Authors (including presenting author) :
Ko S(1), Wong OF(1), Chan KI(1), Hui TM (1), Chan WK(1), Chan SL(1), Cheng SK (1)
Affiliation :
(1) Accident and Emergency Department, North Lantau Hospital
Introduction :
With rapid growing population, the healthcare needs in North Lantau Hospital (NLTH) exceed its inceptive capacity. The NLTH Emergency Medicine Ward (EMW) advocated the implementation of Emergency Medicine Advanced Care Unit (EMACU) service since November 2020, aims to cater patients with varying complexity, mitigate the risks of patient transfers and elevate the overall quality of patient care. This innovative model distinct from traditional EMW service, addresses the specific healthcare needs in the locality and contributes to the evolving landscape of emergency care.
Objectives :
NLTH EMW has been strengthened with EMACU to embrace a self-sustaining service model. The objective aims to reduce stress from avoidable admission/patient transfers and enhancing the quality of patient care, thereby effectively alleviate the burden of PMH. The EMACU plays a crucial role as a safety net, offering vital support to critically ill patients and those experiencing decline in condition during the EMW stay.
Methodology :
Combination of the resource Emergency Department Intensivist (EDI) model and the Emergency Department High Dependency Unit (EDHDU) model is adopted. EDIs with recognized training are responsible for delivering critical care to patients at AED. Four-bed EMACU is established within the EMW and centralizes critically-ill patients in a designated cubicle.
The admission criteria for the EMACU target on specific groups of critically ill patients, encompassing a wide range of medical emergencies amenable in a remote healthcare setting. Five main categories are: 1) sepsis or septic shock (excluding surgical causes), 2) acute respiratory failure requiring respiratory supports including high flow nasal cannula oxygen therapy (HFNC), non-invasive ventilation (NIV) and mechanical ventilation, 3) diabetic emergencies, 4) severe electrolyte disturbances and 5) critical toxicology conditions. For those who necessitate the need of subspecialty care, such as cardiac intervention, intensive care unit (ICU) support, e.g. renal replacement therapy (RRT), or surgery intervention will be transferred to other facilities accordingly.
Result & Outcome :
Totally 301 cases were recruited in the EMACU from November 2020 to December 2023, with age range 18 to 102. The average EMACU stay was 5.2 days, and the average overall hospital stay was 12.5 days. The primary diagnoses included respiratory failure (n=79), sepsis (n=54), severe COVID-19 (n=35), toxicology emergencies (n=28), endocrine emergencies (n=26), and severe electrolytes disturbance (n=22).
Among them, 174 patients were admitted directly from the AED, while 128 were transferred to EMACU after admission to the EMW due to deteriorated in-patient conditions. Totally 199 patients were successfully discharged from the hospital, 14 cases transitioned to extended care beds in NLTH for rehabilitation. The overall mortality rate was 16.2% (n=49), and all of them received end-of-life (EOL) care.
The rate of transfer-out was 6.6% (n=20), including cardiac interventions (n=4), operations (n=4), ICU assessment (n=3), home NIV arrangement (n=2) and neurology assessment (n=1). Six patients with drug overdose were transferred to psychiatric hospitals after their acute conditions were settled.
Interventions for patients in EMACU included invasive hemodynamic monitoring (n=187), respiratory support (n=117) and inotropic support (n=95).
In summary, the EMACU service has demonstrated her effectiveness and importance in managing critical medical emergencies in NLTH. The analysis of outcomes highlights the successful management of majority of patients, efficient utilization of resources and adaptation of self-sustaining service model. The EMACU serves as an invaluable platform for delivering advanced emergency care in regions with geographical constraints and limited access to conventional ICU support.
