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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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