Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Enhancing Partnership with Patients and Community (Projects initiated to engage patients / carers / community to improve efficiency / quality of care)
Authors (including presenting author) :
Si HY, Lo HY, Mui CM, Ling PC, , Leung SM, Chan CH
Affiliation :
Department of Tuberculosis and Chest, TWGHs Wong Tai Sin Hospital
Introduction :
Delayed discharge leads to poorer outcomes of patients and increases burden in the health system. It was evidenced that early and structural discharge planning can reduce the length of hospital stay of patients in order to decrease the risk of delayed discharge. The earlier the discharge problems are identified, the better the discharge planning can be provided. Therefore, Early Discharge Enhancement Program (EDEP) was formulated and implemented in Department of Tuberculosis and Chest (DTBC), Wong Tai Sin Hospital (WTSH) since May 2023 in order to perform early screening, enhance the discharge planning and facilitate the process.
Objectives :
(1) to perform screening for all admitted cases and identify any risk factors of delayed discharge (2) to facilitate the discharge process by early and individualized discharge planning (3) to provide appropriate interventions and solve the respective problems or risks timely.
Methodology :
An admission screening on potential discharge problems was employed and performed by nurses for all cases admitted or transferred to DTBC, WTSH. The patients were recruited when falling on any one of the criteria shown as the follows: For the subjects who were not aged-home residents, they were (1) Activities of Daily Living (ADL) declined comparing with the premorbid state (2) tube inserted newly such as Ryle’s tube, Foley catheter and etc. (3) countering caregiver problems including lack of caregiver, caregiver(s) with insufficient caring skill, households of old couple, elderly abuse and etc. (4) in absence of discharge destination or homeless (5) having unknown identity (6) Non-eligible patient (NEP) (7) having any financial problems related to placement, medical devices or treatment and etc. For the subjects who were aged home residents, (1) their original OAH beds were not available due to any reasons. The recruited cases were early rationalized and reviewed by link nurses and nurse supervisors cooperating with the multi-disciplinary. Visualized indicator was applied for alarming the healthcare professionals that the patients had the risk of delayed discharge. Weekly sharing session for the recruited cases allowed discussion among nurses on the progress of the discharge planning. Outcome measures were categorized as: (1) The efficacy of the admission screening (2) Compliance of the nurses in performing the admission screening (3) Hospital stay courted from the date of “medically fit for discharge” defined by doctors (aimed <=14 days).
Result & Outcome :
From May 2023 to December 2023, 1215 cases were screened and 238 patients had been recruited in the program. Risk factors were identified and tailored made discharge care plan were instilled accordingly. For the cases successfully discharged to home or aged home, average length of stay (LOS) after defined as medically fit for discharge was 4.37 days. 94.2% recruited cases were able to discharge within 7-14 days after medically fit. Compliance of the nurses on performing the admission screening was 98.2%.
Conclusion: Early detection of risk factors, identify the discharge problems, rationalizing patients' and relatives' needs and expectations, early formulation of discharge care plan, with the cooperation and collaboration with multidiscipline teams, the length of stay of those cases (medically fit for discharge) was shortened.
