Page 49 - HA Convention 2016 [Abstracts (Day 1)]

Service Enhancement Presentations HOSPITAL AUTHORITY CONVENTION 2016

F1.4 Service Revamp 13:15 Room 421

A Seven-year Analysis of Emergency Nurse Practitioner Clinic in Hong Kong
Lee KH, Chung JYM, Cheng CH, Cheung NK
Trauma and Emergency Centre, Prince of Wales Hospital, Hong Kong

Introduction

With the growth in the number of patients and shortage of medical staff over the past few years, there has been an increasing
burden on the delivery of quality patient care. This can be reflected on the prolonged waiting times and length of stay in
Accident and Emergency Department. Evidence suggests that nurse-led services providing high quality patient care may
alleviate the problem of increasing patient attendance.

Objectives

(1) To evaluate the effect of introducing a nurse-led clinic service on patients’ waiting time and patients’ length of stay in Tuesday, 3 May
Emergency Department (ED); and (2) to evaluate the diagnostic and treatment accuracy of the nurse-led clinic.

Methodology

A retrospective observational study was carried out with data recorded between 1 July 2007 and 31 December 2014 from all
patients attending the emergency nurse clinic in the Prince of Wales Hospital. Data reviewed included patient characteristics,
documentation adequacy and appropriateness, diagnostic and treatment accuracy, waiting time for consultation, processing
time and attendance rate.

Results

Among 8,723 patients, 69% aged 16 to 60 years were seen. 95% patients were in triage category four. Problems included:
soft tissue injury to limbs (46%), wounds (12%), limb fracture (11%), soft tissue infection (3%), eye condition (4%), foreign
body in soft tissue or throat (5%), gout (5%), minor head injury (3%), animal bite (2%), scald (2%), and joint dislocation (1%).
Retrospective review of patient record by a senior doctor showed 100% accuracy in choice of investigation and diagnosis,
and 99% accuracy of X-ray interpretation. Clear documentation of the presenting problem for audited items was between
97% and 100%. The Emergency Nurse Service reduced average waiting time (from registration to emergency nurse
consultation) and processing time (from registration to discharge) by 71 minutes and 112 minutes respectively. The re-
attendance rate was 0.4% with no inaccuracy of initial diagnosis made on the first attendance that affected subsequent
patient management outcomes. Reengineering the ED service by fast tracking minor cases to emergency nurses was
positive. Patients with minor injuries received safe, effective and holistic treatment in a timely manner.

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