Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Wong KM(1), Choi TL(1), Chow MC(1), Miu PL(1), Tong CW(1), Chiu PH(1), Cheng HS(1), Wong C(1), Lam YF(1)
Affiliation :
(1) Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
Malignant pleural effusion (MPE) commonly leads to recurrent admissions and is associated with limited life expectancy. Patients with this condition have disabling symptoms resulting in reduced quality of life, repeated chest drain insertion and prolonged hospitalization. Placement of an IPC allows patients and caregivers to manage their symptoms at home. Since 2015, the respiratory team has introduced the use of IPC for patients with malignant pleural effusion in PYNEH.
Objectives :
1. Reduce the need of repeated chest drain insertion 2. Enable patients to manage their symptoms at home 3. Reduce Accident and Emergency Department (AED) attendance, hospitalization and length of hospital stay
Methodology :
1. The Respiratory physician identifies suitable cases and notifies Respiratory nurse for family interview 2. Respiratory nurse interviews the patient and their family members and discusses the care of home pleural drainage together with the financial aspects. 3. The Respiratory physician inserts IPC 4. Respiratory nurse provides three to four pleural drainage training sessions for the caregiver 5. Before patient discharge, Respiratory nurse assesses the drainage skills of the caregivers 6. The patient will be followed up in Respiratory day ward for special procedures including stitches removal and skills reassessment.
Result & Outcome :
From 2015 to 2023, IPCs have been inserted for 16 patients. Half of them are male. The total AED attendance half year before and after IPC insertion dropped from 39 to 17 times (56.4% reduction). Besides, the total unplanned admission rate half year before and after IPC insertion decreased from 32 to 17 times (dropped 46.9%). Nonetheless, the total length of hospitization half year before and after IPC insertion reduced from 356 to 98 days, leading to 72.5% improvement. Last but not least, feedback from patients and their family members was overwhelmingly positive. All patients were truly satisfied with the service. They expressed they did not have to suffer from repeated insertion and removal of pleural catheters. They could stay at home and be free from hospitalization. Most importantly, they experienced decreased symptoms burden, and had better ability to participate in their normal daily activities. Family members also expressed closer relationship with patients and they were empowered to relieve the symptoms for patients. Conclusion: The introduction of IPC improved the care for patients with malignant pleural effusion. Apart from receiving favorable response from patients and their family members, this new management option is also effective in reducing healthcare utilization.
