Room 421 May 14, 2019 oral abstract
Service Enhancement Presentation 10:45 - 12:00

Better Manage Growing Demands

Exploring the Validity and Feasibility of 365-day Rehabilitation of Using Modified Functional Ambulation Classification for Stroke in Kowloon Hospital
10:45 - 10:55
Presented by : Jocelyn CHAN

Introduction

Traditionally physiotherapy has been a weekday-rehabilitation for inpatients stroke, with limited service such as chest-physiotherapy at weekends and holidays. Extended weekend rehabilitation for stroke may improve patient care and outcomes by eliminating the interrupting pattern of stroke rehabilitation. Criterion for effective selection of appropriate candidates and feasibility of 365-day rehabilitation for weekend stroke rehabilitation in local context has not been formulated.

Objectives

This study aimed to evaluate correlations of total number of treatment-session of Physiotherapy and functional outcomes by using admission Functional Ambulation Classification (MFAC) stratifying patients into different level of mobility for stroke in Kowloon Hospital.

Methodology

Patients with stroke receiving weekday-rehabilitation admitted to Kowloon Hospital(KH) from October 2018 to December 2018 were recruited. Functional Ambulation Classification(MFAC) was used to stratify level of mobility on-admission. The score of Modified Barthel Index(MBI), Modified Rivermead Mobility Index(MRMI) and MFAC were rated by in-charge Physiotherapist on-admission and at-discharge. The change score of all outcomes were calculated. The total number of Physiotherapy-session during hospital stay in KH was assessed. Spearman’s rho correlation of SPSS 23.0 was used to analyze the correlations of change score of outcomes with total number of Physiotherapy session by using admission categories of MFAC.

Results & Outcome

Data from 46 patients with stroke aged 65.6±15.4 years were analyzed. 60.9% was male and 58.7% diagnosis of stroke from cerebral infarction and 41.3% from haemorrhage. All outcomes improved at discharged including gain score from MBI 23.3±13.2 (N=46), MRMI 9.7±5.9 (N=46) and MFAC demonstrated a median progression of 2 (N=46). The average total number of Physiotherapy-session was 23.1±11.0 (N=46). The total number of Physiotherapy-session were found to be significantly correlated with change score of MBI (ρ=0.86, p< 0.05), MRMI (ρ=0.97, p< 0.05) and with MFAC (ρ=0.764, p< 0.05), respectively in split group of category II admission MFAC. The significant strong associations uncovered between number of therapeutic-session and progression of functional outcomes in group of MFAC II suggested that prudent identified target clients for the upcoming 365-rehabilitation service for stroke would affect performance. The results warranted the feasibility of 365-day rehabilitation service for stroke and supported using MFAC as a user-friendly stratification tool.

 

 

Success of Technology-Assisted Care Model on Pre-Discharge Home Assessment in Tuen Mun Hospital
10:56 - 11:05
Presented by : Ivan CHEUNG

Introduction

Occupational therapist (OT) are often required to conduct home environmental assessment to ensure safety before discharge as part of their role in rehabilitation teams. To improve the timeliness of occupational therapy home visits for discharge planning, a technology-assisted care model on pre-discharge home assessment was developed in medical convalescence wards of Tuen Mun Hospital. The carers involved in the service needed to fill in a specific home assessment form, and OT received patients’ home photos and measurement forms by using a designated e-mail address and WhatsApp platform. OT assistants were assigned to organize the home photos after information received.

Objectives

(A)To reduce the number of referrals to Community OT team and time during home visit after the home photos and measurement screening. (B)Through online platform, early intervention of home modification could be conducted to facilitate health care team in pre-discharge planning.

Methodology

This care model was implemented in medical rehabilitation services in Tuen Mun Hospital. After conducting comprehensive initial assessment by OT, if home measurement and home photos were indicated for discharge planning, a standard assessment form would be given to patients’ carers. Carers could follow the instructions to measure home environment, take home photos and send back to OT afterwards. After receiving the information, OT discussed with patient and carers about home environment interactively during carer training sessions. Environmental intervention included prescription of assistive device, home modification and advice on home safety. OT could simulate actual home environment for patients to practice skills in managing threshold at toilet entrance and bathtub transfer. Furniture re-arrangement would be suggested to facilitate accessibility of wheelchair use. After screening the information collected, OT might consider to refer community OT team to conduct on-site home visit for major constructional home modification if needed.

