Authors (including presenting author) :
Lit MPK, Lam CHK, Chow PS, Lee KH, Mak FT & Chan WMJ
Affiliation :
Respiratory Division, Department of Medicine, Queen Elizabeth Hospital
Introduction :
Non-invasive (NIV) and invasive mechanical ventilation (IMV) in medical wards were increasing with average annual caseload of 396 and 406 in year of 2016/17 and 2017/18 respectively. The numbers of 90 percentiles of IMV and NIV bed day activities in AGMW were 50 in March 2019 that was the highest amongst the 7 cluster hospitals. MOVES program is a mobile outreach team comprising respiratory doctor and nurse to manage the patients who were on NIV and IMV support in AGMW during winter surge to relieve the burden and improve the quality of care.
Objectives :
To evaluate the outcome and effectiveness of MOVES program
Methodology :
It was a prospective study conducted in 15 AGMW of Queen Elizabeth Hospital in January to March 2019 to provide pilot MOVES by respiratory nurse and doctor. The mobile team visit was carried out on daily basis after respiratory nurse prepared the patient list. Subsequent regular reviews were provided on a need basis. Hand- over and skill transfer to parent team of medical doctors, nurses and allied health professionals with proper documentation were necessary for care continuity. Appropriate patients would also be triaged to enhanced AV bed areas and vice versa to ensure appropriate care and turn over. Advance Care Plan (ACP) would be initiated, and assisted ventilation might be withheld after final decision was reached between care team, parent team and patient’s family according to the best interest of the patient. The expertise care of MOVES included i) optimization of medical and respiratory condition e.g. inhaler use, chest drain care, and bedside bronchoscopy ii) alignment of treatment goal such as ACP iii) IMV & NIV parameter setting adjustment, troubleshooting, monitoring and weaning, iv) selection and arrangement of home equipment for long-term home AV v) Skill transfer to parent team and nursing staffs
Result & Outcome :
There was 47 patients on AV whereas 6 on NIV and 41 on IMV. 32 (68%) were critically ill with poor premorbid condition and low potential for respond to AV treatment. Only 2 (0.04%) requiring continuous IMV for 60 days or more with at least 6 hours of ventilation daily. The overall days on AV, inpatient bed occupied (IPBO), IPBO of dead cases were reduced to 0.6 (6%), 4.7 (19%) and 7.5 (30%) respectively. The overall average length of stay (LOS) and average LOS of dead cases were significantly reduced to 4(16%) and 7.3 (29%) Conclusion: MOVEs program can streamline resources and facilitate expertise qualitative care to reduce average LOS, inpatient bed day occupancy, AV period and unnecessary AV use.
