Authors (including presenting author) :
Cheung CCC, Tsang WM, Kan WY, Ng SY, Yik WMJ, Yip CH, Cheng YY, Tang MKC
Affiliation :
Department of Medicine & Geriatrics, Princess Margaret Hospital, Kowloon West Cluster
Introduction :
DPC was extended to a team and their roles have become more diverse since December 2017. Besides facilitating arrangement of extended care bed (ECB)and diverting clinical admission referrals to day ward to minimize hospital admission, DPC took up the role of proactive screening and coordination in Sincere Treatment Trial (STT), as to promote ‘good death’ and dignity in dying by withdrawal of futile life-sustaining treatment after thorough discussion with medical officer and family. Also, DPC managed complicated discharge cases by engaging multidisciplinary colleagues and family in patient journey and discharge planning, hopefully to shorten the hospital stay and facilitate early discharge with less post-hospitalization adverse events.
Objectives :
-To alleviate prolonged suffering in dying patients and their family and to improve patient’s end-of-life quality by promulgation of STT. -To engage multidisciplinary healthcare professionals and family in advance discharge planning.
-To improve booking efficiency and efficacy with the revamp of ECB booking system.
Methodology :
-DPC bridged the communication gap between the healthcare team and family members in the discussion of end-of-life care decision, as to facilitate the best interest for the dying.
-Identified patient’s needs early in discharge planning as to deliver appropriate services or referrals efficiently and timely.
-Revamped the ECB booking system to ensure booking compliance and to improve transfer appropriateness.
Result & Outcome :
-The recruitment of STT was quarterly reviewed for encouragement to wards for their effort in achieving good death in dying patients.
-Long stay cases were reviewed monthly and found to be minimized through advance care planning. -Improvement in ECB booking compliance had minimized ad-hoc deferrals and cancellations, reduced ECB waiting time and improved ECB bed usage. -The number of patients recruited to STT was significantly increased from 11 to 79 within the one-year interval with DPC’s contribution in screening and coordination of the program. A total of 50 out of 79 cases had withdrawal of futile life-sustaining treatment, achieving good death accounting for hundreds of hospital days.
-Positive feedbacks and appreciation were received from family, medical and nursing staff. A positive image in nursing on end-of-life care was established.
-The number of long stay cases was minimized by 20% through advance care planning.
-Ad-hoc deferral and cancellation of ECB transfer were decreased by 97% and 95% respectively.
-The ECB waiting time was reduced from more than one week to 4.7 days and 5.5 days in female and male patients respectively.
-The ECB occupancy had decreased by 10% though increased transfer quota.
Co-location with:
