Page 61 - HA Convention 2016 [Abstracts (Day 1)]

Service Enhancement Presentations HOSPITAL AUTHORITY CONVENTION 2016

F3.2 Clinical Safety and Quality Service I 14:30 Room 421

Collaboration Using “Gold Standard Framework” — a Review of Three-year Experience of Non-Cancer Palliative

Care Project in Hong Kong West Cluster
Chan KY 1, Sham MK1, Li CW 1, Lai T 1, Wong MS 1, Kwok C 1, Lau VWK1, Cheung KC 1, Jim MH 2, Yip T 3, Yap DYH 4, Chew YT 5,
Wong J 6
1Palliative Medical Unit, Grantham Hospital, 2Cardiac Medical Unit, Grantham Hospital, 3Renal Unit, Tung Wah Hospital, 4Renal
Unit, Queen Mary Hospital, 5Informatics and Operations Research Office, Hong Kong West Cluster, 6TWGHs, Jockey Club

Rehabilitation Complex

Introduction Tuesday, 3 May

Non-cancer palliative care (PC) project was introduced in Hong Kong West Cluster (HKWC) since 2011. By using collaborative
model with different medical teams (cardiac, renal, respiratory, geriatric and neurology), we chose suitable end-stage organ
failure patients for palliative care based on the “Gold Standard Framework” (GSF) criteria during joint round and clinic. The
project also involved community collaboration with “Embracing the Setting Sun” team in an elderly home which served a
group of blinded patients with medical illness. Direct admissions for symptom control and end-of-life care to PC unit were
arranged so as to avoid unnecessary casualty attendance.

Objectives

To study the impact of PC on symptom burden, acute admission rate (AAR) and caregiver burden.

Methodology

(1) Service deliverables were estimated between June 2012 to May 2015. (2) Symptoms were evaluated by Edmonton
Symptom Assessment Scale (ESAS) in outpatient. (3) AAR and total length of stay (TLOS) in acute and convalescent hospitals
for high-risk group were compared six months before and after receiving PC. (4) Caregiver burden was assessed by Zariet
Burden Inventory (ZBI) for six months by paired t-test.

Results

(1) There were 898 new cases in total referred with 3,824 clinic attendances, 3,739 home visits, 4,541 social worker
consultations and 394 hospice day care attendances during the evaluation period. The primary diagnosis included 56
% congestive heart failure, 33 % end-stage renal failure and 11 % (chronic obstructive pulmonary disease, dementia,
myopathy). (2) Notably, renal palliative care patients had high baseline symptom scores. After three month of PC, the mean
ESAS symptom scores were reduced significantly including pain, depressed mood and edema domains [4.6(2.1) vs 1.6(1.4);
3.1(2.6) vs 2.3(2.2); 1.9(1.2) vs 1.2(0.9), p<0.05]. (3) There were 279 patients identified as high risk for readmission. Mean AAR
and TLOS per patient were reduced significantly six months after PC [2.4(1-9) vs 1.1(0-7), 27.7(2-128) vs 11.5(0-105) days
respectively, p<0.05]. (4) “Direct admission” was made in 52% of the elderly home patients. (5) ZBI scores were reduced
significantly after three month of PC [32.8(12.2) vs 21.3(6.6), p=0.009] and found insignificant improved at six month. This
report showed that non-cancer PC project was successfully implemented in HKWC under collaborative model by using GSF.

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