Results & Outcome

From January to December 2018, 450 medical rehabilitation patients adopted technology-assisted care model on pre-discharge home assessment. 110 cases were referred to pre-discharge on-site home visit. This care model could stratify our patients to fast-track home safety intervention, greatly reduce the travelling time by OTs, especially some remote village house, thus the waiting time of home assessment was shortened. The technology-assisted care model on pre-discharge home assessment by occupational therapists was successfully implemented. This could increase the workflow efficiency of OT in services delivery and facilitate pre-discharge planning.

 

 

Occupational Therapy Service for Frail Elderly at Accident and Emergency Department
11:06 - 11:15
Presented by : Connie LEE

Introduction

With more elderly attending Accident and Emergency Department(AED), attention to common frailty syndromes has the potential to improve their outcomes in AED. Occupational therapist(OT) may help to identify their needs and offer support to enhance safe discharge to home. A pilot OT Frail Elderly Program(FEP) at AED of QMH composes of (1)OT screening at risk elderly at AED and (2)OT follow up for elderly with risk of fall or functional decline is developed. Patients underwent screening with fall risk or functional decline risk criteria achieved were triaged to different OT follow up interventions.

Objectives

To evaluate the potential of OT in AED to facilitate safe discharge of frail elderly from AED and to reduce their revisit to AED in six months.

Methodology

Between December 2017 to December 2018, a convenient sample of elderly visited AED of QMH with age above 75 years, lived at home with AED triage category 4 or 5 were screened by OT once a day. Patients with high fragility risk, having fall risk or functional decline risk, and discharged directly from AED were recruited. OT interventions which promoting active lifestyle and activity engagement; resolving risky behavior by multifactorial approach; promoting caregiver’s understanding of the concept of safe & active lifestyle, facilitate frail elderly to build up their reserve. Number of patients revisited AED in six months was retrieved from Clinical Management System. Association of OT follow up with repeated presentation to AED in six months was analyzed between groups of patients with and without OT follow up by independent t test.

Results & Outcome

Total 111 patients were screened with mean age 83.2 years, 57(51.4%) patients discharged from AED. 25(43.8%) patients received OT follow up and 32(56.2%) patients declined service. No significant difference in baseline performance between these two groups. Results showed that significantly less patients who received OT follow up(4, 16%) revisited AED in six months as compared with those without OT follow up(15, 46.8%) (p=0.014). This preliminary finding shows that OT follow up is associated with less revisit to AED in six months due to fall or deconditioning. This suggests that a short but individualized OT intervention might reduce vulnerable of fall and deconditioning in frail elderly.

 

 

Electronic Handover by Using a Structured eNursing Note Template
11:16 - 11:25
Presented by : Shuk Man Lo

Introduction

Nursing documentation is one of the responsibilities of nurses to record clinical documentation promoting continuity of care and safe care. Accurate nursing record is an important factor to facilitate clinical handover and communication of patient information. In previous practice, Handover Sheet was used to record patient information and progress for clinical handover. However, the design appeared incomprehensive. Retrieval of patient information was difficult due to multiple pages without eye-catching remarks. Additionally, physical storage of Handover Sheets was limited and shredding was required for disposal. In view of the corporate direction of building digital workplace and the limitations of the Handover Sheet, an initiative was formed to develop an electronic Nursing Note Template for nursing documentation facilitating electronic based handover. Considering the benefits of the electronic nursing note template, it ensures secure access via Clinical Management System (CMS), turns paper documents into digital files and goes paperless. It markedly helps for efficient search of patient information of standard format facilitating effective handover in a consistent delivery of patient information and enhancing patient information communication between shifts and between health care professionals. More importantly, it retrieves patient information in a timely manner as access is possible everywhere when CMS device is provided.

Objectives

To change nurses’ behaviours by using a structured electronic nursing note template to conduct electronic handover.

Methodology

1. To design a structured electronic nursing note template for nursing documentation. 2. To conduct few meetings in order to explain and clarify any problems and to reach consensus. 3. To develop and introduce an instruction manual on use of electronic nursing note template. 4. To observe the change of the way of using electronic nursing note for handover.

Results & Outcome

The evaluation showed the process was successful. Most of the nurses accepted the change of handover practice. Compliance to using electronic handover was 100%. Effective handover in a consistent manner was achieved. This change is a close match with the current work activities promoting operational efficiency. Apart from this, patient information communication between shifts and between health care professionals was enhanced.

 

Revolutionizing Infectious Diseases Surveillance using Big Data - a Web based Dashboard
11:26 - 11:35
Presented by : Kristine LUK

Introduction

The emergence and spread of multidrug-resistant organisms (MDROs) are causing a global crisis. Among S. aureus isolates identified in the hospitals of Hospital Authority, 43.1% were MRSA; 55% and 8.6% of Acinetobacter species were carbapenem-resistant and multi-drug resistant, respectively (unpublished data). In continuing the response to this serious public health issue, World Health Organization (WHO) stated the priority area is improving surveillance of antimicrobial resistance. To stop the chain of transmission, early identification and monitoring of patients with MDROs are essential. In the Kowloon West Cluster (KWC), for culture isolates which are multiple drug resistant, laboratory staff would manually add infection control team as the printing location of the reports. Infection control personnel would then review the laboratory reports and the patients’ movements to recognize the source of acquisition or association; and the unusual clustering of MDROs at ward units within a time period. As the burden of MDROs is ever increasing, and the complexity of tracking patients’ journeys, early identification of potential MDRO outbreak is extremely difficult, if not possible. Improved efficiency and automation is thus urgently needed to cope with the heavy burden. Reference: 1. World Health Organization. Global Action Plan on Antimicrobial Resistance. [Internet]. Switzerland: World Health Organization; 2015 p. 1–28. Available from: http://www.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1

Objectives

1) To pilot a web-based infectious disease dashboard surveillance information system developed by HA Information Technology & Health Informatics (HA IT&HI) in the KWC hospitals 2) To evaluate the system performance – by accuracy of MDRO detection and classification of specimen reports, and early clustering detection

Methodology

This is a prospective comparative study on the system performance of a web-based infectious disease dashboard https://dccmdro.home/Login.aspx to capture patients with MDROs and their respective hospital movements over a 3 months period. The online system retrieves microbiology culture and screening results from The Laboratory Information System (LIS) and the corresponding patients’ movements from the Patient Admission Information System (PAIS) at every midnight. Patients with history of MDROs are identified, with respective to all the locations in the hospital for the same admission. History of admission to HA hospitals is also displayed for up to 12 weeks. The distribution and the density of MDROs cases within the hospital are also visually displayed in a 3 dimensional floor plan, under Geographical View. A list of MDROs patients (the bed number, transfer-in time, and the duration between transfer-in and isolation of MDROs) residing in a particular ward can be viewed. The statistical view shows the number of newly reported MDROs acquired in different wards, which is defined as detection of MDROs after 48 hours of transfer-in or within 48 hours of transfer-out, in a defined period. Potential clustering can be detected at an early stage; and it also captures the positive specimens collected in other HA hospital. Patient tracing for each type of MDROs within a defined time frame, which is used to be performed manually, can be automated. The image can be exported for communication with frontline managers.

Results & Outcome

The system generated data of newly acquired MDROs at ward units is highly concordant to the data manually defined by infection control personnals. Besides, the automated patient tracing in a graphical presentation allows ICT to alert frontline managers for ward acquired MDROs cases, on a routine basis; which is impossible if performed manually. Last but not least, the system identified additional MDROs cases as laboratory staff may miss adding ICT as the printing location.

 

 

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