Page 126 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F2.6 Staff Engagement and Empowerment 13:15 Room 421

Enhanced Breast Cancer Postoperative Discharge Programme: Reducing Unplanned Readmission and
Increasing Staff and Patient Satisfaction
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Wong KY , Wong SL , Lauw WL , Chan WW , Ng PC , Lau SY , Lee KY , Leung SH , Lee MF , Chow TL 2
1 Kowloon East Cluster Breast Centre, Surgical Department, Community Nursing Department, United Christian Hospital, Hong
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Kong
Introduction
A clinical pathway for breast cancer operation has been established since 2013, aiming to shorten hospital stay and provide
holistic post-operative care. However, in actual context, an increasing trend of unplanned readmission has been seen. In
order to improve effective outcome, an Enhanced Breast Cancer Postoperative Discharge Programme was developed in June
2016. This programme mainly based on a clear clinical guideline to classify patients into different categories according to
their needs and severity. It also includes a training workshop to ward nurses and community nurses, and educational talk as
well as reminder cards are given to patients for enhancing their empowerment in health knowledge and self-caring techniques
in unexpected conditions. Lastly, a telephone hotline is set up with connections to the surgical ward during weekends so that
patients and community nurses can seek support when necessary.
Objectives
Monday, 7 May 2018 Methodology
(1) To reduce unplanned readmission and Accident and Emergency Department (AED) attendance; (2) to shorten length of
stay (LOS); and (3) to increase satisfaction of staff and patient.
The programme was retrospectively evaluated to compare two periods under pre-and-post study design (Pre-programme:
1 July 2015 – 30 June 2016 vs Post-programme: 1 July 2016 – 30 June 2017). The outcomes were measured in terms of
unplanned readmission, AED attendance and LOS after operation. A self-administered questionnaire with a four-point Likert
scale was used to explore the satisfaction of patients and health professionals.

Results
The unplanned readmission is reduced from 4.4% (8/182) to 1.5% (3/200). AED attendance is reduced from 6.6% (8/182) to 3%
(6/200). LOS was shortened from 2.35 days to 1.62 days (p-value <0.006).

The overall satisfaction (mean, Max 4) of patients (n=93) was increased from 3.367 to 3.582. The satisfaction of doctors (n=4)
was increased from 2.1 to 3.9, the satisfaction from breast nurses (n=2) was increased from 2.3 to 3.4, the satisfaction of ward
nurses (n=20) was increased from 2.29 to 3.15 and the satisfaction of community nurses (n=75) was increased from 2.81 to 3.18.

LOS, unplanned readmission and AED attendance are greatly improved after the programme implemented. The programme
could provide clear guidance to our professional staff and holistic care to patients.

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