Page 97 - HA Convention 2015

Special Topics

ST5.4 Allied Health I — Collaborative Service Programmes 13:15 Theatre 2

Cross Disciplinary for Success — the MacLehose Medical Rehabilitation Centre Neuro Team Monday, 18 May
Chan T 1, Cheng S 2, Cheng MW 3, Mak A 4, Fung C 5, Leung R 6, Pu J 7
1Physiotherapy Department, 2Occupational Therapy Department, 3Speech Therapy Department, 4Clinical Psychology Department,
5Nursing Division, 6Medical Social Services Department, MacLehose Medical Rehabilitation Centre,
7Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, Hong Kong

Teamwork is important in contemporary rehabilitation of patients with complex needs who require concerted efforts of
different healthcare professionals with specialised knowledge and skills. Therefore comprehensive quality care can be
provided to enhance patient outcomes. The need for team approach is particularly evident in the neuro-rehabilitation of
neurosurgical patients after surgical interventions. However, it is not easy to build an effective interdisciplinary team as
different skill-mix, working routines, relationships and departmental boundaries can affect teamwork. In this presentation,
we would like to share our experiences of providing interdisciplinary team care to neurosurgical patients in the MacLehose
Medical Rehabilitation Centre (MMRC).

The MMRC NeuroTeam consists of different healthcare professionals, including the neurosurgeon, occupational therapist,
physiotherapist, speech therapist, clinical psychologist, medical social worker and nurses. Coordinated interdisciplinary
care, led by neurosurgeon and active collaboration of team members, is provided to neurosurgical patients. Through team
meetings and communications, patients’ rehabilitation goals and interventions are discussed, agreed and implemented,
with patients’ progress reviewed regularly. Honest discussions and respect are key values upheld among team members
to resolve conflicts. A good working relationship is considered as the prerequisite for effective team functioning. In 2012,
the MMRC NeuroTeam was awarded the Outstanding Team in the Hong Kong West Cluster. The experiences of MMRC
NeuroTeam demonstrate that effective interdisciplinary teamwork is driven by the following components: leadership with core
values in patient-centred care, clear role, effective communication, mutual respect and trust among team members.

In summary, effective interdisciplinary teamwork requires a patient-centred culture which values communication and
collaboration among team members.

ST5.5 Allied Health I — Collaborative Service Programmes 13:15 Theatre 2

A Multidisciplinary Collaborative Rehabilitation Service Model in Pamela Youde Nethersole Eastern Hospital HOSPITAL AUTHORITY CONVENTION 2015
Wan S 1, Yeung J 1, Chiang LF 1, Ng A1, Leong R 2, Cheng KW 2, Ng E 2, Kwong D 2, Wan J 3, Cheng C 3, Cheng YC 4, Chan YK 4,
Tsang WL 4
1Physiotherapy Department, 2Occupational Therapy Department, 3Prosthetic-Orthotic Department,
4Orthopaedic and Traumatology Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong

The Multidisciplinary Day Ward (MDW) in Pamela Youde Nethersole Eastern Hospital was set up in 2009 to provide one-stop,
intensive day rehabilitation services with an aim to achieve faster patient recovery. Acute orthopaedic and medical patients,
after hospital discharge, benefit from specialist services including doctors’ consultation, specialist nursing care and intensive
rehabilitation programmes from MDW. Taking total knee replacement (TKR) as an example, the average length of stay (LOS)
before set up of MDW was 15.62 days in 2008. The LOS decreased to 12.01 days in 2009 and has further decreased to 8.68
days in 2014. The unplanned re-admission rate has remained low (2% in 2014).

Outcome evaluation for physiotherapy: Retrospective review for 127 unilateral TKR patients showed that the average length
of rehabilitation decreased from 148.2 days in 2008 to 84.1 days in 2009, and to 77.2 days in 2014. Those patients discharged
from MDW would be followed up by physiotherapy outpatient clinic with the same team of therapists. Among patients
discharged from physiotherapy outpatient clinic, 80% had an American Knee Society Score of ≥80, which was categorised
as excellent and good. 98.2% of the patients walked unaided or with a stick; 83.3% could walk stairs; 98.2% were outdoor
walkers and 78.9% could walk more than 30 minutes.

Outcome evaluation for occupational therapy: Retrospective evaluation was performed on 69 patients with unilateral TKR.
Progress of functional performance was measured by using the Modified Barthel Index (MBI) and active range of motion
(AROM). Short longitudinal analysis showed that net AROM was improved statistically during early ambulatory phase (Mean:
19.8°+ 9.9°, P<0.001). Improvements were also found in the activity of daily living (ADL) with MBI score (Mean: 98.5+2.1) and
AROM (Mean: 98.62°+17.4°) 4 weeks post discharged from MDW.

To conclude, the “Collaborative Rehabilitation Service Model” facilitates effective rehabilitation for patients after TKR in early
phase. With the success of MDW, the Orthopaedic and Traumatology Department, Accident and Emergency Department
and Allied Health Services have developed a pilot project of Emergency Orthopaedic Day Service (EODS) in 2013. The
Integrated Allied Health day services facilitate same-day discharge for the emergency orthopaedic patients and shorten
LOS of inpatients. The programme has achieved safe practice and encouraging outcome. From January to December 2014,
around 73% of the 766 EODS patients were discharged on the same day whilst the rest were admitted to Orthopaedic ward
for further management.

95