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) :
LIE YW(1), LEE WY(1), SUEN D(1), YIP TH(1), HEUNG LW(1), LI KY(1), CHAN WMM(1), KWONG KY(2), TONG BC(2)
Affiliation :
(1)Community Nursing Service, Princess Margaret Hospital,(2)Department of Medicine & Geriatrics, Princess Margaret Hospital
Introduction :
PEACE (Promoting, Education, Advocacy, Collaboration & Empowerment) Program, an enhanced PMH Community Geriatric Assessment Team (CGAT) service, has been providing end-of-life (EOL) care to terminally ill patients residing in CGAT-covered RCHEs in Kwai Tsing since 2017. PEACE patients are regularly reviewed by CGAT and are cared in RCHEs until the last moment of life. The Pseudo-ward admission established in PMH Accident & Emergency Department (A&E) under PEACE Program allows family to stay with patient in hospital during the final moments. Under current operation of Emergency Ambulance Service, patients with critical condition in 80% of PMH CGAT-covered RCHEs are sent to YCH A&E instead of PMH A&E, resulting in unnecessary reporting to the Coroner and sending of deceased to public mortuary. To improve patient-centered care in the EOL journey, a continuous quality improvement project was conducted to enhance the quality of dying process in YCH A&E for PEACE patients.
Objectives :
1. To facilitate a peaceful dying process for PEACE patients
2. To improve patient-centered care in the EOL journey
Methodology :
With support from cluster management, in liaising with YCH A&E, Finance Services Division and Medical Record Services Department, the algorithm and workflow for patient admission to Pseudo-ward in YCH A&E under PMH PEACE Program were developed to provide guidance for operations and practices among all involved parties. Under the enhanced pathway, YCH A&E arranges Pseudo-ward admission upon confirmation of PEACE status. After certification of death by YCH A&E doctor, the death certificate and related documents are sent to PMH and signed by PMH CGAT designated doctor if the death is relating to natural course of illness. All the documents are then sent back to YCH Death Documentation Office within 3 working days.
Result & Outcome :
The new workflow was commenced on 1 June 2023. Through collaboration of various parties, the admission process for PMH PEACE patients to YCH A&E Pseudo-ward was smooth and successful with 100% admissions to YCH A&E Pseudo-ward. This enhancement promotes dignified and compassionate care for terminally ill patients, ensuring their final moments to be peaceful and be spent with loved ones.
