Authors (including presenting author) :
Yu Teresa(1), Ting KH(1), Lee Mary(3), Tam MY(2), Chan WT(2), Yeung Eric(1), Chung Kenneth(1), Cheng Michael(1), Cheng Thomas(1), Lau YC(1), Man HS(1), Wong YT(1), Mo MM(1), Cheung KH(1), Chow FK(1), Cheng YS(1), Lee WY(2), Wong PY(2), Chang Jenny(2), Kwok YP(2), Chui KC(2). Leung Cynthia(3), Kwan WM(3), Pang H(2)
Affiliation :
(1)Department of Rehabilitation, Kowloon Hospital, (2)Medical Social Services (Social Welfare Dept.), Kowloon Hospital, (3)Medical Social Service (Hospital Authority), Kowloon Hospital
Introduction :
Population aging creates great hospital services demands. Discharge problems and long stay patients are the most difficult of all cases handled in a Convalescent/Rehabilitation (CR) hospitals and it causes decrease in turnover of the CR beds and decrease the capacity of CR hospitals to receive transfers from acute hospitals. In 2015, a snapshot survey showed there were 7 patients staying more than 1 year at Kowloon Hospital Rehabilitation Department. Also, in year 2015/16, the length of hospital stay (LOS) of the department was longer than the Hospital Authority average (25.1 days vs 17.4 days). Prolong hospital stay not only causes adverse effects to patients (e.g. infection risk, deconditioning…etc.), it might also increase risk of work place violence and decrease staff morale. Most importantly, long stay cases will decrease the turnover of CR hospitals and affect download of patients from acute hospitals.
Objectives :
To alleviate discharge problems and reduce LOS proactively by using a multipronged approach.
Methodology :
Several improvement strategies were implemented. 1. Monthly inter-disciplinary discharge planning meeting with doctors, nurses and medical social workers was started in Jun 2015 to discuss our active in-patient cases with LOS >60 days. The LOS cut-off was further reduced to >30 days since Nov 2018. 2. Quarterly communication with doctors on department performance statistics e.g. admissions and LOS of each ward. Half yearly communication with multidisciplinary colleagues on the department’s statistics. 3. Continuous education to staffs the importance of early identification, early discharge planning, interdisciplinary case conference, family conference …etc. for problem discharge cases.
Result & Outcome :
The number of long-stay cases (>90days) has decreased from average 4.42 cases per month in 2014/15 to 1.67 cases per month in 2018/19. Also, average length of stay for our convalescent and rehabilitation beds was shortened from 25.13 days in 2014/15 to 21.45 days in Dec 2018 to Nov 2019. Moreover, yearly in-patient admissions increased from 4772 in 2015/16 to 5394 in 2018/19 (increased by 13%). Our inpatient admissions were continuously increasing and reached record high recently of 3522 admission in 6 months from Apr to Sep 2019. The multipronged approach to tackle problem discharge cases in a CR unit, by way of interdisciplinary discharge planning meeting, regular department performance statistics communication and continuous education for early identification/ discharge planning of problem discharge cases were effective. There were reduction in long-stay patient number, reduction in LOS and increase in inpatient admission number.
