The intra-operative use of vasopressors is safe in free jejunal flap reconstruction.

Background. The 'enhance community geriatric assessment team service for end-of-life care in residential care homes' (ECEOL) scheme has been implemented in Hong Kong West Cluster since October 2015. The aim of the present study was to examine whether advance care planning (ACP) and do-not-attempt cardiopulmonary resuscitationnon-hospitalised (DNACPR-NH) discussion is feasible among residential care home for the elderly (RCHE) residents, whether desired ACP is respected when patients admitted to hospital, and whether there are reductions in emergency attendances, hospital admissions, and health care cost. Methods. Records of residents of the 26 RCHEs with ECEOL in Hong Kong West Cluster between 1 October 2015 and 31 December 2017 were reviewed. The primary outcome measures were the difference in the numbers of accident and emergency department (AED) attendances, acute and convalescence hospital admissions before and after 6 months of ECEOL, and the compliance with ACP and DNACPR-NH. The secondary outcome measure was reduction in healthcare cost after implementation of ECEOL. Results. A total of 223 residents (60 men and 163 women) were analysed. Of them, 208 (93%) had DNACPR-NH established and 214 (96%) had ACP established in the RCHE (n=208) or ward (n=6). During the study period, 115 (52%) residents died. Of them, 69 (60%) died in designated geriatric convalescence wards. Of the 223 residents, the compliance of DNACPR-NH and ACP was 96% and >91.5%, respectively. Comparing 6 months before and after ECEOL, among the 223 residents, the numbers of AED attendances, acute hospital admissions, and convalescence hospital admissions significantly reduced 40%, 43%, and 24%, respectively. Comparing alive and death cases, at 6 months after ECEOL, the death cases had significantly more AED attendances, acute hospital admissions, and convalescence hospital admissions. The potential annual cost saving was HK$6.52 million for 223 residents or HK$29 000 per resident. Conclusion. ACP and DNACPR-NH discussion was feasible in older RCHE residents. Compliance to DNACPR-NH and ACP was good, and most residents died in geriatric convalescence wards. ECEOL reduces unnecessary hospital service utilisation and healthcare cost. Further expansion of ECEOL to all RCHEs is recommended.