A 5-year cross-specialty collaboration to reduce the pressure on hospital emergency beds in the Emergency Medicine Ward (EMW) of a regional emergency department in Hong Kong

Mr Edward Hong1, Dr Jeffrey Fung1, Dr SM Lam2, Ms Kat Wong2
1Department of Accident and Emergency, Tuen Mun Hospital, Hospital Authority, Hong Kong, 2Department of Child and Adolescent Psychiatry, Castle Peak Hospital, Hospital Authority, Hong Kong

Introduction: EMW of emergency department (ED) in Hong Kong provides a platform for multi-disciplinary and cross-specialty collaboration in managing selected acute conditions. The pressure on those emergency hospital beds is markedly increased during winter surge period in Tuen Mun Hospital. Child and adolescent (C&A) psychiatric patients admitted into EMW have a longer length of hospital stay due to limited in-patient consultation sessions. Nurse management need to explore the solutions to tackle this issue without any additional resources.

  1. Shortening waiting time for in-patient C&A psychiatric consultation in EMW
  2. Enhancing bed utilization in EMW so as to reserve more beds for emergency admission
  3. Reducing burden on the short-supplied interview room facilities at EMW

Methodology: Through workflow reengineering by nursing and medical management both in EMW and C&A Psychiatry (CAP), a series of kaizen programs have implemented from 2012 to 2017.

  1. To increase in-patient consultation quotas by means of extra sessions after long holidays/long weekends.
  2. To decrease C&A psychiatric patients’ length of stay in EMW by bed overflow management between EMW and CAP.
  3. To minimize in-patient consultation demands from ED and EMW by early discharge of those stable C&A psychiatric patients with adequate social support and arranging early out-patient follow up by CAP.

Results: Under no additional resources situation, extra in-patient C&A psychiatric consultation sessions are added on 42% of the first working days that followed public holidays/long weekends from 2012 to 2017 to shorten the waiting time effectively. With the bed overflow arrangement during the winter surge periods from 2015 to 2017, 10 bed-days per month are successfully reserved for improving the overcrowding situation in EMW.

Conclusion: For the past 5 years, nurse management has taken up an effective role in this cross-specialty re-engineering collaborative program to reduce the pressure on hospital emergency beds.

Mr. Edward Hong received his nursing bachelor’s degree and his master’s degree in “Management in Health and Social Care” both in Oxford Brookes University.
He has worked for Hospital Authority in Hong Kong for over 30 years and he is responsible for the efficient administration of all activities relating to Emergency Medicine Ward in Tuen Mun Hospital and he has been appointed as Ward Manager since 2012. He is also being appointed as an Honorary Tutor in the School of Nursing in the University of Hong Kong since 2014.