Page 114 - Hospital Authority Convention 2018

Service Enhancement Presentations
Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F1.1 Better Manage Growing Demands 10:45 Room 421

Success Model of Pre-discharge Lounge in Department of Medicine of Queen Elizabeth Hospital
3
3
3
3
Cheng WY 1,2,3 ,Yao PW 1,2,3 , Pang HL , Siu YS ,Cheng HS , Lam TC , Leung KL 3
1 2 3
Admission Working Group, Workflow Committee, Task Force on Pre-discharge Lounge, Department of Medicine,Queen
Elizabeth Hospital, Hong Kong
Introduction
Emergency department (ED) access block is an urgent problem faced by many public hospitals today. It increases ED waiting
time and leads to ED overcrowding. It affects the efficiency and quality of care, and increases incidence of adverse events as
well as mortality.
To alleviate access block, Pre-discharge Lounge (PDL) was set up as a pilot programme in Department of Medicine in Queen
Elizabeth Hospital. This lounge is designed for patient to wait for transport and discharge arrangements.

Objectives
To assess if the PDL can facilitate patient flow with effective use of inpatient acute care beds; (2) to reduce admission waiting
time; and (3) to review overall patient experience and satisfaction outcomes.

Methodology
Monday, 7 May 2018 service model for discharge was developed.
Taskforce on PDL was formed under the Department of Medicine. Access block factors were identified and an innovative

The lounge was available for use by patients on the day of discharge or transfer and awaiting completion of discharge
arrangements. In PDL, nursing care such as hygiene, nutrition, administration of medications was continued and patient
education was also conducted. Beds and sitting facilities are available for up to 12-14 patients.

Operating hours of PDL is from 10am to 7pm weekdays supported by nurses, supporting staff including clerical staff, patient
care assistant and sunshine transport team, and with emergency support from medical team.

Booking and logistic workflows were introduced to wards. Patients who meet met the criteria for PDL could be arranged to
PDL by ward staff will be informed by staff and escorted to PDL by sunshine transport team. The effectiveness of PDL was
evaluated based on bed utilisation; number of patients in ED access block and workload distribution in wards was compared
before and after PDL was set up.
Results
The first phase was (winter surge) from 30 December 2016 to 12 May 2017 and the second phase was (summer surge) from 24
July to 29 September 2017. 1,151 and 803 patients were transferred to PDL during winter and summer surge with 90 & 62 bed
days saved respectively. The ED access block was decreased from 1,655 to 278 patients, and admission time was reduced
from 15:00 hours to 12:00 hours when compared to with 2016 winter surge.
Moreover, 150 satisfaction questionnaires were received from patients (19% return rate) in second phase. 82% and 18% rated
excellent and good in the overall experience in PDL respectively. The result reflected that PDL provided a good environment,
smooth discharge arrangement and better care with discharge education. It facilitates ED patient flow and expedites patient
discharge.

Conclusion
PDL can provide a safe and comfortable area for patient to wait for discharge. This new discharge service significantly
improved patient flow and effective use of bed to decrease access block in ED. In conclusion, PDL should be promulgated
and included in new hospital design.

112