Authors (including presenting author) :
Lee PY(1), Chan WMJ(1), Lau TH(1)
Affiliation :
(1)Emergency medical ward, Department of Medicine, Queen Mary Hospital
Introduction :
The demands of using non emergency ambulance transfer service (NEATS) in hospital authority is increasing every day. In Queen Mary Hospital, the number of inpatient discharged with NEATS are around 50-60 per day. In daily operations, doctor usually orders blood testing and investigation during the morning round. After reviewing the blood results and investigation results, he then orders discharge in noon time. In order to prepare the patients to be discharged with NEATS, house officers are required to prepare the discharge documents, then send the medications prescription to pharmacy by portering. When the medications and documents are ready, the ward staff will notify the NEATS control. The NEATS control will arrange ambulance according to the destination.
However, doctor is always occupied by the heavy workload e.g. working in clinic. He may need to come after clinic and delay the discharge process. If staff was unable to prepare all discharged documents and medications before 6pm, ward staff may need to get the medications from pharmacy. This may also occupy the dinner time of staff.
With the implementation of Hospital Command Centre, the whole discharge process was under monitoring once ordered discharge. By identify the constraint and time consuming activities, several measures are implemented to minimize the patient waiting time and reduce the unnecessary extra manpower spent.
Objectives :
To achieve 80% of the patients to be discharged with NEATS with documents and discharge medications be ready before 18:00 in A2 emergency medical ward from Jan-Sept 2024.
Methodology :
After reviewing the discharge process, the time spent on waiting blood tests and assessment by allied health and sending the medication prescription to pharmacy and back to the ward by portering were two of the major tasks spared most of the waiting time. In order to streamline the discharge workflow of patients, we worked align with doctor, pharmacy, relative and portering service.
Firstly, shift in charge and team nurse communicated well with doctor and physician in order to have a better patient management planning. Doctor ordered blood taking the day before, so that blood was checked at early morning at around 6am and results were ready before morning round. Also, doctor had their early pm round before going to clinic, so that they could review the blood tests that ordered in the morning and order discharge. Furthermore, the discharge documents prepared by house officers were prioritised accordingly: Convalescence bed -> Discharge with NEATS-> Self discharge/with relative.
Secondly, we coordinated with the clinical pharmacist to check the discharge medications in the same sequence. Then we sent the medication prescription to pharmacy by fax, so that the pharmacists could prepare the medications in advance. The time needed to wait for the portering to send the prescription to pharmacy and the time that portering need to wait for medications in pharmacy were greatly reduced.
Thirdly, we encouraged the engagement of relative in the discharge process. We invited the relative to pick up the patient to reduce the use of NEATS. If it is not possible, we invited the relative to help taking the medications from pharmacy, so that the relative could receive pharmacy education on the medication. At the same time, the patient was then discharged first and no need to wait for the medications.
By implementing the above measures, the time patients spent on waiting would diminished. Furthermore, the discharge statistics were monitored and reviewed with the NEATS control in charge Mr. Gary Tsang.
Result & Outcome :
There were total 826 patients discharged with NEATS from January to September 2024. Only 70 cases were failed to get documents and medications ready before 6pm. In summary, 91.5% in total were achieved.
