Relocate Hospital Inpatient Care to Residential Care Home for the

Elderly in the Community

Yeung KM1, Law CB1, Ho CYS1, Leung J2, Lit CH3

1Department of Medicine & Geriatrics2Community Nursing Service

3Department of Accident & Emergency

Princess Margaret Hospital

INTRODUCTIONRCHE Project:

Since 6/20043-year data

Mission:Reduce hospital admissionShorten length of stay

Relocate care to community

INTRODUCTION

ResidentialCare Home

for theElderly

Subvented 4Private 5

Capacity 1,670

15.7% TW/KT/Lantau

Visiting Medical Officer

CommunityNursing Service

Accident & Emergency Department

CommunityGeriatric Assessment Team

HospitalInpatient

Care

RESULTS

Year A&E Attendance

Emergency Admission

200/month 130/month

100/month

- 30/month

↓ 23 %

180/month

- 20/month

↓ 10 %

Bed-day

2004 1,500/month

2006 700/month

- 800/month(26/day)

↓ 53 %

Health Economics for 9 designated RCHEs

RESULTS

0

20

40

60

80

100

120

140

160

180

200

220

240

4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3

A&E Attendance Emergency Admission Clinical Admission Observation2004 2005 2006 2007

Hospital Utilization by 9 designated RCHEs

RESULTS

0

200

400

600

800

1000

1200

1400

1600

1800

4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3

Resident Bed-day

2004 2005 2006 2007

Hospital Utilization by 9 designated RCHEs

METHODOLOGY1. Strategic selection of RCHE:

1. High admission record2. Cooperative attitude

2. Accident & Emergency:1. Tagging 9 designated RCHEs2. Triage moderately ill patient to

observation ward

3. Visiting Medical Officer:1. Observation ward assessment2. Decision for admission or discharge3. Regular & ad hoc consultation in RCHE

METHODOLOGY4. Hospital Geriatrics Team:

1. Coaching Visiting Medical Officer2. Multidisciplinary care3. Expedient discharge

5. Community Geriatric Assessment Team:

1. Early follow-up2. Coaching Visiting Medical Officer

METHODOLOGY6. Community Nursing Service:

1. Liaison A&E ↔ Ward ↔ RCHE2. Coaching RCHE staff3. Case management4. Infection control5. Specialized nursing treatment

7. RCHE:1. Seminars2. Management guidelines

8. Continuous Quality Improvement model

CONCLUSIONS1. Inpatient bed-day ↓

Health care in hospital⇒ RCHE in community

2. New model of health careCost-effectiveApplicable to other RCHEs

PERSPECTIVE1. Key elements of success:

Strategic planning

Collaboration of teams

Empowerment of staff

CQI model

2. Obstacles:High RCHE staff turnover

COLLABORATORSGeriatrics

TeamAccident &Emergency

CommunityNursing Service

RCHE

Dr. TK Kong

Dr. TC Tam

Dr. CF Ko

Dr. BC Tong

Dr. KY Kwong

Dr. CL Kwok

Dr. WS Lam

Dr. JH Chiu

Dr. P Yeung

Dr. KK So

Dr. LH Chiu

Dr. KH Chan

Mr. WS Kwan

Ms. LW Heung

Ms. YL Chick

Ms. YL Chan

Ms. SC Chung

Ms. PL Lam

Ms. LW Lau

Ms. SP Wong

YCH Chinachem C&A Home

Wah Fung Nursing Centre Ltd

YCH Kwok Yuk Cheung C&A Home

Kwai Shing East Rhenish C&A Home

On Fok Nursing Home Ltd

HK SKH Lam Woo Home for the Elderly

Kwai Sing Elderly Care Home

Kong Chak Nursing Home

Oi Tak (Kwai Chung) Old People’s Home Ltd

End

RESULTSHospital Bed Days Occupied in M&G Unit

0200400600800

1000120014001600

Apr-04

May-04

Jun-04Jul-04A

ug-04Sep-04O

ct-04N

ov-04D

ec-04Jan-05Feb-05M

ar-05A

pr-05M

ay-05Jun-05Jul-05A

ug-05Sep-05O

ct-05N

ov-05D

ec-05Jan-06Feb-06M

ar-06A

pr-06M

ay-06Jun-06Jul-06A

ug-06Sep-06O

ct-06N

ov-06D

ec-06Jan-07Feb-07M

ar-07

Res

iden

t No

0

500

1000

1500

2000

Resident No No. of In-patient bed days in M&G

Hos

pita

l Bed

Day

s

VMO Started

Hospital Bed Days Occupied in M&G Unit

050

100150200250300

Apr-04

May-04

Jun-04

Jul-04

Aug-04

Sep-04

Oct-04

Nov-04

Dec-04

Jan-05

Feb-05

Mar-05

Apr-05

May-05

Jun-05

Jul-05

Aug-05

Sep-05

Oct-05

Nov-05

Dec-05

Jan-06

Feb-06

Mar-06

Apr-06

May-06

Jun-06

Jul-06

Aug-06

Sep-06

Oct-06

Nov-06

Dec-06

Jan-07

Feb-07

Mar-07

Res

iden

t No

0

100

200

300

400

500

Resident No No. of In-patient bed days in M&G

Hos

pita

l Bed

Day

s

VMO Started

Close Collaboration

Loose Collaboration

RESULTS

Date of Death Name Sex/Age RCHE Problem/Diagnosis1. 02/01/2006 CF LAU F/94 林護 Unconscious

