Authors (including presenting author) :
Fung YF(1), Chan YSA(1), Kwong WF(1), Leung KW(1)
Affiliation :
(1)Nursing division, Department of Orthopaedics and Traumatology, Queen Mary Hospital
Introduction :
Musculoskeletal infection (MSKI) is commonly encountered in orthopaedic setting. The first multidisciplinary team providing collaborative and holistic care among all hospitals under Hospital Authority to focus on MSKI patients has been established in Queen Mary Hospital (QMH) to improve clinical outcomes and out-patient service. From November 2017 to October 2018, 235 operated MSKI cases consumed 22.8 in-patient bed-days averagely. There were 12 (5.1%) unplanned 28-day readmission via Accident and Emergency Department (AED). The surging trend and dreadful complications of MSKI have been costing a lot in terms of patients’ suffering and resource allocation. Long-term complications cause permanent damage to patients. Multiple operations and long course of antibiotics prolong length of stay (LOS) in hospital which bring further sufferings to patients and burden to healthcare system. Meanwhile, repeated radiological examinations and laboratory tests additionally consume the limited clinical resources. Therefore, it is necessary to formulate a standardized management plan to combat MSKI. Hence, nurse plays a significant role throughout the patient journey.
Objectives :
To focuses on MSKI patients in (1) promoting continuity of care throughout whole patient journey; (2) providing better wound management with advanced nursing competence; (3) enhancing service of orthopaedic nurse-led clinic in delivering complex and holistic care; and (4) sharing heavy burden interdependently with orthopaedician in out-patient service.
Methodology :
A prospective study of a multidisciplinary team approach to a single-centre cohort of patients who were enrolled in our MSKI service from November 2018 to December 2020 was conducted. All operated cases hospitalized in Orthopaedics and Traumatology (O&T) unit of QMH were screened and recruited by nurse and then reviewed by the team in subsequent ward round weekly. Baseline characteristics and demographic data were collected. Progress of patient condition was updated by each discipline in a share folder set up in the intranet. Only team members were granted access to it to ensure confidentiality. Eligible cases were followed up in nurse-led clinic run by O&T nurse consultant with the assistance of nurse in monitoring progress and handling complex wound. O&T nurse consultant is authorized to cancel patients’ follow-up in orthopaedician clinic according to guidelines endorsed by O&T consultant. Also, O&T nurse consultant can make clinical referral for admission, with an approval from the in-charge orthopaedician, from nurse-led clinic or after liaison with community nurse, for deconditioning in discharged cases.
Result & Outcome :
A total of 428 cases fulfilled the inclusion criteria (n=428). Two hundred and eighty-seven cases (67.1%) were male. The mean age ± SD was 63.7 ± 17.9 years (median 63, range 13 – 98). The mean LOS ± SD was 21.8 ± 20.9 in-patient bed-days (median 15, range 1 – 174). Three hundred and eighteen cases (74.3%) were discharged to community. Ten admissions (2.3%) were day-case follow-up to avoid unnecessary hospitalization. Twenty-seven cases (6.3%) were noted for unplanned 28-day readmission via AED. One hundred and seventy-eight cases (41.6%) were followed up in nurse-led clinic. The attendance of nurse-led clinic was 430 times. Thirty-nine cases (9.1%) had their follow-up in orthopaedician clinic cancelled by O&T nurse consultant. Five cases (1.2%) were referred back for clinical admission by O&T nurse consultant. Fifty-six cases (13.1%) were referred to community nursing service (CNS) for wound management. Eleven cases (2.6%) were referred for out-patient intravenous antibiotics injection.
