Authors (including presenting author) :
Yuen MSY (1), Kwok WS (1), Chiang SC (1), Chan J (2), Chan YP (2), Lee ST (2), Mak MY, (2) Lao WC, (2) Lo E, (2) Chao HY (2), C Kng (3), Mak F (3), Ho S (3), Wong M (4), Cheung K (4), Chan LW (1), Leung J (1), Lau PF (1)
Affiliation :
(1) Department of Accident and Emergency, Pamela Youde Nethersole Eastern Hospital
(2) Department of Medicine, Pamela Youde Nethersole Eastern Hospital
(3) Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals
(4) Department of and Family Medicine and Primary Health Care, Hong Kong East Cluster
Introduction :
Introduction
Patients age 65 and older are the most frequent attendances of Emergency Department (ED) in Hong Kong. According to CDARS of ED attendance in PYNEH, the rate of elderly was the highest among all age group from 2015 to 2019; half of them required admission and one-fourth of them were re-attendances. In view of aging attendances, Winter Surge Geriatric Discharge program was introduced in ED in 2018, where elderly with Geriatric Syndromes were screened by Emergency Physician and assessed by Community Nurse for discharge care plan and follow-up. The recruitment was low (20) in 2018.
Objectives :
Objective
To report on the implementation of improvement measures in Emergency Department in 2019
Methodology :
Method
Patients attend ED at the age 65 or above and with triage category of 3 and 4 are screened before admission to Emergency Medicine Ward (EMW) by Emergency Physicians or Nurses. The criteria are fulfilled if patient is presented with Geriatric Syndromes or Low Acuity, and Post-discharge monitoring of condition or social care social problem are required. The patient would be assessed by Emergency Nurse and referred to Integrated Care Model (ICM) Nurse for multidisciplinary discharge care plan. Geriatrician would be consulted if needed. Outcome of re-attendance within 28 days and re-admission are monitored.
To prepare for the above implementation, Multidisciplinary team of Emergency Medicine, Medicine and Geriatrics, Family Medicine and Primary Health Care were invited, meetings were held to review the program in 2018. The inclusion criteria, Geriatric screening and assessment and discharge care plan were revised; where location of the program was changed from ED to EMW, Emergency Nurses were invited to do the Geriatric screening and assessment, ICM Nurses were invited for the discharge care plan, Staff education on Geriatric screening and assessment was duly carried out. Barriers to implementation were overcome in the trial-run period and prospective evaluation were carried out in the formal implementation period and thereafter.
Result & Outcome :
Results
133 patients were recruited to the program from January 1st to May 31st 2019, in which two-third were female patients. The mean and median of age were 81 and 83. The mean and median of Reported Edmonton Frailty Score in the Geriatric Assessment was 7. Almost half of the patients were presented with Geriatric Syndrome of Dizziness and Fall, another half for Blood Pressure Control. The mean, median and mode of length of stay in EMW were 1.
On Discharge Care plan: one-third of the patients were recruited to ICM follow-up, one-fifth to General Out-patient for early follow-up, few were recruited to Fast Track Clinic (5.3%) and Geriatrics Day Hospital Rehabilitation (3.8%), one-fifth were follow-up as scheduled. There were 24 (18%) ED re-attendance within 28 days and 20 (15%) re-admissions, in which 14 were presented with similar symptoms.
Month before the program, two-third of the ED Nurses had received training on Geriatric Screening and Assessment. Change of program location was accepted by patients and staffs, who found the time, place and progress of patients appropriate for the program. Implementation was smooth and Workload was regards as acceptable from staff survey.
Conclusion
Through multidisciplinary collaboration, the improvement measures were feasible and resulted in significant improvement in overall recruitment of patients for Geriatric Discharge program in ED and outcome of patients.
