Replies to LegCo questions
LCQ15: Contingency measures at Prince of Wales Hospital
Following is a question by the Dr Hon James Tien Pei-chun and a written
reply by the Secretary for Food and Health, Dr Ko Wing-man, in the
Legislative Council today (May 15):
Question:
According to media reports, a large number of healthcare personnel in the
Accident and Emergency (A&E) Department of the Prince of Wales Hospital (PWH)
in Sha Tin have recently left the service, resulting in a serious shortage
of manpower. To avoid making wrong diagnoses due to manpower shortage, the
healthcare personnel in that A&E Department transferred a large number of
patients to the medical wards of the hospital, making these medical wards
fully occupied and overloaded. Other media reports have pointed out that
PWH has recently closed two medical wards which were added earlier, making
quite a number of medical patients who needed hospitalisation stranded in
the A&E Department for a long time waiting for admission due to a shortage
of hospital beds. Some members of the public have expressed their concern
that, in case of a major outbreak of influenza in the community, PWH's
medical wards will have difficulties in coping with the situation. In this
connection, will the Government inform this Council, whether it knows:
(a) the respective numbers of the existing healthcare personnel and the
shortfalls in the various departments of PWH (set out in a table);
(b) the quarterly healthcare personnel wastage of the A&E Department of
PWH in the past two years and the reasons for the wastage, as well as the
average monthly occupancy rate and the number of hospital beds in the
medical wards of PWH;
(c) whether the Hospital Authority (HA) has assessed if the workloads of
the A&E Department and the medical wards of PWH have already exceeded
their capacity at present; if they have, of the assessment results; if
not, the reasons for that;
(d) whether HA has assessed if the healthcare manpower, the number of
hospital beds and medical facilities of PWH are sufficient to cope with
the situation of a major outbreak of influenza; if they have, of the
assessment results; if not, the reasons for that; and
(e) what measures HA has put in place to cope with the manpower shortage
and workload problems of the A&E Department and the medical wards of PWH?
Reply:
President,
Despite the severe manpower situation in recent years, the Hospital
Authority (HA) has introduced a number of measures to improve the Accident
and Emergency (A&E) services in view of the increasing demand. Specific
measures include:
(a) Implementing a pilot scheme since February 2013 to recruit additional
medical and nursing staff to alleviate the work pressure in A&E
Departments and enhance A&E services. The scheme is being implemented in
12 hospitals. As at April 2013, a total of 191 doctors and 542 nurses have
been recruited. HA is currently reviewing the effectiveness of the scheme
before deciding whether it should be continued and expanded;
(b) Increasing doctor manpower through measures including enhancing the
special honorarium scheme, implementation of additional promotion
mechanism and appointment of part-time doctors;
(c) Strengthening manpower of nurses and supporting staff through
provision of short term employment of retired nursing staff and
undergraduate nurses, enhancement of recruitment and retention, promotion
opportunities, improvement of working conditions and training
opportunities for nurses, as well as strengthening of phlebotomist
services and clerical support;
(d) Setting up additional observation areas to alleviate the congestion of
A&E Departments; and
(e) Stepping up publicity to call on the public to avoid using A&E
services under non-emergency situation.
In fact, after implementing a range of measures at the Prince of Wales
Hospital (PWH), the waiting time at the A&E Department and for admission
has been improved. The occupancy rate of medical specialty has reduced
from the peak of 127% in January 2013, to the recent figure of about 112%.
The median waiting time for patients who are triaged as semi-urgent
(category 4) had also reduced from the peak of four hours or above in
April to the recent figure of less than two hours recently.
In addition, to ensure that patients with more serious conditions are
accorded higher priority in medical treatment, HA adopts a triage system
which classifies patients attending the A&E Departments into five
categories according to their clinical conditions, namely critical,
emergency, urgent, semi-urgent and non-urgent. Under the triage system,
the majority of patients with pressing medical needs received timely
medical treatment.
My reply to various parts of the question is as follows:
(a) The manpower situation and vacancies of healthcare staff in various
clinical departments of PWH as at March 2013 are set out in Annex 1.
(b) The quarterly healthcare personnel wastage of the A&E Department of
PWH in the past two years is set out in Annex 2.
