Page 109 - Hospital Authority Convention 2017

Parallel Sessions
Parallel Sessions

PS1.1 Nursing Services at the Front Door of the Hospital 13:15 Room 221

Geriatric Front Door Programme – How the Geriatric Nurses Strive to Make the Best Possible Elderly Care
Lee MY
Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
High medical inpatient occupancy rate up to 114.2% in Prince of Wales Hospital was noted in 2016. Frail elderly Accident
and Emergency Department (AED) attendances were likely to be admitted since the current emergency care model does
not fit their needs. In the winter surge months of 2016-17, Geriatrics at AED Front Door Team (GFD) was introduced that
Geriatric Nurses work together with geriatrician for active diversion screening. Elderly patients aged>65 triaged with category
3 and 4 pending for ward admission in Medical and Therapeutics (M&T) unit by AED physician were screened by brief
Comprehensive Geriatric Assessment (domains such as acute illness conditions, cognitive impairment, functional disabilities,
frailty, caregivers stress and individualised focused assessments) to decide the appropriateness for geriatrician diversion for
direct home or direct transfer to Shatin Hospital for further care. Geriatric Nurses help to coordinate GFD admission diversion
workflow in AED such as communication with caregivers, collaboration with Rapid Response Community Team for discharge
support and performing focused patient care. With the introduction of Geriatric Nurses in 2016-17 during winter surge period
(19 December 2016 to 31 March 2017), 1,035 elderly patients were screened and 377 of them were identified for geriatrician
assessment in which 229 patients are successfully diverted eventually. The results showed that the Geriatric Nurses were
able to identify a significantly increased number of patients for GFD admission diversion purpose by 2.5 times (148 in 2014-
15 vs 377 in 2016-17 and 2 times (187 in 2015-16 vs 377) in 2016-17 respectively, compared with the previous model in which
patients were selected by AED senior physicians for geriatrician screening. Geriatric Nurses are competent to identify suitable
patients when compared diversion results among three years’ period [82 out of 148 (55.4%) in 2014-15, 123 out of 183 (67.2%)
2015-16, 229 out of 377 (60.2%) in 2016-17]. Geriatric Nurses facilitate geriatrician diversion process with proactive initial
screening to increase efficiency and throughput, and promote a more elderly friendly emergency care. Tuesday, 16 May

PS1.2 Nursing Services at the Front Door of the Hospital 13:15 Room 221

Extended Roles of Stroke Nurse to Streamline Acute and Hyperacute Stroke Care Service
Mok MYN
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong

Stroke is a very common life-threatening disease, and is the fourth leading cause of death in Hong Kong. There are
approximately 13,000 acute stroke admissions in Hospital Authority annually with 80% ischaemic stroke (IS). In view of this,
worldwide initiatives have focused on current evidence-based and acute hyperacute stroke care in IS that nurses play a
pivotal role in all phases of stroke patient care.
In the past 10 to 20 years, Stroke Nurse (SN) has become a new post with core role as a coordinator in Hong Kong. SN also
takes the combined roles as case manager, facilitator, tissue plasminogen activator (TPA) nurse, and has brought in new
challenges with an advanced path to become a SN expert; either as Advanced Practice Nurse or even Nurse Consultant to
run Nurse-led Clinic in secondary prevention. Moreover, SN not only works independently in planning and leading a team
to develop clinical tools, organising team members and departments to expedite activities in stroke care, but also monitors
outcomes and initiates quality initiatives to improve care. The increased TPA usage, improved door-to-TPA times, and
enhanced department collaboration in running thrombolysis service all serve as strong evidence of what SNs have achieved.

In most foreign countries, SN is only assigned for a single duty. But Hong Kong is relatively short of neurologists, well-
trained SNs do support our new challenging service. They follow hospital guidelines and protocols, tailor-make workflows
and specific stroke assessment tools for early identification of acute stroke with Emergency Department (ED) to provide
appropriate treatment. In other words, SN service has been associated with some operational changes to make things more
effective. For better collaboration, “Stroke Nurse/Nursing Team” was formed such that all SNs can work together in rotation
on all different jobs, complement with stroke multidisciplinary team support for catering more comprehensive stroke care
service from Accident and Emergency Department to community.

In future, roles of SNs will be expanded to stroke rehabilitation care in the continuum of stroke care.

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