Authors (including presenting author) :
Mo KC(1), Poon KH(1), Tsang HC(1), To YL(1)
Affiliation :
(1)Physiotherapy Department, North District Hospital
Introduction :
In October 2022, Geriatrics support at Accident and Emergency Department(AED) was commenced in North District Hospital(NDH). The support was facilitated by the Integrated Care and Discharge Support for Elderly Patients (ICDS) service, which provided multi-disciplinary community support.
By offering appropriate community assessment and treatment, physiotherapists (PTs) were able to closely monitor patients, provide timely follow-ups and rehabilitation. This approach allowed treating mild cases in the community, thereby reducing hospital service utilization.
Objectives :
To evaluate the effectiveness of ICDS service with Physiotherapist as case manager, in enhancing Geriatric support at AED services in NDH for specific patient groups.
Methodology :
Working statistics between October 2022 and September 2023 with NDH ICDS PTs managed cases were retrieved and reviewed retrospectively. Patients’ outcomes were compared before and after program.
Result & Outcome :
ICDS PTs managed 34 patients, majority were female(67.6%) mean aged 76.8±7.8 years. All cases were triaged as either Category 3 (urgent)(73.5%) or Category 4 (semi-urgent)(26.5%) in AED. Falls(47.1%) and low back pain(32.4%) accounted for 80% of all cases. Patients' mean Clinical Frailty Scale(CFS) was 3.7±0.9 indicating very mild frailty.
In post-fall group(n=14), fall prevention program including home exercise prescriptions and education was provided, with mean program length 5.7±2.4 sessions. 13 patients(92.9%) were able to stay in the community without re-attending AED within 28-day post-discharge. Six patients(42.9%) were referred Home Support Team(HST) for necessary social support, while two patients(14.3%) were referred General Out-Patient Clinic(GOPC) for episodic problems. Tele-health was used in at least one episode for 11 patients(78.6%) for timely assessment and support. Upon completion of 8-week ICDS program, significant improvement was noted in patient’s general mobility with Elderly Mobility Scale(EMS) improving from 13.4±5.1 to 14.8±5.2(p=0.019).
In low back pain group(n=11), pain management program including acute pain relief and self-management education was provided, with mean program length 6.3±3.6 sessions. Eight patients(72.7%) were able to stay in the community without re-attending AED within 28-day post-discharge. One patient(9.1%) was referred HST, while one patient(9.1%) was referred GOPC. Upon completion of 8-week ICDS program, significant improvement was noted in patients’ pain intensity with Numeric Pain Rating Scale(NPRS) improving from 5.1±1.6 to 1.9±1.6(p<0.001), general mobility with EMS improving from 16.5±2.5 to 18.4±1.8(p=0.025) and ability to manage activities of daily living with Bathel Index-20(BI-20) improving from 19.1±0.8 to 19.7±0.5(p=0.007).
To conclude, multi-disciplinary community support for patients discharged from AED effectively facilitates community care, promotes patient self-management and encourages aging-in-place.
