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) :
YUE NT (1), CHEUNG Edith (1), YEUNG WS (1), CHAN NY (1), MOK ML (1), CHOY Felix (1), CHEN KK (1), WONG YF B (1)
Affiliation :
(1) Department of Medicine & Geriatrics, North Lantau Hospital, Kowloon West Cluster
Introduction :
With the launch of Hospital Command Centre (HCC) in Kowloon West Cluster, patient journey in Extended Care Ward (ECW) of North Lantau Hospital (NLTH) was reviewed since August 2023 especially the workflow in patient discharge process. Generally, more than 80% cases were discharged after 1pm from ECW due to the high dependency of Non-Emergency Ambulance Transportation Service (NEATS) which might crash with the time of new case admission transferred from acute hospital, and further worsen the delay of case discharge when healthcare team was being occupied by new cases. Therefore, patient discharge workflow re-engineering was proposed in ECW as team approach to enhance the patient discharge process. A remarkable improvement of discharge percentage before 1pm was observed after the implementation of re-engineering program.
Objectives :
1. To enhance the readiness of discharge cases in ECW before 11am in daily basis.
2. To maximize the utilization of NEATS to discharge cases in ECW before 1pm.
3. To improve the in-patient discharge percentage before 1pm of ECW to at least 28%.
Methodology :
1. Re-engineering patient discharge processes in ECW:
(i) Enhance the preparation of patient discharge items one day before discharge by using checklist, including confirmation of the discharge summary and medication by CMO and other appointments or referrals.
(ii) Early case review in the date of discharge with expected discharge time at 1pm and confirm the readiness of NEATS before 11am.
(iii) Early screening of discharge medication by Pharmacy and arrange supporting team for discharge medication delivery.
(iv) Ongoing liaise with NEATS team by ECW nurse in-charge, who would coordinate the confirmed discharge cases via HCC information in order to fill up the vehicle of NEATS as early as possible, including both stretcher and wheelchair cases.
(v) Regular monitor staff compliance in patient preparation for discharge by supervisor.
2. Monitor the outcome of in-patient discharge before 1pm via HCC information.
3. Regular feedback to NEATS regarding to the service utilization for enhancement.
Result & Outcome :
With the re-engineering of discharge process in ECW since October 2023, the percentage of in-patient discharge before 1pm in ECW had been significant improved from 14% in September 2023 to 37% in February 2024. NLTH ECW served as extended care ward for mainly Princess Margaret Hospital M&G patients, in which about 80% cases were living outside Lantau Island and most of them required stretcher transport by NEATS due to aging and co-morbidities. That was the one of contributing factors affecting patient discharge process in NLTH. In order to optimize the capacity and improve the cost-effectiveness for NEATS, the booking of NEATS stretcher and wheelchair were further reviewed every day during the demand surge period.
Overall, the discharge process re-engineering program has achieved the objective to expedite the in-patient discharge rate before 1pm in ECW of NLTH.
