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