Authors (including presenting author) :
Cham EYK(1), Cheung EHL(1), Lee KW(2), Lam DKH(2), Chan DYC(3), Lam PKN(4)
Affiliation :
(1) Intensive Care Unit, North District Hospital
(2) Intensive Care Unit, Alice Ho Miu Ling Nethersole Hospital
(3) Department of Neurosurgery, Prince of Wales Hospital
(4) Intensive Care Unit, Prince of Wales Hospital
Introduction :
Patients with high cervical spine injuries experience respiratory failure and tetraplegia. Despite overcoming significant medical challenges, many struggle to reintegrate into their communities due to inadequate caregiver support and limited community resources. We encountered a ventilator-dependent patient following a road traffic accident, who faced a prolonged stay in the ICU/HDU. Although the patient and family demonstrated motivation to return home, empowerment within our NTEC healthcare model was insufficient. Our team collaborated to address these multifaceted challenges and to share our experiences from this process.
Objectives :
1. Assemble a multidisciplinary team to implement a care plan for ventilator-dependent tetraplegic patient.
2. Empower family and community to provide comprehensive care.
Methodology :
Collaboration among a multidisciplinary team, including intensivists, HDU nurses, occupational therapists, physiotherapists, COST and NDH Respiratory Collaborative Care Team (RCCT), and the Spastics Association of Hong Kong (SAHK), was essential. Intensivists and nurses developed the holistic strategy for the patient’s home transition.
Empowering Caregivers: We trained caregivers inside HDU to manage daily routine, incorporating simulation scenarios and drills for medical emergencies. This training evolved from patient mobilization within the hospital to community care.
Equipment Preparation: Occupational therapists and HDU nurses conducted home visits to assess necessary modifications and equipment tailored for the ventilator-dependent patient.
Home Leave Trials: A stepwise approach extended home leave duration from a few days to two months, involving home visits and joint assessments by HDU nurses, COST and RCCT. Intensivists and Respirologist utilized HA Go telemedicine platform to address issues that arose during the home stay.
Emergency Pathway: An emergency hotline was established for direct access to care, alongside negotiations with Fire Services Department for ambulance services ensuring direct HDU emergency admission.
Community Empowerment: Our team visited SAHK New Page Inn to assess community needs. We conducted training sessions for SAHK staff in HDU focusing on care for ventilator-dependent patients, with the goal of providing respite care within the community.
Result & Outcome :
The successful transition of a ventilator-dependent, tetraplegic patient from acute treatment and rehabilitation to home discharge spanned four years (2021-2025) and necessitated collaboration among NTEC ICU, AHNH HDU, allied health professionals, and community teams. Feedback from the patient, family, and caregivers indicated increased confidence in long-term care. We anticipate that the insights gained from this experience will inform future efforts to address similar challenges within the NTEC service model.