2. 02/01/2006 W WU F/90 葵盛東 Collapse

3. 11/01/2006 C KWOK M/93 葵星 Collapse

4. 14/01/2006 SH WONG F/94 葵星 Collapse

5. 13/02/2006 W SETO M/81 安福 Unresponsive

6. 14/02/2006 Y WONG F/82 華懋 Collapse

7. 25/02/2006 S LAM M/84 港澤 Collapse

8. 21/03/2006 S Tai M/80 葵盛東 Unconscious

9. 27/03/2006 S Yau M/96 華豐 Collapse

10. 27/03/2006 K Wong M/99 華豐 Collapse

11. 29/03/2006 M Fok F/96 郭玉章 Unresponsive

12. 16/04/2006 HW Hai F/94 華懋 Collapse

13. 13/06/2006 P Lam M/73 葵盛東 Collapse

14. 24/06/2006 FK Law F/85 華豐 Collapse

15. 05/07/2006 YY Leung F/85 郭玉章 Unresponsive

16. 30/07/2006 NY Yau M/68 葵盛東 Unresponsive

17. 31/07/2006 KF Yeung F/93 葵星 Reduced consciousness

18. 03/10/2006 LL Au F/90 郭玉章 Reduced consciousness

19 04/11/2006 AN Chau F/95 郭玉章 Collapse

Regular review of audit data (e.g. death on A&E arrival) to ensure quality of medical service

RESULTS

Bed-day Annual Reduction Cost Saving

Number Percentage ($3,300 per bed-day‡)

2004 13,067 NA NA NA

2005 11,296 -1,771 -13.6% -$5,844,300

2006 7,582 -3,714¶ -32.9% -$12,256,200 §

Health Economics for 6 designated RCHEs

¶ The bed-day saving ⇔ 0.25 ward occupancy (40 beds)

‡ General hospital fee as published on 1/4/2003§ The cost saving ⇔ Salaries for 1 VMO + 3 RN

RESULTS

2004 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Resident 1090 1092 1007 1087 1098 1103 1102 1109 1112 1115 1112 1122

A&E Attend

165 182 147 162 173 155 159 155 144 149 141 149

E – Adm 97 124 94 107 114 99 97 99 101 90 80 79

C - Adm 0 3 1 1 4 3 7 3 7 3 10 6

Bed Days 1692 1004 490 1095 1205 1287 1152 1061 968 1348 1037 728

Hospital Utilization by 6 designated RCHEs

Total bed-day in 2004 = 13,067

RESULTS

2005 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Resident 1101 1100 1103 1109 1112 1123 1136 1138 1160 1144 1139 1135

A&E Attend

190 180 157 145 155 144 114 112 146 134 162 153

E – Adm 116 99 104 106 110 88 62 62 80 86 88 87

C - Adm 5 3 7 6 3 3 10 10 7 4 13 5

Bed Days 1221 1042 1074 1153 1002 839 915 665 847 842 897 799

Hospital Utilization by 6 designated RCHEs

Total bed-day in 2005 = 11,296Previous data shown total bed-day in 2005 = 12,396

RESULTS

2006 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Resident 1134 1130 1129 1129 1123 1135 1132 1127 1123 1120 1121 1127

A&E Attend

158 119 137 138 162 158 136 113 107 104 117 154

E – Adm 92 65 72 82 83 87 69 66 58 58 68 89

C - Adm 7 8 8 3 9 8 10 4 6 9 6 3

Bed Days 865 738 718 677 681 769 700 513 530 516 480 395

Hospital Utilization by 6 designated RCHEs

Total bed-day in 2006 = 7,582Previous data shown total bed-day in 2006 = 7,682

RESULTS

0

20

40

60

80

100

120

140

160

180

200

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3

A&E Attendance Emergency Admission Clinical Admission

2004 2005 2006 07

Hospital Utilization by 6 designated RCHEs

RESULTS

0

200

400

600

800

1000

1200

1400

1600

1800

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3

Resident Bed-day

2004 2005 2006 07

Hospital Utilization by 6 designated RCHEs

Relocate Hospital Inpatient Care to Residential Care Home for the Elderly in the CommunityINTRODUCTIONINTRODUCTIONRESULTSRESULTSRESULTSMETHODOLOGYMETHODOLOGYMETHODOLOGYCONCLUSIONSPERSPECTIVECOLLABORATORSEndRESULTSRESULTSRESULTSRESULTSRESULTSRESULTSRESULTSRESULTS