Authors (including presenting author) :
Leung HY(1), Tong WCM(1), Lee MY(1), Cheung PK(1), Tsang WW(1)
Affiliation :
(1)Department of Medicine, North District Hospital
Introduction :
In the past 20 years, the CR care for our medical patients was mainly supported by Tai Po Hospital. With the increased demand of acute care due to aging population, the CR care became more important to support early discharge, patient rehabilitation and sustainability of community care after acute illness condition so as to reduce emergency readmission. Due to the geographical reasons, some patients and carers who lived in the North District were reluctant to cross district. It would increase the burden in acute wards as the manpower and bed resources were very tight. In view of its service needs, a male CR ward was established and collocated in an acute hospital.
Objectives :
1. To shorten the length of stay in acute care
2. To improve patient journey from acute to CR care
3. To facilitate the continuum and coordination of care
Methodology :
Geriatric Nurses are responsible for screening the patients in mixed gender wards or male wards under the criteria for CR transfer and select suitable case upon bed availability of CR bed. The elderly patients with complex needs are being assessed by CGA (Comprehensive Geriatric Assessment). Since the screening has been done on every weekdays, “Patient screening”, “CR bed booking” and “Patient transfer” are feasible to be performed on the same day. A multidisciplinary team which included Geriatrician, Physical therapist, Occupational therapist, Medical social worker, Geriatric nurse and Case nurse will conduct case conference regularly to address the focused problems of the patients with an agreed treatment plan or early discharge plan.
Result & Outcome :
Starting from 20th April, 2018, there were 20 CR beds led by Geriatrician located in one general medical ward to support post-acute care in NDH and it increased to 40 CR beds in October. “Patient screening”, “CR bed booking” and “Patient transfer” performed on the same day accounts for 20% of total admissions. In conclusion, the length of stay in acute care is shorted and the patient journey from acute to CR bed can be faster, flexible and focused. As a collocated CR ward within an acute hospital, it serves a better support and benefits for our patients in NDH, since the continuity of care can be maintained under our Medical Department.
Co-location with:
