Authors (including presenting author) :
Leung Wai Ming(1), LEE KY (1), Karn KY (2)
Affiliation :
(1) Community Nursing Service, United Christian Hospital (2) Nursing Services Division, United Christian Hospital
Introduction :
During the winter surge, the Accident & Emergency Department (AED) attendance rate & the hospital bed occupancy rate are higher. According to the Hospital Authority statistic showed that the medical inpatient bed occupancy rate in United Christian Hospital (UCH) was 120%. In Kwun Tong area, there have 36 Residential Care Homes for the Elderly (RCHEs) covered by UCH Community Geriatric Assessment Team (CGAT). Based on the community trust with RCHE, the UCH CGAT provides support on symptoms and disease management for the RCHEs residents. Thus, a CGAT and AED collaboration program was initiated in Dec 2018 with the aim to coordinate an early post discharge support by CGAT as an alternative management options to RCHE residents in AED to reduce avoidable admission.
Objectives :
1. To reduce the unnecessary admission 2. To liaise a collaborative network with the UCH AED and the Community Geriatric Assessment Team (CGAT) to facilitate a supportive discharge plan for the RCHE residents.
Methodology :
The pilot project was commenced from 16 Dec 2018 to 31 May 2019. The RCHE residents under CGAT service attended to AED with one of the following admission diagnosis of 1) breakthrough seizure, 2) coffee ground aspiration from feeding tube, 3) fever and 4) other medical problems( e.g. chest infection and fall incident ) were recruited. Since CGAT electronic documentation program was implemented at 2012, AED physician will retrieve the patient’s updated medical information via CMS to make a wide range of decision. Furthermore, 3 clinical pathways have been established regarding the selection criteria by CGAT and AED physicians. According the clinical pathways and patients updated medical information, the AED physician can make the tough decision faster. Indeed, the rapid response of the CGAT to assess the resident‘s condition and provided intensive medical and nursing intervention to the discharged RCHE residents as an alternative management options for the patient instead of hospital admission. In this connection. the RCHE residents would be discharged early and referred to the CGAT for the post discharge support.
Result & Outcome :
Total 90 discharged RCHE residents were referred by AED physician to CGAT team under collaboration program. The average response day of CGAT was 1.63 days. Moreover, total 67 out of 90 (74%) OAH residents were sustained in community without readmission within 28 days discharged from AED. CGAT Rapid Response team provided the intensive and quick actions are proved as a recognized service model to facilitate the early and supportive discharge plan for the RCHE residents.
