Authors (including presenting author) :
Cheng JN (1), Leung CP (1), Cheung PH (1), Chan LH (1), Tse LK (2), Leung CS (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Caritas Medical Centre (2) Community Nursing Service, Caritas Medical Centre
Introduction :
Unplanned readmissions are common for elderly patients, especially those residing in Residential Care Home for the Elderly (RCHE). Elderly patients are frail and a lot of them have multiple comorbidities and polypharmacy. They are prone to have Hospital Associated Deconditioning. Their medical conditions are complicated and meticulous care by experts in elderly care is crucial to maintain their health. This pilot project aims to explore the feasibility of utilizing telemedicine, to improve the care of our elderly patients residing at RCHEs, especially those just admitted to the hospital, who are at high risk.
Objectives :
1. To have rapid assessment and review of patients discharged from the hospital through telemedicine 2. To identify Hospital Associated Deconditioning early and avoid medications errors after discharge 3. To avoid unplanned hospital readmissions
Methodology :
Three selected RCHEs were recruited in this pilot project. Patients who fulfilled the inclusion criteria (1) were seen by geriatricians in the telehealth clinic within 2 weeks upon discharge. Clinical conditions and on-hand medications were reviewed and interventions were done if necessary. If on-site visit was deemed required, it was arranged accordingly. The number of unplanned readmission, which was defined as the emergency admission within 28 days of the index discharge, was recorded. Comparisons would be made with the rate of unplanned readmission for all CGAS patients in that period. (1) Inclusion Criteria: 1. Patients resided in the 3 selected RCHEs, under our Community Geriatric Assessment Team (CGAT) follow up 2. Patients discharged from the department of Medicine and Geriatrics of Caritas Medical Centre from 17 July 2023 to 8 September 2023
Result & Outcome :
We recruited 50 patients, 30% (n=15) of them were male, their mean age was 88.2 (SD=9.6), 76% (n=38) of them had severe frailty (Clinical Frailty Scale 7 or above). The commonest cause of the index admission was respiratory diseases (n=21). The unplanned readmission rate was 24%. When compared with the average unplanned readmission rate of 34.2% for all discharged patients under CGAT from July to September 2023, the unplanned readmission rate of patients recruited in this pilot project was 10.4% lower. A total of 28 problems were identified in the telehealth clinic and 36 interventions were done. Drug modification (n=21) was the commonest intervention. The results showed that frail patients resided in RCHEs who were seen in telehealth clinic within 2 weeks of discharge, had a lower rate of unplanned readmission than average. Post discharge telehealth clinic may decrease unplanned readmissions in CGAT.
