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Clinical Services Plan for the Redevelopment of Kwong Wah Hospital

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Clinical Services Plan for the Redevelopment of Kwong Wah Hospital KWONG WAH HOSPITAL Clinical Services Plan for the Redevelopment of Kwong Wah Hospital Planning Tomorrow’s Hospital 1=.8KVUXZEIU\KXESSOTJJ 63 Contents Executive Summary 02 Purpose of Plan 11 Background 12 Planning Process 18 Capacity Planning 22 Models of Care 30 Key Recommendations on Clinical Specialties 39 Role Delineation 57 Traditional Chinese Medicine 60 Principal Recommendations 63 Design Implications 67 Abbreviations 74 Appendices Appendix I Organisation Chart of Kwong Wah Hospital 75 Appendix II Site Map of Kwong Wah Hospital 76 Appendix III Terms of Reference and Membership of Steering Committee 77 Appendix IV Key Roles and Membership of Consultant Panel 78 Appendix V Membership of Project Team 79 Executive Summary This report presents the Clinical Services Plan for the rebuilding of the Kwong Wah Hospital (KWH). It maps out the planned future services of the hospital taking into consideration amongst other things its current and projected service demands. The Clinical Services Plan will form an integral part of a master development plan that guides the design and construction of the new buildings and facilities. The executive summary can be read in isolation but readers are encouraged to address the report in its entirety. About KWH The KWH, a district hospital under the management of the Hospital Authority (HA), is part of the Tung Wah Group of Hospitals (TWGHs). It is located in central Kowloon and is one of the hospitals in the HA’s Kowloon West Cluster for purposes of management and service networking. Physically it is at the boundaries of the Kowloon Central Cluster and within a comfortable walking distance to the major referral hospital of the Kowloon Central Cluster, the Queen Elizabeth Hospital (QEH). The hospital has a unique culture which reflects its charitable origins and community identity. The staff members are intensely loyal and for many it is more of a vocation than a job. The commitment to Traditional Chinese Medicine (TCM) also reflects the historical development of the TWGHs. 2 Background of the Review The majority of the infrastructure of the KWH is over 50 years old and not conducive to the type of care now being offered. The decision has been made, with the full support of all stakeholders, to rebuild the hospital on its current campus. This strategic planning process was established to determine the models of care, technological advances and human factors necessary to fulfil the aspirations of all parties for a redeveloped KWH. The shared objectives for the redeveloped hospital are: • A greater focus on care in an ambulatory setting • True integration of service delivery and research in TCM • To build on the skills that have enabled KWH to become a leader in minimally invasive procedures Clinical Services Plan for the Redevelopment of Kwong Wah Hospital 3 Planning Process An international consultant with experience in similar projects was appointed to advise the project team. The project team was drawn from members of the Strategy and Planning Division of the HA and chaired by the Director of the Division. An advisory panel of eminent health experts was also established to advise the project team on matters of process as well as to provide professional insight into aspects of clinical practice. The Steering Committee chaired by the Chief Executive of the HA oversaw the project. The review examined each clinical discipline / specialty. The methodology involved a questionnaire which was distributed to 30 clinical departments of KWH and to a further 55 in the four adjoining hospitals: Princess Margaret Hospital (PMH), TWGHs Wong Tai Sin Hospital ( WTSH), Our Lady of Maryknoll Hospital (OLMH), and QEH. Data from the HA’s own data warehouse was analysed and reconciled with the survey responses from the individual clinical units. An intensive one month consultation period was held in March 2009. In all, about 200 staff members participated in the 30 sessions conducted at KWH and 8 sessions at PMH and QEH. The project team recognises that planning hospitals on the perceived future and aspirations of individual disciplines is valid but likely to produce a dysfunctional aggregation of fiefdoms. The project team has also examined international trends in hospital development and models of care. These considerations frame the recommendations. 