Authors (including presenting author) :
Kwong PY (1) Lam HC (1) Chan YC (1)
Affiliation :
(1)Accident and Emergency Department, United Christian Hospital
Introduction :
Emergency department crowding and access-block continue to be a threat to the core emergency care around the world. With the aging population in our community, escalating service demand and access block from various specialties is an unavoidable challenge. Measures, including effective use of Emergency Medicine Ward (EMW), have been implemented to reduce acute medical admission without compromising patient safety and quality care. One proposal is to fully utilize Emergency Medicine Ward (EMW) to reduce the pressure of inpatient wards of other specialties. In United Christian Hospital (UCH), there were more than 5,000 orthopaedic admission via Accident and Emergency department (AED) every year with lower limb cellulitis accounted for about 10% of the admissions. The EMW of UCH AED has implemented a protocol for managing lower limb cellulitis since 2019.
Objectives :
1. To report the clinical experience of management and outcome of lower limb cellulitis patient in EMW of UCH
2. To review the performance and identify suitable service model for EMW
Methodology :
Patients diagnosed with lower limb cellulitis and required an orthopaedic admission for treatment would be admitted to EMW for management by a designed protocol.
The inclusion criteria include a.) non-purulent cellulitis, mild to moderate severity (Eron class 1, 2; Dundee 1, 2, +/-3) and b.) inpatient monitoring required for initial response.
And the exclusion criteria are severe signs of systemic toxicity, purulent discharge or abscess, suspected necrotizing fasciitis, uncontrolled co-morbidities, immunocompromised patient, suspected MRSA infection, retained foreign body including implant, suspected vibrio infection.
Result & Outcome :
Since 2019, the number of patients diagnosed with cellulitis treated in EMW has been increasing from 58 (2019), 58 (2020), 55(2021), 72(2022) to 92 (2023). The mean age of patients has been increased from 64.7 years old in 2019 to 74.0 years old in 2023.
In 2023, 966 patients attended AED and diagnosed to have lower limb cellulitis. 299 cases were discharged home directly. 623 patients required admission for inpatient management, including 531 (85%) orthopaedic ward admissions and 92 (15%) EMW admissions
The majority of the EMW cases were treated and discharged uneventfully, and 14 cases need transfer to orthopaedic ward for further management.
Conclusion
EMW reduced 15% of the acute admission of patient with lower limb cellulitis to orthopaedic wards. More EMW clinical workflow could be explored and adopted to provide safe and efficient care to patients of other disease and maximize its benefit.
