Establishment of Convalescence and Rehabilitation Ward in an Acute Hospital – Experience of North District Hospital

Abstract Description

Authors (including presenting author) :

Choi CM(1), Tsang HC(1), Wan BY(1), Chui TK(1), Tang KL(1), Yam TF(1), To YL(1), Leung HY(2), Sun TF(3)

Affiliation :

(1)Physiotherapy Department(2)Department of Medicine(3)Hospital Chief Executive Office, North District hospital

Introduction :

Convalescence and Rehabilitation (CR) ward has been established in North District Hospital (NDH) since October 2017 to address the lack of extended care in the North District as suggested in the Clinical Service Plan of New Territories Easter Cluster (NTEC). Patients admitted to the CR ward either through internal transfer or clinical admission. Patients with convalescence and/or rehabilitation needs are referred from Emergency Medicine Ward and other departments. Patient screening was done by liaison nurse supported by input from geriatrician. Physiotherapists work closely with doctors, nurses, occupational therapists and social workers to facilitate the rehabilitation progress and discharge planning. Management of complicated cases will be discussed in the weekly multidisciplinary case conference.

Objectives :

To review the provision of physiotherapy services in the CR ward

Methodology :

Physiotherapy service statistic in the CR ward was retrieved since its establishment in October 2017. Rehabilitation outcomes in the latest 4 months were analysed.

Result & Outcome :

Physiotherapy services provided to patients in CR ward included bronchial hygiene management, oxygen titration, long term oxygen therapy (LTOT) arrangement, pulmonary rehabilitation, strengthening exercise, mobility training, walking aids prescription, carer training, post discharge community support etc. From 10/2017 to 12/2018, the total physiotherapy attendances provided to the patients was 6575. The referral rate was 96.69%. From 9/2018 to 12/2018, 91 sets of patient data were captured. All were male patients with a mean age of 78.14 (range 55-95). The primary diagnosis included respiratory problems (e.g. pneumonia, acute exacerbation of chronic obstructive pulmonary disease, asthma attack etc.), medical problems (e.g. sepsis, renal failure, heart failure etc.), musculoskeletal problems (e.g. gouty attack, back pain, polyarthritis etc.) and others like fall, dizziness, dementia etc. Their length of stay in the acute wards before transferred to CR ward ranged from 1 to 115 days (mean=12.33 days). During the above period, 5 oxygen titration and LTOT arrangements were completed. Improvements in their mobility level could be revealed from their Modified Functional Ambulatory Categories (MFAC) upon arrival to the CR ward and upon discharge. On admission to CR ward, 24.47% of the patients were categorised as MFAC CAT I or II while 72.53% of them were categorised as MFAC CAT III or above. Upon discharge, in terms of MFAC, 25.75% of the patients had advanced one category, 9.09% advanced 2 categories and 3.03% advanced 3 categories. 67.03% of them were successfully discharged to home or old-aged home after hospitalization and rehabilitation, 15.38% passed away and 8.80% transferred back to acute ward due to sudden change of condition. In conclusion, the establishment of CR ward in NDH facilitate the transition of care along patients’ rehabilitation journey and relieve the bed tightness of the rehabilitation hospital within the cluster.