Authors (including presenting author) :
Kwan WMC (1), Cheng CK(2), Chu LS(3), Lee WYE, (1), Cheng SY (1), Chuk CY(1), Tsang TW (3), Tang H (4), Mok KWA(1), Ko HM(2)
Affiliation :
(1) Palliative Care, Bradbury Hospice, (2) Medicine, North District Hospital, (3) Hospice Center, North District Hospital, (4) Palliative Care Team, Alice Ho Miu Ling Nethersole Hospital
Introduction :
The idea of Co-Care bed was conceived while having terminally ill patients not being able to be transferred from North District Hospital (NDH) to the limited palliative care beds in Bradbury Hospice. The Palliative Care (PC) consultative team and the Medical team were both very eager to enhance the care of this group of patients particularly those at the very end stage of their life. Thus, the workers of the two teams sat together and developed the MED-PC Co-Care bed model. This is the collaboration of the two teams to look after the terminal patients in a selected medical ward in NDH.
Objectives :
The program meant to enhance the palliative care support to patients not able to be transferred to specialist PC beds. There are three main objectives, • In collaboration with parent team to enhance care for in-patients with needs of intensified palliative care. • Sharing on multi-disciplinary palliative care approach with skills and knowledge transfer • Promote the culture of palliative care for patients with advanced terminal conditions.
Methodology :
Ward 4B of NDH was selected to host the Co-Care beds. It was planned a maximum 4 beds at one time would be able to satisfy the demand according to the referral and transfer experience. Before the project commence, PC team physician and APNs provided 5 sessions of training related to symptoms management and psychosocial support to 4B ward nurses. Equipment like syringe driver, and symptoms checklist form were ready. A list of selection criteria of appropriate patients was developed which include, 1) complicated treatment regime, or 2) difficult symptoms control, 3) complex psychosocial needs, 4) anticipated to deteriorate and die within the same episode. Patients who were selected either by PC consultative physician or ward 4B physicians. These patients would also need to fulfill the triage criteria to 4BCR ward. A booking system managed by 4B triage nurse was in place. These patients would be supported by PC team doctors and nurses daily on top of the Medical team case doctor and nurses. In addition to the Allied health colleagues of NDH, the PC team Medical Social Worker and Clinical Psychologist would share the care according to the patients’ needs. There was also a weekly case conference with 4B ward to discuss the progress of the patients.
Result & Outcome :
A service evaluation was performed. Data was retrieved from Sep 2022 to Dec 2024. The total number of patients referred to the MED-PC Co-Care bed was 59 with 49 admitted. There were 40 patients died and 9 discharged. The average length of stay in the Co-Care bed was 8.9 days. The average waiting time was 2 days. Palliative Outcome Scale was used to evaluate the symptoms. There was improvement in pain, shortness of breath and mouth problems. A survey of the family members also showed satisfaction with various care items during the stay. The Co-Care bed model is practical and effective in enhancing PC support to the terminal patients in a medical ward. The MED-PC Co-Care bed model seems able to enhance the quality of palliative care to those patients not able to be transferred to specialist PC beds. It also serves to promote the knowledge and skills of general palliative care to staff at the medical ward. With the aging population and rising need for end-of-life care, this model may help to enhance the quality of care and manage the growing demand.
