Page 123 - Hospital Authority Convention 2018

Service Enhancement Presentations

F2.3 Staff Engagement and Empowerment 13:15 Room 421

Post-operative Care Service in Tseung Kwan O Hospital – One Stop Nurse-Led Discharge Programme
Lo YC, Sin MW, Wong SH, Yan YM, Yeung LF, Chan HC, Ngai YY, Cheng HK
Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong
Introduction HOSPITAL AUTHORITY CONVENTION 2018
Day Surgery is widely practiced in Hong Kong. The expansion of day surgery service in Tseung Kwan O Hospital (TKOH) has
a consequential rise in the postoperative care workload. To increase the service quality and efficiency, a nurse-led discharge
programme of phase II recovery in the Ambulatory Surgery Centre (ASC) was first piloted in 2014. The safe practice was
extended to phase I recovery - Post-anaesthesia Care Unit (PACU) in 2016. The two phases combined one-stop Nurse-led
Discharge (NLD) programme was implemented to optimise post-operative care service in Tseung Kwan O Hospital (TKOH).
The NLD is a protocol driven guideline with standardised discharge criteria. The modified Post-Anaesthesia Discharge
Scoring System (MPADSS) was adopted to determine patients’ readiness for discharge from PACU. This greatly improves the
efficiency in PACU and ASC while maintaining patient safety and satisfaction.

Objectives
(1) To facilitate timely discharge of post-operative patients; (2) to ensure patient’s safety by providing a set of objective,
reliable, and well-defined criteria for nursing assessment and patient discharge; and (3) to ensure a high quality of care and
nursing staff satisfaction through effective inter-disciplinary collaboration.

Methodology
The Guidelines of NLD programme for PACU and ASC was designed and launched in TKOH in April 2016. Task groups
were formed and workflow and protocols were developed, after extensive consultation with the Chief of Service (COS), all Monday, 7 May 2018
anaesthetists and the senior nurses within the department. 18 operating theatre nurses and nine ASC nurses were recruited,
with intensive training being provided. All staff are required to complete the competency test after training. To evaluate
the effectiveness of NLD services, relevant data was retrieved from the Anaesthesia Clinical Information System (ACIS).
Meanwhile, telephone follow up service was provided by ASC staff on post-operative day one.
Finally, satisfaction survey of nurses was conducted in the form of questionnaires (Likert scale).
Result
(Period form 1 January 2017 to 31 Dec 2017)

(1) Improved Efficiency
Phase I and II Recovery (PACU and ASC)

In total 5,719 patients were admitted Phase I Recovery while 50.2% were referred for NLD. 5% did not fulfil the discharge
criteria and were referred back to anesthetists for re-assessment and discharge. When compare with the discharge time
before the implementation of NLD, average length of stay was reduced by 17%. Meanwhile, 1458 day surgery patients entered
into Phase II Recovery. 97% was discharged by nurses successfully. 834 patients participated in the combined phases (Phase
I to Phase II). 97.5% were successfully discharged by nurses and the remaining patients were discharged by anesthetists.
Only 0.04% of the patients attended A&E after discharge due to postoperative-op surgical complications. Nevertheless, no
patient discharged by nurses was re-admitted.
(2) Patient’s Safety and Nurse Satisfaction Ensured

Zero incident or complication has been reported from NLD. All patients are satisfied with the discharge process and willing
to seek assistance through the telephone follow up services. 92% of nurses feel empowered and can manage patient flow
effectively. All of them agreed that they are able to carry out the NLD and are satisfied with the programme.

Conclusion
The one-stop nurse-led discharge services in phase I and phase II recovery have satisfactorily shortened the duration of
recovery room stay and improved the efficiency. It can facilitate timely discharge, maintain patient safety and quality of care,
and enhance nursing autonomy.

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