Authors (including presenting author) :
WONG CW(1), SIU TS(2), CHOY YL(1), LEUNG KC(1), CHAN YF(2), LAM CY(1), PO MYY(2), WONG CK(1), KNG C(1)
Affiliation :
(1) Department of Medicine & Geriatrics, RTSKH (2) HKEC Community Geriatric Assessment Team, RTSKH
Introduction :
Hong Kong East Cluster (HKEC) Community Geriatric Assessment Team (CGAT) pioneered telemedicine in 2002 to facilitate medical consultation for older patients living in Residential Care Home for the Elderly (RCHEs) in remote area such as Cheung Chau. However, it was until COVID-19 pandemic, telemedicine utilization increased dramatically for all RCHEs covering by CGAT. Recent Hospital Authority statistic revealed that increasing the frequency of medical visits by CGAT might be associated with fewer Accident and Emergency Department (AED) attendance and admission. Furthermore, in order to facilitate the CGAT coverage to new RCHEs, increasing telemedicine service may be the solution against limited resources.
Objectives :
1. Review telemedicine service in CGAT for regular clinical follow-up and during service demand surge
2. Review Hospital Command Centre (HCC) to screen patients at high risk for readmission for early post-discharge support.
Methodology :
Telemedicine has been extensively used in HKEC CGAT since COVID-19 pandemic in 2020. Apart from regular clinical follow up, telemedicine is also used for Ad hoc consultation for patients infected with COVID-19 for timely medical support, and for proactive outbreak screening. Starting from 21st December 2023, high risk patients for readmission upon discharge were screened by geriatricians from two acute geriatric wards through the implementation of HCC for early tele-follow-up to minimize readmission. Number of patients attended the tele-consultation was recorded and 28-day readmission rate for early tele-follow-up upon discharge were calculated.
Result & Outcome :
During the period from April 2023 to February 2024, total tele-consultations were 2,971 which constituted 13.6% of total regular clinical follow-up. During the services demand surge from 21st December 2023 to 29th February 2024, there were total 953 tele-consultations arranged in which COVID-19 cases constituted 49.2% (469) while Ad hoc medical support and early follow-up upon discharge constituted 42.6% (407) and 8.1% (77), respectively. There were 218 (22.9%) consultations for non-CGAT covering RCHEs. The 28-day readmission rate for patients who had early follow-up upon discharge was 9.4% compared with 24.9 % for all discharge under CGAT during the same period.
Through proactive screening of patients at high risk for readmission by HCC, there were 24 cases referred for post-discharge support via tele-consultation from 21st December 2023 to 29th February 2024.
Conclusion
Telemedicine can maximize clinical follow-up for patients in RCHEs and provide timely medical support to minimize hospital admission. Proactive screening high risk patients for readmission by hospital command centre is feasible but more data for the efficiency is anticipated.
