Authors (including presenting author) :
Yau KP (1), Li YW (1), Kung SW (1), Tong M (1), Chan SM (1), Amelia Chang, Yim CW (2), Lau CK (2), Yeung CK (2), Cheng HY (2), Cheng MK (2), Lai TL (2)
Affiliation :
(1) Accident and Emergency Department, Tseung Kwan O Hospital (2) Department of Medicine, Tseung Kwan O Hospital
Introduction :
With the increasing population in the district, there is increasing attendant and admission. Medical wards face lots of pressure for the surging service-demands especially during the COVID19 outbreak period. Thus, the pilot program “Medical Support in Emergency Ward during emergency response level” was introduced in TKOH in September, 2020.
Objectives :
Medical consultation services during weekdays at Emergency Ward to provide early medical input, facilitate care process, timely formulate subsequent care plan and hence facilitate direct discharge from A&E to lower acute medical wards burden. The service model acts as a pathway for future development of conjoint services especially during surging service demand.
Methodology :
Medical and Geriatric provide consultation & assessment daily (quota 5-7) on weekdays at Emergency Ward from 1st Sep 2020 to 30th September, 2020. Appropriate adult patients of Cat 3, 4, 5 were selected by selection criteria. Multi-disciplinary care, including physiotherapy, occupational therapy, psychiatric assessment, social worker is provided. Medical and Geriatric assessment e.g. MFAC, Clinical Frailty Scale; Suggestions on drugs treatment, Diagnostic and therapeutic interventions; Booking of appropriate investigations e.g. OGD, Echo, holter, EEG etc.; Arrangement of subsequent follow-up e.g. Medical Early Referral Clinic, Day Medical Centre, SOPD, Geriatric Fast-track clinic; Post-discharge community support services were provided.
Result & Outcome :
91 patients were recruited with the diagnosis of: Atrial fibrillation, Hypertension, palpitations, chest pain, TIA, Stable CVA, Head injury, Dizziness, Headache, Acute confusion, Arthritis, Thyrotoxicosis, Poor DM control, Anemia, Frequent fall, LBP, Rash and Cellulitis. 53 (58.2%) were female, 38(41.8%) were male and the mean age was 75.7. 68 (75%) were Cat.3 cases, 65 (71.4%) were > 60- year-old. There were 46 interventions by medical team including medications change, laboratory tests, X-rays, holter, Echo, OGD etc. and 14 allied health supports. 61 (67%) were discharged home; 9 (10%) were discharged to rehabilitation bed; 21 (23%) needed further management in acute wards. Total 70 (77%) safe disposals and 70 (4.66%) acute ward admissions were reduced. The average length of stay (LOS) was 1.6 days. 1 (0.01%) re-attended case within 48 hours with other unrelated diagnosis; none was recorded death within 4 weeks after discharge. Promising conjoint service model for future development.
