Authors (including presenting author) :
Wong KC(1), Ng YM(1), Yeung SM(1), Pong KC(1), Wong WL(1)
Affiliation :
(1)Department of Surgery, Princess Margaret Hospital
Introduction :
Delays in discharging patients, defined as inability to discharge medically fit patients due to non-medical reasons, is one of the causes of overcrowding (occupancy>110%) and long length of stay (LOS) in surgical units of PMH since 2017, leading to extra healthcare costs, reduced patient care quality and increased complications, as well as further prolonged LOS. Adequate discharge planning (DP) with the aid of screening tools indicating specific actions to be undertaken in timely manner becomes essential.
Objectives :
(1) To understand the situation of delayed discharge in surgical unit.
(2) To investigate frontline staff perspective on the influence of overcrowding situation and the barriers to DP.
(3) To explore a validated and practical DP screening tool to be adopted in surgical unit.
Methodology :
This study was conducted in the Department of Surgery, Princess Margaret Hospital, with 3 phases: (1) a retrospective convenience-sampling case review on the common characteristic and reasons of 86 long stay patients discharged during Jan 2017 – May 2019; (2) a self-administered survey using open-ended questionnaire conducted by 24 frontline staff with different ranks and experience in June – July 2019; (3) literature comparison, test of applicability in current surgical patients and focus group discussions with a total of 35 staff conducted in Oct – Nov 2019 for identifying a suitable DP screening tool.
Result & Outcome :
Reviewed 86 long stay patients were delayed discharge and no specific disease group had longer LOS. Staff survey revealed that “preoccupied with delayed discharge patient” and “failure to practice timely DP resulting in unnecessary hospital costs” ranked top 4 and 7 among the concerned issues, respectively; and all respondents supported the use of DP screening tool. Among the 4 commonly used screening tools, early screening for discharge planning (ESDP) was found to be more reliable (sensitivity:82%, specificity: 78%, reliability: 0.91) and applicable (accuracy: 82%) in terms of LOS and post-discharge needs. From the focus group discussion,100% staff opted that ESDP was simple and quick to be applied and 86% of them chose ESDP as the first step of DP service. In conclude, Utilization of an evidence-based decision support tool to identify patients for early DP intervention in surgical unit can minimizes biases inherent in decision making and facilitate patient discharge.
