Ambulatory care for patients with influenza and pneumonia in Accident & Emergency Department in Prince of Wales Hospital

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Authors (including presenting author) :
Tai CK (1), Cheung NK (1), Chung JYM (1), Lee KH (1), Leung CSM (1), Lo WK (1), Hui E (2)(3), Ma HM (4)(5), Lui CY (4), Li CM (4), Yiu LP (4), Chim CK (5), Lai WM (6), Chow CY (6), Ho PY (7), Chan SP (7), Liu YW (7), Tong CI (7)
Affiliation :
(1) Accident and Emergency Department, Prince of Wales Hospital (2) Department of Medicine & Geriatrics, Shatin Hospital (3) Primary and Community Health Care, NTEC (4) Department of Medicine & Therapeutics, Prince of Wales Hospital (5) Community Outreach Services Team, Prince of Wales Hospital (6) Department of Microbiology, Prince of Wales Hospital (7) Central Nursing Division, Prince of Wales Hospital
Introduction :
Respiratory tract infection like influenza and pneumonia is one of the commonest disease entity encountered in A&E. Routine in-patient treatment of these patients poses a huge burden to medical wards especially during winter surge period. Treating suitable patients in outpatient settings can lead to better utilisation of resources.
Objectives :
To study the feasibility of out-patient treatment of patients with influenza and pneumonia attending A&E in Prince of Wales Hospital by certain inclusion and exclusion criteria designed by task force including A&E, Department of Medicine and Therapeutics, Department of Microbiology, Central Nursing Division and Community Outreach Services Team.
Methodology :
FLU program was commenced since 13/7/2017. Haemodynamically stable patients with major comorbidities will be recruited if criteria are met. They are either followed up by A&E nurse practitioners (NP) with the support of emergency physicians or by Community Outreach Services team (COST) to review symptoms. The service extended to pneumonia cases and the program was re-named as FLU-monia program since 1/8/2018. CURB-65 score is used to stratify the severity of pneumonia cases. Ambulatory patients with CURB-65 score ≤ 2 will be recruited. All of them are followed by A&E NP and emergency physicians.
Result & Outcome :
Data was analyzed up till 31/1/2019. For flu cases, there were totally 327 patients enrolled. 288 patients (88.1%) were followed up by A&E NP while the remaining 39 patients (11.9%) were reviewed by COST. 303(92.7%) of them were case closed. 22(6.7%) of them were admitted later during follow up or reattendance. For pneumonia cases, total 121 patients were recruited. 99 patients (81.8%) were case closed during follow up. 18 (14.9%) of them were admitted later. There was no major adverse outcome noticed for those patients managed under FLU-monia program.

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