Improving Management of Long Stay Patients in a Neurosurgical Rehabilitation Unit

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Authors (including presenting author) :
POON CYM (1), Chan TMD (1), Cheng BW (1), Man HK (1), Chan YF (1), Leung WM (1), Fook SMS (1)
Affiliation :
(1) Surgical Department, Shatin Hospital
Introduction :
In 2017, the average length of stay for neurosurgical patients in Shatin Hospital was 58.5 days which is the longest among other specialties. Many were young stroke cases with sudden onset. Patients and families had unrealistic expectation and different social problems that required long time to settle. Prolonged hospitalization was associated with significant social, economic, physical and psychological burden.
Objectives :
(1) To coordinate early discharge plan in team approach (2) To shorten patient length of stay (3) To resolve complex discharge barriers with management support
Methodology :
Key principles are culture of respect and empowerment, collaborative approach to solutions, valuing of patient and staff input across all disciplines, patient safety focus, patient and carer involvement, and supportive monitoring processes. (1) Ward manager took up the role to be the discharge coordinator and lead the nursing team as initiative. (2) Ward manager conducted weekly round with the ward APNs or In-charge nurses to highlight early escalation of discharge planning issues and identify discharge barriers. (3) Active management by the nursing team collaborated with multidisciplinary professionals in day-to-day operation. (4) Nurses communicated with families actively. Family meeting initiated by nurses and involved Patient Relation Officer if necessary. (5) Multidisciplinary team round to explore possible solutions. (6) A reporting system is established for long stay and discharge problem cases. Cases are reported in department meeting and closely monitored by ward manager. (7) Early reporting to hospital management team. Long stay and discharge problem cases were reviewed quarterly by hospital management team to monitor the progress and provide guidance and assistance to resolve complex discharge issues.(8)Clinical pathway for haemorrhagic stroke was established to enhance effective care planning with multidisciplinary team involvement. Length of stay for two months was expected to achieve better health outcome and reduce length of stay.
Result & Outcome :
To reduce the length of stay for neurosurgical patients and tackle discharge problem cases 1. The average of length of stay for neurosurgical patients decreased from 58.5 days in 2017 to 46.06 in 2018 2. The average number of cases over 60 days decreased from 22.75 to 18.25

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