Geriatrics Evaluation and Management (GEM) Service for Winter Surge at the Front Door of Ruttonjee and Tang Shiu Kin Hospital (RTSKH)

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Authors (including presenting author) :
Ho SKS(1), Yuen WM(1), YM Chau(2), Pak KW(3), Wan KA(2), Kwan CY(3), Mak MY(3), Mak TYF(2), Wan MC(1), Yu WTC(2), Tse LKD(1), Mak PKF(1), Leung CP(2, Kan PG(2), Kng PLC(1),
Affiliation :
(1)Division of Geriatrics, Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospital (2)Accident and Emergency Department (AED), Ruttonjee and Tang Shiu Kin Hospital (3)Community Healthcare Service, HKEC
Introduction :
Overseas experience proved geriatrics intervention at the “front door” of hospital was promising in reducing avoidable admission and reducing hospital occupancy. Locally, RTSKH had proven the effectiveness of a tripartite collaborative service model of AED, CHS & the Geriatrics team in the winter surge of 2017 for selected AED elderly patients to reduce hospitalization. Enhancement of the program in 2018 was to employ GEM Nurse as key assessor and care planner for the service jointly with AED doctors.
Objectives :
• To strengthen front door gatekeeping during winter surge through (a) frailty assessment and intervention, (b) front door mobilization of community and ambulatory services and (c) a shared multi-disciplinary care plan bridging the hospital to community interface. • To obtain the prevalence of frailty on the older person attending AED and the care needs that encountered.
Methodology :
In the Winter Surge period, from 4 Dec 2017 to 25 Apr 2018, the GEM service was implemented at AED of RTSKH. Patient aged >65 of Category 3 or 4 fulfilling inclusion criteria were selected by AED doctor for referral to GEM nurses for frailty assessment and discharge support. Discharge supports included early Geriatrician / medical consultation; short course of rehabilitation; outreach team case management from the community teams. Weekly case conferences were conducted among the nursing teams in the 28-day post discharge period. A service satisfaction survey was conducted upon completion of the service. Concurrently, convenient samples were collected for a prevalence screening of frailty and care needs among elderlies that attended AED.
Result & Outcome :
80 patients were recruited to the service, 42% (34) were male, mean age 82 (range 65 – 95). 91% (73) community dwelling, 16% (13) were daytime alone, and 19% (15) living alone. The top reasons for attending AED were fall 30% (24), dizziness 25% (20) and musculoskeletal pain 12.5% (10). Among the subjects, 61% (49) being frail or vulnerable; 33.5% (27) received support from community teams using a shared care plan based on frailty needs assessment. 21% (17) followed up by geriatrician for fast tract consultation and 19% (15) followed up at GDH for rehabilitation. 54% (43) received phone follow up of GEM nurse. As a result, 78.8% (63) patients were discharged from the front door with support of community based geriatrics services instead of being admitted for in-patient geriatric care. After completed 28-day discharge support services, 66.7% (42) patients had no record of re-attendance to AED and no readmission. Common care needs identified in frailty screening of 300 elderlies were poly-pharmacy (58%), cognitive (38%), Incontinence (33%), functional performance (30 – 50%) and social support (31.8%). It concluded that Front Door interface geriatrics and multi-sectorial collaborations can deliver safe quality care for frail elders with options other than hospitalization.

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