SSEM 2019 Post Conference Workshop:

Clinical Skill Workshop in Emergency Medicine Ward

Dr. Jeffery Lai / Dr. Wong Oi FungEMEC subcommittee

Roles of EMW from HA Perspective

• Reduce avoidable admissions

• Improve quality and efficiency of short-stay patient care in term of service timeliness and shortened hospital stay

• Provide suitable platform for multi-disciplinary and cross-specialty collaboration in managing selected acute condition

• Centrally manage patients with psychiatric illnesses, violent behavior or drug overdose to reduce disturbance to other clinical specialties

Emergency Medicine

Extended Care

EMW = PlaceEMEC = Knowledge/skill basis

◼ Patient Care

◼ Administration & Management

◼ Development

Characteristics

of EMW service

Cluster Total Beds Hospital Bed Stat

HKEC 52PYNEH 42

RHTSK 10

HKWC 20 QMH 20

KCC 80(+40)KWH (40)*

QEH 40+40

KEC 40UCH 20

TKOH 20

KWC 130

CMC 24

NLTH 40+(20)*

PMH 34

YCH 32

NTEC 94

AHNH 28+6 SUR SS

NDH 20

PWH 40

NTWC 102

POH 40

TMH 30

TSWH 32*

EMW Bed Stat in 7 Clusters

◼ Attendance & Case-Mix

◼ Space & manpower

◼ A&E management & culture

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Heterogeneity of Service Models

INTERNAL

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Heterogeneity of Service Models

◼ Service need & pressure area

◼ Ancillary support

◼ Backup - specialties/ICU/OT

◼ Political

EXTERNAL

Widening Case-Mix Spectrum

Chest painPSVT

Vertigo

GE dehydrationAsthmaUTI/AP

Fever ILIBT Seizure

COADAECHF

PneumoniaRenal/Liver

derangementSyncope

Toxi UnitGEMEOL

Critical Care

ADVMEDEM

MEDEMA&E

UGIBDVT

Fast/new AFConvulsion

PnTxAngina

Complexity + LOS

Evolution of EMW◼ Extended Observation

◼ Diagnostic Unit

◼ Short Stay Unit

◼ Gatekeeper/buffer

◼ Integrated EM (right place right time right care)

◼ Toxi Unit/Critical Care/EOL……

Basic EMW Service Model:

Focused Patient Care Goals

◼ Diagnostic

◼ Short term therapy

◼ Procedures

◼ Psycho-social needs

Diagnostic Evaluation

◼ Abdominal Pain

◼ Cardiac➢ Undifferentiated chest pain,

syncope, palpitation

◼ Neurological➢ headache, dizziness, seizure

◼ Fever

◼ Trauma

Short Term Therapy

◼ Resp➢ Asthma, COPD, PSP

◼ Cardiac➢ CHF, HTN Em, AF/SVT

◼ ID➢ AP, cellulitis, chest infection

◼ Metabolic➢ DM, AoCRF, electrolyte disturbance

Placement

Social support

Rehabilitation

Mental illness

Psychosocial Needs

Emotional

Communication skills

PsychosocialShort term Tx

• Mx updates

• Complex therapeutics

Diagnostic

• Imaging interpretation

• Laboratory

Procedures

• Orthopaedics

• Diagnostic

• Chest drain

Knowledge & Skill Gaps

Training in EMEC

Academic development vs service needs

Blend of specialties, disciplines

Heterogeneity of centers

Start from zero• Trainers, curriculum, exams

Segregation from A&E floor• Specialists vs trainees

Enhancement

of Training

First Training Course in EMEC

Special Thanks to

Dr. Patrick Tang