Page 178 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP6.1 Managing Service Demands 10:45 Room 221

A Casemix Analysis of Long Stay Extended Care Patients: Insight for Subacute Management Care Plan
Chan HLI
Department of Occupational Therapy, Kowloon Hospital, Hong Kong

Introduction

The transferral of patients from acute hospital to subacute hospital in the cluster can help to release overloading of high
occupancy rate in the acute wards. Despite comprehensive medical treatment and management, a number of patients still
require longer stay before ultimate discharge. An analysis of these patients will give insight to the frontline professional
colleagues on good practice of subacute management care plan.

Objectives

To understand the need and characteristics of the patients in subacute medical extended care wards who had a prolonged
stay.

Tuesday, 19 May Methodology

(1) Retrospective analysis of patients who admitted to two medical extended care wards in Kowloon Hospital, with a length
of stay (LOS) of 90 days or more. Only patients who were cared at home in premorbid state were included in the study. (2) To
illustrate that multidisciplinary management is the key to facilitate discharge of patients with complicated medical and social
problems by two case studies.

Results

24 cases in total were included in the analysis. Demographic characteristics are as followed: Sex - male: 8 (33.3%), female:
16 (66.7%). Mean age - 82.25 (Range from 61-90). LOS - 125.3 days (Range from 91-188). FIM(total 126) - score 18 (n=9
37.5%), score >19<50 (n=4 16.67%), score >50(n=2 8.33%, no record (n=9 37.5%). Discharge destination - death: 3 (12.5%),
Old Age Home: 13 (54.2%), home: 8(33.3%). Principal diagnosis on admission - cerebrovascular accident: 9 (37.5%), other
neurological conditions: 3 (12.5%), cardiac conditions: 4 (16.7%), respiratory medical conditions: 2 (8.3%), neoplasm: 1 (4.17%),
chronic renal failure: 2(8.3%), others: 3(12.5%). Death after discharge - 8 (33.33%). Cause of death (n=11) - pneumonia: 5
(45.45%), neoplasm: 3 (27.27%)), plmonary oedema: 1 (9.1%), acute myocardial infarction: 1 (9.1%), encephalitis/myelitis
1 (9.1%). Detailed study on two cases with prolonged LOS found that close communication of all team members by case
conference could start off the pre-discharge plan more smoothly. Motivational interviewing technique could help to
understand caregivers’ concern and could hasten process of making agreement on the discharge details. In addition, follow-
up actions by multidisciplinary effort would make safe discharge successful.

HOSPITAL AUTHORITY CONVENTION 2015

176