Page 117 - Hospital Authority Convention 2018

Service Enhancement Presentations

F1.4 Better Manage Growing Demands 10:45 Room 421

Pilot Service of Occupational Therapy in Geriatrics at Hospital Front Door Programme
Choi WKG, Leung LFT, Ng PCA, Yiu HHS, Au LYF
Occupational Therapy Department, Prince of Wales Hospital, Hong Kong
Introduction HOSPITAL AUTHORITY CONVENTION 2018
High medical inpatient occupancy rate persisted in Prince of Wales Hospital especially during winter surge. In March 2017,
Occupational Therapy Department collaborated with Acute Care of Elderly unit (ACE) to provide Geriatrics at Hospital Front
Door service (GFD) in order to promote early and safe supported discharge of elderly patients in Accident and Emergency
Department (AED)/Emergency Medical Ward (EMW).

Objectives
(1) To screen patients in AED to prevent avoidable admissions;
(2) to enable early and safe supported discharge from AED/EMW; and
(3) to support “Through Train Service” in both AED and ACE in assessment and essential urgent service for discharge.
Methodology
In mid of February 2017, discussion was made on GFD and Community Rapid Response Team Service (CRRT) by the hospital
management, Medical Officer in-charge, Nursing Consultants, and Department Heads of Allied Health (AH). The logistics of
the pilot service by AH was developed rapidly in early March 2017. After reviewing the service need for geriatric OT service,
five groups of elderly patients were selected for this OT pilot service. They were patients with cardio-pulmonary diseases,
aspiration pneumonia, high risk of pressure injury or bed-chair bounded, recent fall incident as well as cognitive impairment.
Elderly patients aged 65 or above under medical care in AED/EMW would be screened by geriatric nurse and those indicated
for OT as the criteria mentioned above would be referred to us immediately. OT would conduct screening assessment in AED/ Monday, 7 May 2018
EMW, provided interventions accordingly and home visit after discharge. Occupational Therapists started its pilot service for
GFD on 13 March 2017 and ended it on 31 March 2017. All together 15-working day service was provided.

Results
30.77% of the elderly patients from both AED and EMW referred for OT in this pilot project could be discharged home directly.
13 patients were included in this pilot service and they had history of fall, cardio-pulmonary diseases, cognitive impairment,
or pressure injury. OT provided immediate assessment and related interventions in AED/EMW accordingly. Nine patients
were eventually transferred to Shatin Hospital for further management while four of them could be discharged home directly.
Three of them required OT home visit and we could provide it within three working days post discharge. The majority of OT
interventions included care-giver education, fall prevention, coordinated breathing and energy conservation techniques for
ADL, and home safety advice.

All patients and caregivers showed their appreciation to OT intervention. They found the coping skills learnt were very useful
and applicable. Onsite training and advice were highly relevant and easily understood by care-givers compared with the
centre-based training. In the near future, OT would like to be in line with ACE to expand the service in GFD in order to meet
the up-growing demand.

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