Page 68 - HA Convention 2016 [Abstracts (Day 2)]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F6.2 Managing Service Demands 10:45 Room 421

Enhancing Management of “Category A” Emergency Operation Booking to Optimise Care and Use of Scarce
Resources — Pilot Study
Cheang SN 1, Lam SC 2, Hung KN 3
1Department of Cardiothoracic Anaesthesia, Queen Mary Hospital, 2Department of Surgery, Tung Wah Hospital, 3Operating Theatre

Services, Hong Kong West Cluster, Hospital Authority, Hong Kong

Introduction

In Hong Kong West Cluster, prioritisation decisions would be difficult in situations of multiple Category A emergency
operation bookings due to tight operating theatre (OT) resources, limited OT sessions and great discrepancy in estimated
time frames between Category A (<1 hour) and Category B (<12 hours) operations. To ensure effective use of OT resources
and optimise care for patients requiring emergency operations, an initiative was implemented to better prioritise multiple
Category A emergency operation bookings using Modified Early Warning Scoring (MEWS).

Objectives
To better prioritise and optimise care of patients in situations of multiple Category A emergency operation bookings.

Methodology

(1) Introduce MEWS in Operation Theatre Management System (OTMS) to identify category A patients requiring earlier
operations.

(2) Assess all booked cases on an ongoing basis for re-categorisation if required.

(3) MEWS was used to facilitate prioritisation decision because of the following reasons: (a) Raised MEWS was associated
with increased mortality in a group of patients requiring emergency operations. Calculation of MEWS could therefore be
useful for identifying patients with highest risk of deterioration and making prioritisation decisions in order of performing
emergency operations among Category A patients. (b)MEWS can be used as objective reference to prioritise use of
scarce OT resources in situations of multiple Category A patients awaiting emergency operations. (c) MEWS can improve
communication and cohesion among surgeons, anaesthetists and nurses in emergency teams to “flag-up” patients
requiring immediately Category A emergency operation.

Wednesday, 4 May Results

From January 2015 to May 2015, 50 Category A patients were randomly selected for collection of MEWS and for emergency
operations. The result confirmed good correlation between MEWS and waiting time for Category A emergency operations.
Patients with higher MEWS showed a trend of shorter emergency operation waiting time; and patients who were originally
booked as Category B and subsequently upgraded to Category A emergency operation also showed increased MEWS due to
deteriorating conditions.

Conclusion

MEWS has proven useful in identifying patients with high risk of deterioration. It is effective in prioritising Category A
emergency operations bookings and optimising use of scarce OT resources.

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