The reasons for wastage of healthcare personnel at the A&E Department of
PWH in the past two years are categorised in Annex 3.
PWH provides a total of 355 medical beds, and the bed occupancy rates (%)
broken down by month in the past two years are set out in Annex 4.
(c) and (e) Owing to factors such as ageing population, the demand for
acute medical beds in Shatin District has been increasing in recent years.
The number of patients admitted to the medical ward of PWH has increased
by more than 6% in the past two years.
To cater for the increasing demand, PWH has adopted a series of
contingency measures in recent years, which include providing additional
wards and beds, as well as speeding up the workflow of discharge and
transfer of patients to rehabilitation hospitals, with a view to vacating
beds to cater for admission of in-patients as soon as possible. Other
contingency measures include increasing A&E Nurse Clinic sessions from two
days a week to seven days a week, subject to the manpower situation.
Non-emergency and mild trauma cases will be treated by nurse specialists
so that doctors could attend to patients in critical condition. During the
peak seasons of influenza, the community outreach nursing team will extend
service to seven days a week, and strengthen visits to local residential
care homes for the elderly so as to reduce the need for hospitalisation of
their residents. Direct admission to Shatin Hospital (without going
through the A&E Department) will be arranged for the elderly as necessary
to alleviate the burden on the A&E Department.
On manpower deployment, an additional of 9 nurses were deployed to the A&E
Department of PWH in April 2013, and 31 more nurses will be deployed to
the Department of Medicine of PWH in August 2013 to relieve the work
pressure of frontline staff.
(d) PWH adopts standardised policies and measures with other public
hospitals in handling outbreaks of epidemic disease. Currently, the
overall strategy of Hong Kong in addressing the threats of avian influenza
A (H7N9) and novel coronavirus is "diagnose it early", "isolate the
patients early", "report it early" and "treat the patients early"; and
remind the public through the media to avoid related risks and seek
medical attention when suspicious symptoms are noticed, so that patients
could be identified, isolated and treated early in the course of illness.
Hospitals will re-prioritise core activities and set aside manpower
resources to cope with additional service demands according to the
response level in place.
Frontline healthcare staff adopts the monitoring standards of "FTOCC" in
identifying the attendants, that is, Fever, Travel (have visited areas
with suspected or confirmed H5N1/H7N9 infection cases within the last six
months), Occupation (working in laboratories or places where contact with
wild birds/poultry is required), Contact (having contact with the infected
patients or wild birds/poultry) and Cluster (presenting infection clusters
with symptoms of fever or pneumonia). Suspected patients will be referred
for further exanimations in negative-pressured consultation rooms and then
transferred to isolation wards for specimen taking and testing. The
attending doctor will, at the same time, notify the Centre for Health
Protection. Cases confirmed as novel influenza by rapid screening tests
will be immediately referred to the HA Infectious Disease Centre at the
Princess Margaret Hospital for treatment.
Like A&E Departments of other public hospitals, the A&E Department of PWH
has set up a designated registration and waiting area for patients with
symptoms of fever and respiratory tract infection to avoid cross infection
with other patients.
At present, 97 isolation beds in PWH are equipped with negative pressure
air-conditioners and high efficiency particulate air filters so as to
reduce the possibility of airborne transmission of diseases. Healthcare
staff is also required to put on full personal protective equipment and
comply with the infection control practices during work.
To combat any infectious disease outbreaks and reduce the risk of
infection in hospitals, all healthcare staff of HA have received
comprehensive training and will receive refresher training on the response
levels and relevant infection control measures at an interval of 18 to 24
months. Seminars and talks are also conducted regularly to raise the
awareness of staff as well as to enhance their personal hygiene and
hygiene practices in taking care of patients.
Besides, the Head Office of HA and various hospitals organise routine
drills for infectious diseases in different domains and scales on a
regular basis and participate in the annual inter-departmental drill for
infectious disease outbreaks, with an aim to ensure that healthcare
personnel understand their roles and responsibilities, especially in the
communication process; and to test and assess the capability of and
coordination among HA and various hospitals in implementing the
contingency plans.
Ends/Wednesday, May 15, 2013
Issued at HKT 17:57
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