Authors (including presenting author) :
Kwok Y(1), Chu KW(1), Cheung YH(1), Yuen WT(1)
Affiliation :
[1[ Department of Medicine, Haven of Hope Hospital
Introduction :
The Plan on Admission Program (POA) was initiated in the orthopedic rehabilitation ward in February 2023 to address challenges in the discharge process for post-hip surgery patients. We observed that many families were unprepared for the relatively short discharge timeline, which aligns with the benchmark length of stay for hip fracture patients. To tackle this issue, we aimed to enhance early communication during admission to minimize misunderstandings, set realistic expectations, and improve the overall discharge process, ultimately reducing length of stay (LOS) and managing complex cases more effectively.
Objectives :
1) To Shorten the average length of stay (LOS) for post-hip surgery patients. 2) Enhance staff engagement in discharge planning. 3) To structuring the management process for challenges cases
Methodology :
The POA employed a structured framework centered around four key components: Informed Admission Process: Patients and their families received detailed information about rehabilitation expectations and the anticipated length of stay for hip surgery upon admission. This proactive communication helped set realistic expectations and promoted collaborative recovery. Setting Expected Discharge Dates: Individualized discharge dates were established based on each patient’s progress, enhancing planning and reducing uncertainties for families, which facilitated a smoother transition after discharge. Dedicated Discharge Coordination: A senior nurse acts as a discharge coordinator, actively participated in weekly ward conferences to facilitate discussions and address barriers to timely discharge. Management of Complex Discharges: The program emphasizes the early identification of patients at risk for discharge challenges. family conferences were organized promptly to address concerns and prepared necessary resources, ensuring a seamless transition after discharge. Regular multidisciplinary team meetings were conducted to foster effective communication and coordination, allowing for the development of strategies to overcome identified challenges.
Result & Outcome :
The average LOS for post-hip surgery patients decreased from 29.6 days (August 2022 to January 2023) to 26.8 days (February 2023 to November 2024), representing a statistically significant reduction of 2.8 days (p-value = 0.04). Post-implementation surveys indicated improvements in staff engagement and morale related to discharge planning. Difficult cases were effectively managed through various strategies developed during multidisciplinary meetings and early family conferences. The POA contributes to a more efficient and supportive rehabilitation environment, significantly enhancing the discharge experience for patients, families, and healthcare providers. It demonstrates its relevance and effectiveness within orthopedic rehabilitation settings.
