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the Integrated Care and Discharge Support (ICDS) Programme was introduced in January 2011, targeting older patients discharged from acute medical wards in a major teaching hospital in the north-eastern part of Hong Kong. The catchment area has a population 0.7 million, of which 11% or 77,000 are aged over 65 years. A statistical model that predicts the early (28-day) unplanned readmission rate in older patients is applied daily to all acute medical admissions. Those predicted to have > 20% chance of readmission will be assessed by a Link Nurse who will formulate discharge plans and assign services accordingly to individual patients’ needs. These include case management, community nursing, home and personal care provided by social services and rehabilitation at the Geriatric Day Hospital. The above services are not mutually exclusive, and patients will spend on average 8 weeks in the ICDS programme. Patients with a moderate predicted risk of readmission of 30 to 40% will be offered 8 one-hour home visits by a Case Manager, who will provide comprehensive assessment, education focusing on chronic disease management and carer training. Objective: A pilot study was conducted to examine the use of iPad in the ICDS in 2 of the major components of the programme: discharge planning and case management. Assessment items were standardized and patient recruitment and follow-up attendances were recorded in an electronic health record. For the case managers, additional education material focusing on chronic disease management was loaded on to the iPads. Methodology: iPads were issued to the Link Nurses and Case Managers with preloaded electronic health records (e-forms) specially designed for the ICDS programme. The Link Nurse was responsible for opening newly recruited case files and conducting a comprehensive needs assessment. Case Managers documented home visits using templates designed for generic use

Applications for the iPad in an Integrated Care and Discharge Support Programme for older patients in Hong Kong