Authors (including presenting author) :
Tang WK(1), Cheng SY(1), Luk YC(1), Ng YB(1), Sha KY(1), Tsang WY(1), Wong CL(1)
Affiliation :
(1) Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
Every month in United Christian Hospital, more than 700 in-patients (Medical ward) need to book Haven of Hope Hospital (HHH) convalescent bed (via KEC bed booking system) for extended care. Actually, some patients do not need to transfer to convalescent and some patients are not suitable for transfer. This situation will increase the length-of-stay (LOS) (after booking convalescent) in acute bed unit, increase the backflow rate (from convalescent unit) and increase the unplanned readmission rate (if patient is direct discharge to community). A comprehensive discharge planning process and Discharge Coordination is the key areas known to reduce the above problems. In collaboration with multidisciplinary of the health care team, the Discharge Coordinator will use expert knowledge of internal and external resources to lead the coordination of a comprehensive, patient-centered, plan of community care facilitating the flow of medically complex across the continuum from booking convalescent bed to transfer to extended unit / direct discharge to community. In August-September 2019, the Safety Approach For Early Discharge by Discharge Coordinator (SAFED-DC) Pilot Program was launched and Discharge Coordinator started to screen all patients, who are in the waiting list of KEC bed booking system.
Objectives :
SAFED-DC Pilot Program is effective at reducing the acute bed LOS, backflow rate and unplanned readmission rate.
Methodology :
The pilot program took place from August-September 2019. Target patient with poor disease control (such as Heart Failure, COPD etc.), in-patient rehabilitation need (such as fall, deconditioning) and caring issue. Discharge Coordinator will consider all of patient’s needs and make a comprehensive discharge planning with input from the patient and multidisciplinary healthcare team. The interventions included: 1. Preliminary assess each patient, who are in the waiting list of KEC bed booking system, through Clinical Management System to select the potential patient and preset a discharge offer, such as priority bed for early transfer to HHH for in-patent extended care; Case Management for disease monitoring in community by ICDS; early GDH appointment for out-patient rehabilitation and CNS. 2. Conduct comprehensive pre-discharge assessment of patient, discuss the discharge plan with Healthcare professional (Team Doctor and Nurse), also explore patient’s preferences on his/her discharge planning, then finalize the discharge offer to each selected patient.
Result & Outcome :
From August-September 2019, Discharge Coordinator screened 1491 patients and selected 171 patients into SAFED-DC Pilot Program. The accuracy rate of pre-onsite assessment discharge offer was 57.3%. The reduction of LOS was 14% (from average 5.61 days to 4.82 days); the reduction of backflow rate was 46%; the reduction of unplanned readmission rate was 5.2%. The result has shown that SAFED-DC Pilot Program can lowered the acute bed LOS, backflow rate and unplanned readmission rate. Both Health care professionals and patients have also expressed their appreciation for the SAFED-DC pilot program and believe that this program will facilitate patients discharge to extended care unit / back to community.
