Authors (including presenting author) :
PO MYY(1), Lee HTJ(1), Tsang KY(1), Mak MY(2), Mak F(1), Kng C(1)
Affiliation :
(1) HKEC CGAT, Ruttonjee & Tang Shiu Kin Hospitals (2) Community Nursing Services, Pamela Youde Nethersole Eastern Hospital
Introduction :
Supporting earlier discharges during surge demand is the role of community teams. Patients with complex infections require prolonged iv antibiotics, occupying up to 6 weeks in hospital beds. Moreover, poor ambulation and transport impedes access to ambulatory ward iv antibiotics.
Objectives :
Since HKEC has integrated CGAT and CNS services in 2015, this winter surge CQI project aims to reduce hospital bed-days occupied (BDO) with community delivery of iv antibiotics for elderly in Residential Care Home for the Elderly (RCHE), by facilitating early discharge and enabling treatment of elderly in their usual ‘home’ environment.
Methodology :
Target patients with inclusion and exclusion criteria were defined. During Dec 2018 to May 2019, patients discharged to RCHEs on once daily iv antibiotic with infusion time less than 30minutes, assessed by doctor to be stable with active infection under control and with patient consent were recruited. Protocol included safeguards such as first 2 days of inpatient antibiotics, with quota limited to 2 cases per day. Workflow on referrals, preparation checklist for discharge and the communication system AEDs were developed. Education have been given to patient and RCHE for managing the iv access site. Contingency support from AEDs of PYNEH and RTSKH for adverse weather or failed intravenous re-cannulate by CGAT nurses.
Result & Outcome :
Of 34 referrals from cluster hospitals of PYNEH, RTSKH & TWEH, high success rate of 88% (n=30) who completed iv antibiotic in RCHEs, leading to 129 days iv drug administration which equate to 129 BDO saved. 50% (n=17) were referred by PYNEH Surgery. 97% (n=33) prescriptions were intravenous Carbapenem antibiotics. The main site of infection is urinary tract (72%) & the top micro-organisms were ESBL (91%). There was 1 episode of AED attendance for failure of resetting intravenous access by CGAT nurse. Patients & RCHE carers were satisfied with the educational leaflet for care of iv access site, hotline & measures for contingency. Community supported discharge is a cornerstone of demand management at winter surge. The high success rate of this CGAT home iv antibiotic program without extra resources demonstrates saved significant hospital bed-days without adverse consequence such hospital readmission or reactivation of infection. The beneficial impact of this program for both hospital and patients can be explored for surge demand in future.
