Authors (including presenting author) :
(1) Lam WK Queenie, (2) Lau CL, (1) Ong KL, (1) Tsui KL, (1)Billy Wong, (3) Tang CT Heyman (1) Chan SY, (1) Lee SN, (4) Derek Kwan, (5) Nicole Wen, (5) Sam Au Yeung, (6) Frankie Leung
Affiliation :
(1) Accident & Emergency Department of Pok Oi Hospital
(2) Accident & Emergency Department of Tuen Mun Hospital (3) Accident & Emergency Department of Tin Shui Wai Hospital (4) Quality & Risk Division ofPok Oi Hospital (5) Administrative Department of Pok Oi Hospital
(6) Health and Information Record Department of Pok Oi Hospital
Introduction :
Every healthcare professional and hospital is committed to improving the quality and safety of patient care. The patient transfer to another hospital for further healthcare management is the norm for most HA hospitals. However, there was an incident occurred during a patient transfer from Accident & Emergency Department of Tin Shui Wai Hospital(TSWHAED) to Pok Oi Hospital (POH). Fortunately, the incident did not create any harm to patient but it exposed a “cheese loop” in the whole patient journey.
Objectives :
1) To define the roles and responsibilities of various team members
2) To prepare a workflow chart by giving a clear logistic flow of patient with oxygen management
3) To prepare a tracing record system according to the workflow
Methodology :
1) Set up a working group in multidisciplinary approach to standardize the patient with oxygen therapy from TSWHAED to POH
2) Staff briefing and relevant equipment preparation
3) Invite Fire Services department_Ambulance Services to participate into the program
Result & Outcome :
The new workflow is implemented within the incident occurred around in 2 months. The ambulance crew will directly escort the patients’ those needed oxygen therapy to the designated area at POHAED instead of leaved the patients’ at waiting hall. The cases’ will be received by the POHAED staff and then the prescribed oxygen therapy from TSWHAED will be given immediately then recorded on the tracing form. The designated area is near the Nursing station and therefore the patients’ are easily to be observed. ISS will approach to the POHAED staff while the admission folder is ready and the patients’ will be reassessed, including their condition and the amount of oxygen given. POHAED staff will sign their name again on the tracing form before the patients’ are escorted by ISS to the designated ward. The whole patient flow can be traced in case of any necessary instead of there was a “cheese-loop” before.
There is no more same incident has been happened after the implementation of this workflow.
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