Authors (including presenting author) :
Li MY(1), Wong KY(1), Lau SY(1), MC Li(1)
Affiliation :
(1)Department of Surgery, United Christian Hospital
Introduction :
A collaboration project between United Christian Hospital (UCH) and private hospitals, including St. Teresa’s Hospital (STH) and Hong Kong Adventist Hospital – Tsuen Wan (HKAH-TW), was launched on 10 May 2023. Suitable patients from UCH will transfer to private hospitals to continue care and discharge thereafter. However, between 1 October 2023 and 30 March 2024, a notable number of UCH surgical patients missed community nursing services (CNS) referrals after discharge from private beds. Missed care included medication supervision (n=1), medication administration (n=1), drain care (n=3) and wound care (n=1). Root cause analysis identified two main issues: private hospital nurses failed to notify parent ward for CNS referrals (n = 3), and parent ward nurses delayed referrals (n = 3).
Objectives :
To evaluate the effectiveness of structured interventions using nursing coordination to reduce missed CNS referrals in the public-private hospital collaboration project.
Methodology :
A pretest-posttest design compared the rate of missed CNS referrals during 6 months pre- (1 October 2023 – 30 March 2024) and post-intervention (1 April 2024-30 September 2024).
Interventions include:
1. Private Bed CNS Referral Workflow
A standardized workflow for private bed CNS referral has been developed and adopted in surgical wards. Nurses need to highlight the CNS needs of the patient on transfer documents and remind to refer patient to CNS on discharge days.
2. Enhanced Communication
UCH discharge coordinators followed up on discharge dates and reminded private hospital nurses to notify parent unit for CNS referrals.
3. Central Documentation
CNS needs were recorded in a shared folder, with UCH discharge coordinators updating the shared folder and alerting parent ward nurses upon discharge date confirmation.
4. Family Engagement
Patients and relatives were encouraged to remind private hospital nurses of CNS needs before discharge, verbal reminder to patients and phone reminder to relatives were provided on transferring day.
Result & Outcome :
During the pre-intervention period, among 47 patients needing CNS support (n=119 transferred), 6 missed referrals (13%) occurred. Post-intervention, among 36 patients needing CNS support (n=91 transferred), no missed referrals were reported (0%).
Structured interventions using nursing coordination successfully reduced the CNS referral missing rate from 13% to 0%. Enhanced workflows, communication, documentation, and patient engagement were key to improving continuity of care in the public-private hospital collaboration.
