Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Shea YF(1), Mak LS(1), Chow TY(2), Choi LH(2), Fung WS(2), Wong MY(3), Tang KY(3), Wu MC(1), Yung PH(1), Ho KY(1), Lee TH(1), Tung SY(1), Koo KF(1), Chiu KC(1)
Affiliation :
(1)Geriatric Medical Unit, Grantham Hospital,(2)Department of Speech Therapy, Grantham Hospital, (3)Department of Dietetics Services, Grantham Hospital
Introduction :
In Hong Kong West Cluster (HKWC), the Enhancing Community End of Life Program has been addressing the needs of elderly residents in Residential Care Homes for the Elderly (RCHEs) since 2015. Concurrently, for hospitalized elderly patients, the End-of-Life Clinical Plan – Inpatients (EOL-CPi) Program was introduced at Fung Yiu King Hospital (FYKH) to cater to individuals facing irreversible health decline. The Geriatric Medical and Infirmary units in Grantham Hospital, sharing patient demographics with FYKH, encounter patients in their final stages of life, suffering from discomforts like pain and dyspnea. These conditions, compounded by chronic illnesses, require intensive care nearing death. The EOL-CPi Program aims to provide this care, ensuring a dignified death and supporting the patient's family.
Objectives :
1. Improve end-of-life care quality for elderly in HKWC, in accordance with the HKWC Clinical Service Plan.
2. Implement the EOL-CPi program in the Geriatric and Infirmary wards at Grantham Hospital (GH).
3. Enhance end-of-life care training for staff in these wards.
Methodology :
1. Conducted targeted training for ward staff to boost their end-of-life care competencies.
2. Established and communicated a new workflow for the EOL-CPi Program to nursing and care teams in the Geriatric and Infirmary wards.
3. Developed and integrated new clinical and individual care plan templates, with clinical teams making informed final treatment decisions.
4. Assembled a multidisciplinary team—comprising medical staff, dietitians, therapists, and care assistants—to oversee program execution and stakeholder communication, including patient and family engagement.
5. Monitored the transfer rate back to Queen Mary Hospital (QMH) acute medical ward as a program efficacy indicator, comparing it with non-EOL-CPi patients.
Result & Outcome :
Between 1 July 2022 and 31 April 2023, 115 patients (mean age 85.8, 60 female, 55 male) were enrolled in the EOL-CPi program, predominantly from Geriatric wards. The average stay was 11.3 days, with 85 (73.9%) patients passing away within the program and 15 (13%) discharged. Notably, the program significantly reduced transfers back to QMH (0.9% vs. 11.2%; p<0.0001). A critical outcome was the facilitation for nearly 90% of families to be present during their loved one's final moments, enhancing their involvement and understanding of the care process.
The EOL-CPi Program demonstrates that patients can receive effective management in a non-acute setting, with a significant emphasis on symptomatic relief and comfort, supporting a dignified end-of-life experience.
