Authors (including presenting author) :
SUEN YL, FUNG LS, LAW HK, MAN KH, WONG SH, WAN SY, CHAN WH, YU LF, WONG WC
Affiliation :
Department of Orthopaedics and Traumatology, Kwong Wah Hospital, HKSAR
Introduction :
Kwong Wah Hospital started redeveloping since 2016, O&T department sustain the essential clinical services without additional manpower during the redevelopment. The impacts were resulting in high bed occupancy rate and increasing heavy work pressure to the frontline healthcare staff. Developments of Ambulatory Wound Care Service (AWCS) in integrated model for reducing burden on acute inpatient and unnecessary hospitalization in an attempt reduce length of stay (LOS), improving patient-care experience and addressing sustainability of hospital services.
Objectives :
It’s to provide a holistic wound care, improve patient-care experience and address the sustainability of hospital services. And evaluate the effectiveness of AWCS on reducing unplanned admissions and decreasing patient’s length of stay.
Methodology :
New AWCS in integrated model had been implemented in year 2018 to provide specialist wound care by AWCS team nurses. The targets were clinical stable patients who had non-progressing wounds or requiring advanced wound care, recruited from ward as well as SOPD. In this model, patients were early discharged and referred to AWCS by their case doctors, the case doctors will be prolonging their follow-up appointments and AWCS nurses were taken over subsequence follow up,
AWCS nurses act as frontline gatekeepers to monitor patient’s status, detect deteriorate signs and inform case doctor for timely follow up actions according to the patients’ clinical needs. Once patient’s wound stabilizes, AWCS nurse refer back to GOPD for ongoing wound care and regular follow up to monitor patients progress.
Role of AWCS Nurses
• Initial wound assessment, provide comprehensive wound care management
• Provide patient, patient caregivers’ & relatives informative education on wound care and provide psychosocial supports • Inpatient weekly wound-round collaborate with multidisciplinary teams • Regular wound case sharing & meeting • Provide staffs training programs for frontline staff • In addition, WCS nurses conducted a post discharge phone follow up and patient satisfactory survey after case discharge to provide supportive care and collect the patient feedback
Result & Outcome :
Results from January to December of 2018, total 227 attendances in the services, 61.54% close case were healed or improved. The average LOS for past admission was 18.56 days and decrease to 17.17 days after attended the AWCS. The most common diagnosis was diabetes, probably 50% of the attendances. Meanwhile, high service attendance rate 87% and the unplanned re-admission rate 2.8% were observed. The evaluation also revealed 100% of attended patients satiated the AWCS and had better management on their wounds. The enhanced AWCS offer opportunities & challenges to patients and hospital. Patients obtain adequate supports, minimize psychological fears, shorten length-of-stay, and increase patient satisfaction. Hospital utilizes usage of beds & resources, streamline administration works. Nurses being frontline gatekeepers to monitor patient’s wound situation, detect deterioration signs, inform case doctor for timely & scheduled follow-up action, can complement and share out doctor’s workload and consultation time. Consequently, increasing the nurse professional autonomy. The integrated model in AWCS could successfully elevate the effectiveness of patient outcomes and cost-efficiencies to the health care system.
Co-location with:
