Work rehabilitation (WR), target at helping patients return to work, was one of the core service of Occupational Therapy (OT) since its beginning in 1950s. In 2002, a major revamp of the service model to reorganize the WR service for standardization and improvement was conducted by the Work Rehabilitation Specialty Group (SG) under the OTCOC in HA. Idea of designated centers in each cluster was adopted which helped to align service standard and nurture expertise. As a result, 10 designated Work Rehabilitation Centers (DWRC) is formed.
In 2004, the 10 Work Rrehabilitation centers started to collect data on patients’ profile, throughput and outcome; and formed a minimal data set. Regular analysis of the data provided valuable information for service planning and evaluation. This presentation is the review of the application of the data set from 2004 till 2018.
Over these years, a number of quality improvements were made.
1. Learning that the majority of the caseload condition is Low Back Pain (LBP) of Musculoskeletal Conditions, a LBP Work Rehabilitation Protocol was developed in 2005 - 2007 to share among the DWRC.
2. Analyzing the factors for delaying the outcome of return to work is related to psychosocial issues, a reference to enhance work readiness and return to work process were developed in 2013. The practice was aligned among the OTs of the DWRC.
3. After learning the data characteristics of the majority condition groups, focus of data collection changes towards those new emerging clinical conditions which in need of work rehabilitation protocol development in 2016. These include Cardiac, Oncology, CVA, Neurological and Other Medical conditions.
4. With increasing cases of injured commercial drivers refer for work rehabilitation, a Driver Rehabilitation Protocol for this occupational group is developing in 2018
Lately, with the OT Work Rehabilitation Assessment report (in CMS) could be interfaced by the Clinical Data Analysis and Reporting System (CDARS) in December 2016, the collection method change from paper marking format to extraction of minimal data in CMS by CDARS. The validation of the conversion was conducted by a 3-month project. Satisfactory outcome was shown with the mean of accuracy is 90% .
In conclusion, the minimal data set helped to build a more effective Service Delivery Model among the DWRC. Quality of practice of OT in work rehabilitation service in HA is standardized. This further facilitates the development of relevant condition-specific protocols with evidence and local trial.
 

Attaining upper limb functional recovery in stroke patients is always an ambitious goal for health care professionals. Recent evidences suggested that Non-invasive Brain Stimulation (NIBS) techniques could enhance upper limb functional recovery in stroke patients. 
A pilot upper limb rehabilitation program utilizing one of the NIBS techniques – Transcranial Direct Current Stimulation (tDCS) for stroke patients was developed. The program evaluation showed that combined tDCS and physiotherapy treatment have positive effect on enhancing upper limb functional recovery in stroke patients. In the light of the positive results of this program, another NIBS technique – Transcranial Magnetic Stimulation (TMS) was introduced in physiotherapy department.
This presentation will give an overview on TMS, and share the local experience of developing physiotherapy TMS service. Service review suggested that repetitive TMS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in acute stroke patients. And these positive findings warrant further investigation of the application of this non-invasive brain stimulation technique to neuro-rehabilitation.
 

Incidence of incorrect annotation of radiological images is common in radiology  department and can lead to grave consequence of patient. At radiology department, image annotation about the laterality (e.g. Left, Right) or view position (e.g. AP, PA) is required for every image. As the annotation process is a pure human performed procedure, human error is inevitable. The common type of  incorrect image annotation includes wrong laterality of extremity images and falsely flipped Chest  images. Falsely flipped Chest images can cause the patient misdiagnosed as dextrocardia. If physician based on the falsely flipped Chest image to perform the drainage procedure for pleural effusion, a wrong side chest drain incidence can occur. Wrong laterality of extremity images is the other commonly occurred incidence at radiology department. For example a left hand X-ray image may be labeled with right, such error can potentially mislead radiologist and result in wrong side report. In order to minimize the incorrect annotation incidence at radiology department of Pok Oi Hospital, a radiological quality control application SureSide is developed to minimize the wrong annotation of radiological images.
SureSide is a self developed DICOM application with computer vision capability to analyze the dicom tag and the annotation of radiological image, it is a server-client application with server situated at PACS network to receive auto-routed DICOM objects from PACS server and client  installed at the workstations of radiological exam room to display the warning windows if incorrect annotation is detected at the image. By extracting the pixel data of the DICOM object, the image is evaluated by the open source computer vision library OpenCV to detect image of digital marker or physical maker. Simple computer vision technique “template matching” is used to detect image of digital marker, while feature descriptor named “KAZE” is used to detect the image of physical marker. If discrepancy is found for image’s dicom tag of “View Position” and the image of annotation, a warning window will pop up at SureSide’s client to alert Radiographer, so Radiographer can rectify the problem image as soon as possible.
Apart from the falsely flipped Chest images, SureSide is also capable to detect the wrong laterality labelled images. By counter checking the laterality of requested exam and the marker(Left/Right) applied at the image, SureSide can spot out the wrong laterality marker.
 

Facing with an ever-increasing turnover rate and increase fragility of in-patient in Shatin Hospital, finding an effective method to improve the accuracy in treatment prescription and improving the patient safety is always our utmost concern. 
Recent advancement of technology empowers us to have an innovative idea in address this issue. In 2014, we work together with an IT company in designing and creating the PMS.
In this new project, we designed the layout and display of the hardware and laid down the simple logistic in operation while the company offers us the technical support in software and hardware development.
PMS is a computerized system for Occupational therapist to manage daily treatment activities scheduling and provides vital signs monitoring for patients. When using PMS, patient’s journey in Occupational Therapy starts from check-in to the system, implementation of training activities, vital signs real-time monitoring, precautions alert and check out. This system can also provide summary reports for therapist to review patient’s progress and update treatment accordingly.
PMS launched out in Jul 2015 after about a year’s development and preparation work.  The succeed of PMS in improving patient safety, treatment accuracy and operation efficiency encouraged us to continue develop and explore its application potential.
Currently we are developing the phase 5 PMS in Shatin Hospital. With continuous evolution and enhancement, PMS is now consisting 6 operation modules: 1) Monitoring and Scheduling System (MS), 2) Monitoring and Scheduling System GDH (MS GDH), 3) Aids Loan System (AL), 4) Wheelchair Management System (WSM), 5) Mobile Outcome Measurement (MOM) and 6) Psychiatric Mobile Outcome Measurement (PMOM).  The coverage is not limited to rehabilitation in-patient, but also extended to Geriatric Day Hospital and psychiatric in-patient as well.  From now on, every detail about our patients, including their diagnosis, precautions, monitoring data, prescribed training and performance outcomes were stored in the Hospital no. as a barcode on their wristbands.
Objectives
1. Provide the right treatment to right patient within the right amount of time
2. Minimize human error in vital data capturing
3. Improving efficiency and accuracy of treatment scheduling and monitoring
4. Facilitate electronic documentation and clinical outcome evaluation 
5. Improve the efficiency and monitoring of clinical operation systems 
Major components of PMS
1. Tablet PC for prescription of training, precautions and monitoring 
2. Handheld barcode scanner for recap of prescribed instructions and data recording
3. Bluetooth gadgets for vital monitoring 
4. VGA TV for display of scheduling and monitoring information
5. Back-end server for centralized data analysis and management 
 

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care resulting in substantial improvements in clinical outcomes and cost effectiveness. It is a multimodal and multidisciplinary approach for surgical patients. A local ERAS team was established in United Christian Hospital since 2017 and Physiotherapy (PT), as one of the core members had her key roles re-defined from pre and post-operative physiotherapy to (1) pre-operative risk stratification; (2) pre-habilitation; and (3) post-operative early mobilization for facilitation of recovery.
In pre-operative phase, PT delivers the service directly in surgery clinic where stratification of cardiac risk and empowerment for pre-operative physiotherapy are performed. Screening of cardiac risk through Functional Capacity Evaluation using Step Test enriches Anesthetist’s comprehensive pre-operative assessment. Cases with the Revised Cardiac Risk Index score > / = 2 are indicated for the test and patients achieved lower than 4 METS would be alerted for further investigation and optimization before the surgery.
Multi-disciplinary collaboration in the joint clinic not only facilitates one-stop patient service, but also enhances inter-disciplinary communication in which patients with suboptimal physical capacity are identified and recruited for pre-habilitation. This is either a home-based or out-patient conditioning program, making use of individualized and specific exercise regime to augment functional incapacitation and speed up recovery after operation.
Post-operative “Early Mobilization” defined as mobilizing out of bed at least once in the first 24 hours (D1) after operation is one of the key predictors of successful hospital discharge. With better pain management and nausea control, upright mobilization could be advanced to operative day. Mobility Cue Card facilitates inter-disciplinary communication and collaboration in ward where patients are continuously receiving rehabilitation until regaining independency in ambulation.
From 2017 to 2018, a total of 351 patients (224 male, 127 female, mean age 70.6) having colorectal surgeries are under the ERAS program. Data analysis reveals that (1) 51% of patients required Functional Capacity Evaluation Test; (2) more than 80% of patients achieved upright mobilization on D1 and (3) more than 98% of patients achieved independent ambulation and directly discharged home after surgery.
ERAS is an evidence-based care improvement process requiring collaborative team work and PT is a core member throughout the patient journey from risk stratification to rehabilitation pre- and post-surgery.