E patients requiring special imaging, investigations like echocardiogram, Holter, and treadmill, are recruited with standard PPI referral templates and logistics to the PPI office. Internal promulgations within medical and nursing teams in A&E were conducted followed with an audit.
Result & Outcome :
From January to October 2020, 179 cases were referred to PPI office, of which 147 were booked investigations and 135 cases attended A&E follow up.
The mean waiting time for private investigations was 10 days and the median was 7. Upon follow up when investigation results were available, 57 were referred, 4 admitted and 42 closed case and saved from referral.
Conclusion: Public-Private-Interface expedites diagnoses, including life-threatening diagnoses. The newly introduced PPI workflow enables better risk stratification with patients being directed to appropriate setting according to clinical needs for timely care. There is reduction of SOPC referrals leading to better utilization of the service. Expansion of case-mix can further extend the impact of the service model.