4 Existing Service KWH offers a comprehensive range of clinical services, however, notable gaps in the services are non-radiation oncology, cardiothoracic surgery, paediatric surgery and psychiatry. There are presently about 1,200 beds. Each day a total of 1,800 to 2,000 patients attend the specialist, family and general outpatient clinics. Around 350 to 400 patients attend the Accident and Emergency Department each day of which slightly more than one quarter are admitted. These admissions are, in turn, around 45% of the total daily admissions. About 5,500 babies are born in the hospital each year. Although the hospital is of necessity a large general hospital, pockets of excellence and innovation exist in, for example, stroke management and minimally invasive procedures across a range of disciplines. A significant proportion of the hospital’s workload relates to cancer which, in addition to the emergency presentations is fuelled by the Well Men’s and Well Women’s clinics operated by the TWGHs. Considerable expertise and experience is available for breast, head and neck, colonic and prostate malignancies. Recommended Service Direction A very condensed presentation of future direction for each clinical service is presented in the tables on the following page which were developed for each discipline (i) a scored role delineation, (ii) recommended service enhancement, (iii) ambulatory care component, and (iv) opportunities for collaboration with TCM. Clinical Services Plan for the Redevelopment of Kwong Wah Hospital 5 Recommended Future Direction for Clinical Specialties at KWH Specialty Ambulatory Care Collaboration with Service Enhancement (Role Delineation) Component Chinese Medicine Accident and • Introduce Emergency Not applicable (NA) Management of Emergency (6) Medicine ward bone and joint injuries by bone • Enhance isolation facilities setters • Fast track system for, e.g. minor injuries • 24-hour Computed Tomography (CT) Anaesthesia (6) • 24-hour obstetric epidural • Integrated pain centre • Integrated pain service centre • Pre-anaesthetic clinic • Multidisciplinary pain service for pre-op care • Acupuncture anaesthesia • Operating Theatre (OT) for minimally invasive surgery, robotic surgery, digital subtraction angiography (DSA) • Positive pressure OT Intensive Care • Co-location of services with NA Nil Unit (6) similar level of care • Enhance nursing support • Isolation room for infectious cases Medicine & • Elderly friendly facilities • Involve most sub- • Palliative care for Geriatrics (6) specialties cancer and renal • Enhance primary patients percutaneous coronary • Diabetic centre, intervention and cardiac endoscopy centre, • Patients with catheterization facilities cardiology general medical investigations problem, • Non-radiation oncology e.g. diabetes, support for medical patients hypertension Neurosurgery (5/6) • Neurosurgical High • Pre-op and follow-up Acupuncture Dependency Unit cases services for stroke and neurological • Endovascular theatre • Neurological rehabilitation with DSA diagnostic procedures patients Note: Service enhancement has to be considered under the context of the proposed Centre of Excellence in Neuroscience Obstetrics & • Enhance obstetric epidural • A large proportion of Joint TCM clinic Gynaecology (6) support gynaecological service • Non-radiation oncology • Obstetric and day support for patients with fetal assessment gynaecological malignancy • Endoscopic and laparoscopic surgery 6 Specialty Ambulatory Care Collaboration with Service Enhancement (Role Delineation) Component Chinese Medicine Orthopaedics & Development of minimally • Strength in • Minor injuries also Traumatology (6) invasive and computer ambulatory care and treated by bone navigated spinal surgery arthroscopic surgery setters • Joint replacement • TCM for diabetic foot surgery in ambulatory • Acupuncture setting for chronic musculoskeletal pain Paediatrics (5/6) • Child friendly facilities • Multidisciplinary Nil involvement • Improved isolation facilities • Dedicated facilities for Note: Service enhancement has to children be considered under the context of • Neurology, obesity, the proposed Centre of Excellence in Paediatrics adolescent and respiratory care Pathology (6) • Enhance specimen Fine needle aspiration Authentic Chinese transport system biopsy Medicine laboratory • Positive pressure rooms for biochemical safety Radiology (6) • Filmless imaging • Significant proportion NA of radiology service • Picture Archiving & Communication system • Endovascular procedures and • Endovascular OT suite high technology • Additional CT shared treatment modalities with other services, e.g. e.g. selective infusion A&E, endovascular theatre of chemotherapy • Consider universal imaging suite Surgery (6) • Non-radiation oncology • Same day surgery Perioperative support support for surgical for various surgical patients subspecialties • Endovascular OT suite • Combined endoscopy centre • Minimally invasive surgery training centre • Endoscopic/robotic surgery • Emergency endoscopy Family Medicine Chronic disease care model NA Integrated service & GOPC (5/6) for musculoskeletal disorders Psychiatry (3/4) Strengthen psychiatric NA NA liaison in A&E and Emergency
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