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LCQ15: Contingency measures at Prince of Wales Hospital
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     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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