Authors (including presenting author) :
Yuen MSY (1), Choi YF (1), Wan S (2), Tong E (2), Lo N (2), Liu S (3), Ng R (3), Chan LW (1), Lau PF (1)
Affiliation :
(1) Department of Accident and Emergency, (2) Department of Physiotherapy, (3) Department of Occupational Therapy, Pamela Youde Nethersole Eastern Hospital
Introduction :
Introduction
Patients with fall, vertigo, cognitive impairment and musculoskeletal problems constitute 12% of Emergency Department (ED) attendances and 12% of Emergency Medicine Ward (EMW) admission of PYNEH in 2018. One-stop collaborated service to patients with screening, early intervention and post-discharge follow-up management could reduce hospitalization in ED, shorten the length of stay in ward and streamline the patient flow. There was no on-site support of Physiotherapy Services (PT) in ED and Occupational Therapy Services (OT) in EMW in 2018.
Objectives :
Objective
To report on the implementation of improvement measures in ED and EMW
Methodology :
Method
Patients attend ED with fall, vertigo and musculoskeletal problems (pain, walking exercise and aids) are screened for PT services before discharge in ED and EMW, the criteria are fulfilled if patient presents with the above problems, have stable vital signs and willing to accept the services. Patient would be screened by Emergency Physician or Nurse and referred to therapist for on-site services.
Likewise, patient with cognitive impairment of dementia or delirium, fall, frailty, Chronic Obstructive Pulmonary Disease (COPD) and pain would be screened and referred to OT services in EMW. Recruitment to PT and OT Services are monitored.
To prepare for the above implementation, Department of Physiotherapy and Occupational Therapy were invited, meetings were held to explore working opportunity and review the services in ED and EMW in 2019. The inclusion criteria, PT and OT screening (particularly on overlapping services), workflow and discharge care plan, quotas and location of the services were revised. Staff education on PT and OT screening, workflow and services was duly carried out. Barriers to implementation were overcome in the trial-run period and prospective evaluation were carried out in the implementation period.
Result & Outcome :
Results
3 and 187 patients were recruited to the PT services from October 8th to December 31st 2019 in ED and EMW respectively. In ED, two-third of them were for walking exercise and aids and one-third were for limb physiotherapy, they were discharged home right after the services. Whereas in EMW, one-fifth were for fall prevention, one-fifth for vertigo (vestibular rehabilitation), one-fifth for pain management, one-fifth for walking exercises and aids, and the rest of them were for chest physiotherapy. The mean and median length of stay in ward were 1 day, majority of them (90%) were discharge home with follow-up.
Similar results were noted in the OT services in EMW, 77 patients were recruited from September 2nd to December 31st 2019. Almost half of them were for fall assessment and intervention, one-fourth for cognitive assessment and another one-fourth for functional reconditioning training. The mean and median length of stay in ward were 1 day, majority (90%) were discharged with follow-up.
Promulgation of the services were done month before implementation of PT and OT services. Implementation was smooth. Workload was regards as acceptable from staff survey. The service locations were accepted by patients and staffs, who found the time, place and progress of patients appropriate for on-site services.
Conclusion
Through collaboration with Department of PT and OT, the improvement measures were feasible and resulted in significant improvement in recruitment of eligible patients for on-site PT and OT services in ED and EMW.
