Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Enhancing Partnership with Patients and Community (Projects initiated to engage patients / carers / community to improve efficiency / quality of care)
Authors (including presenting author) :
LAU CC (1), WONG YY (1), CHEUNG YL (1), CHAN CH (1), LAU CK (1), LAM KM (1), SY CHIU (1), TSE LS (1), HAI MK (1), YIK WT (1), IP SM (1), WONG MT (1), MAK MYM (2), HO OLL (2), LAI PW (2), LAW PLB (2), CHEUNG WL (3), CHAN SP (3), KAM KW (4), CHAN WT (4), KUNG KM (4)
Affiliation :
(1) Department of Medicine & Geriatrics, TMH
(2) Department of Physiotherapy, TMH
(3) Department of Occupational Therapy, TMH
(4) Patient Resource Centre, TMH
Introduction :
Delirium is a common and costly complication of hospitalization for elderly patients. It poses a major challenge for quality of care, patient safety and costs of hospital care. In view of the rising numbers of elderly patients, the Geriatric Ward of Tuen Mun Hospital launched a pilot project, namely Geriatric Rehabilitation and Care for Elderly (G.R.A.C.E.), to prevent delirium and functional decline in hospitalised elderly patients.
Objectives :
The objectives of G.R.A.C.E. are to improve geriatric medical cases’ physical and cognitive functioning as well as maximise their independence at the time of discharge.
Methodology :
The project involves skilled interdisciplinary staff (geriatrician, geriatric nurses, physiotherapists, occupational therapists, social workers) and trained volunteers to implement intervention protocols targeted toward three delirium risk factors: orientation, therapeutic activities, early mobilization. Other interventions include nursing assessment and intervention, interdisciplinary rounds, and post-discharge community linkages.
For pilot phase, elderly patients of TMH R9C are screened based on the presence of risk factors for delirium. The assigned interventions are tailored to each patient in accordance with their abilities and preferences. Interdisciplinary teams assisted by trained volunteers conduct interventions with tracked daily, and quality assurance measures incorporated at each step of the program from admission to discharge.
Pre and post-test are administered anonymously to all staff involved with a satisfaction questionnaire. Meanwhile, Elderly Mobility Scale (EMS), Modified Functional Ambulation Classification (MFAC), Modified Barthel Index (MBI)and Abbreviated Mental Test (AMT) are adopted for measuring patients’ functioning.
Result & Outcome :
From July-December 2023, 89 patients with 987 man-time serviced. The intensity of volunteer assisted training days is around 70% in average (11.75 training days out of 16.7 hospitalisation days). The pre and post-test results indicate that 25% involved patients increased 2-12 points (total 20) by EMS; 21% increased 1-2 categories (total 7) by MFAC; 42% increased 2-10 points (total 100) by MBI; 21% increased 2-3 points (total 10) by AMT. The physical and cognitive functioning for most of the remaining patients maintained the same while 8-12% of patients’ score slightly deceased. These results suggest that the project successfully prevents cognitive and functional decline in geriatric medical cases. Feedback from staff also shows that the project can maintain physical and cognitive functioning of patients throughout hospitalisation as well as maximise independence at discharge. They also observed mood improvement in patients. Future studies are needed to evaluate cost-effectiveness and long-term outcomes (e.g. shorter length of stay) of the project.
