HA ICU Contingency Plan for Human Swine Influenza* (HSI) / Influenza A (H 1 N 1 ).

Transcription

1 Version: 1 Page 1 of 8 1. Title HA ICU Contingency Plan for Human Swine Influenza* (HSI) / Influenza A (H 1 N 1 ). 2. Background 2.1 The current H1N1 flu pandemic is expected to increase demands for ICU services and beds in the coming winter season and Hong Kong Hospital Authority (HA) is a well equipped health system that has prepared contingency for the effect of H1N1 flu pandemic. 2.2 From the 1st wave of the HSI outbreak in the past few months, it has been found that the majority of patients have mild symptom and a minority will be severely affected. Patient groups at increased risk include the young, pregnant mothers, increased BMI and those with chronic illnesses. 2.3 Although the disease prevention is now focused on vaccination, maintaining hygiene practices and use of antiviral, based on the Australia and New Zealand winter experience in 2009, it is anticipated that about 210 patients will require ICU care in Hong Kong in the coming winter, with peak ICU daily occupancy around 55 patients. 3. Current ICU Services 3.1 According to the quarterly bed statistical report prepared by the HAHO Statistics and Research Section, with the confirmation by the ICU Directors, as at 30 November 2009, there are 189 Adult ICU beds and 42 Paediatric ICU Beds over 7 clusters. The overall ICU bed occupancy is about 90%. To monitor the demand profile and trend, a daily statistics report of the number and distribution of HSI in ICU is sent to all COS of the ICUs in HA by the HO Major Incident Control Centre (MICC).

2 Version: 1 Page 2 of 8 4. Adult ICU Contingency 4.1 Although up to date it is still difficult to ascertain the incidence of HSI infection in the population and hence the true proportion of affected patients who require ICU admission, to match surge capacity with the potential increase in demand during the 2nd wave of pandemic, HA has prepared a staged approach for increasing ICU beds for serious/critical HSI patients: Stage I: 61 of 189 existing ICU beds, mostly ICU isolation beds, for HSI patients Stage II: 133 ICU beds (i.e. more than double) for HSI patients will be made available when 90% occupancy of Stage I capacity has been reached. Stage III: 169 ICU beds will be made available for HSI patients from a total of 271 ICU beds. Mobilization will be activated when 90% occupancy of the allotted capacity in Stage 2 has been reached. (Annex I) 4.2 Increased ICU beds for HSI patients in Stage II and III will come from either opening the outreach ICU in the designated isolation wards, cohort the normal ICU as HSI ICU, or switching other clinical areas such as HDU, recovery room, CCU and new wards into outreach ICU. A phased introduction of the following measures will be implemented with the reduction of normal clinical services: Adjustment and triage of Admission Criteria: aim to provide high quality care able to benefit the maximal number of patients Early discharge to appropriate wards of patients normally monitored in an ICU setting Expansion of nursing capacity by training and redeployment Secondment of medical staff Postponement of elective surgical procedures that require ICU care Cancellation of all no urgent surgery Leave Cancellation 4.3 Activation to the next stage will be decided by the Central Command Committee (CCC) when the overall ICU HSI bed occupancy reaches 90% in that stage. If there is a rapid escalation in hospitalized or ICU cases, the next stage may be activated before 90% occupancy is reached.

3 Version: 1 Page 3 of For occasion of 100% occupancy of ICU patients (either swine flu or non swine flu) in one cluster/hospital, the current mechanism of inter-cluster transfer to other ICU is still in force. 5. Paediatric ICU Contingency 5.1 HA has limited number of PICU beds, and a two-staged approach with a maximum of 25 beds will be allocated for the serious/critical HSI paediatric patients. (Annex II) 5.2 During peak periods it is envisaged that there will be an increased need for the paediatric patient to be cared for in AICU. It is also envisaged that non-icu staff will be required to deliver nursing care under the supervision of ICU trained nurses. In principle, nurses working outside of their normal role should work within their scope of competence and receive adequate training and supervision. The training for nurses on paediatric intensive care has been started to support the contingent deployment of manpower as required 5.3 Based on point 5.2, each hospital should also have planning ahead of a surge to assess skills profiles of their staff, identify staff that can be redeployed to critical care and to provide training. It can be supported by coordination of adult and paediatric ICU service in the cluster, and close link with cross cluster PICU services to ensure that as far as reasonably possible agreed policies are adhered to. 6. Equipment 6.1 The stock of ventilators and other equipment in ICUs will be closely monitored to ensure adequate support for the services. There are currently a total of 1,182 ventilators available, of which 30% under ICU inventory.

4 Version: 1 Page 4 of 8 Trigger for mobilization of ICU beds Annex I Number of ICU beds When 90% HSI ICU beds (~55) are occupied When 90% HSI ICU beds (~120) are occupied Other specialties HSI 0 Stage 1 Stage 2 Stage 3 Stages of ICU Bed Mobilization Plan

5 Version: 1 Page 5 of 8 AICU beds for HSI cases: Location and extra manpower required in different stages Stage I: Provision of ICU isolation facilities for HSI patients with existing manpower Cluster HKEC Hosp ICU Bed for other specialty cases ICU Bed for HSI cases Extra Manpower PYNEH 10 (D10) 7 (B10) -- RH 6 (C1) HKWC QMH 4 (C2) 12 (E2) *1 AC + 1 MO for outreach ICU KEC UCH 11 (ICU) 2 (HDU) -- TKO 6 (2C) 2 (2C) -- KCC QEH 8 (D6) + 8 (B6) 4 (D6) -- PMH 5 (F4) 12 (S6) 5 RN for outreach ICU KWC KWH 9 (E5 ICU) 4 (E5 ICU) -- CMC 6 (WS5A) 2 (WS5A) -- YCH 8 (B5S) PWH 18 (3AB ICU) 4 (3AB) -- NTEC AHNH -- 4 (CCMU) -- NDH 9 (ICU) 4 (ICU) -- NTWC TMH 12 (B8) + 8 (D8) 4 (D8) --

6 Version: 1 Page 6 of 8 Stage II: Surge ICU capacity for HSI with the reduction of normal service and mobilization of extra manpower Cluster HKEC Hosp ICU Bed for other specialty cases ICU Bed for HSI cases Extra Manpower PYNEH 10 (D10) 7 (B10) +12 (B10) 4 Anaes MO + Anaes on site senior + 51 RN RH 4 (A5) 6 RN HKWC QMH 4 (C2) 12 (E2) +12 (C4) MO +4 NO + 50 RN KEC UCH 8 (ICU) 2 (HDU) + 3 (HDU) ICU internal deployment TKO 6 (2C) 2 (2C) -- KCC QEH 8 (B6) 4 (D6) + 8 (D6) 3 MO + 12 RN KWC PMH 4 (F4) 12 (S6) + 4 (S10) 4 MO +2 APN+ 15 RN deployed from YCH ICU KWH 4 (E5 ICU) + 9 (E5 ICU) 8 RN CMC 6 (WS5A HDU) + 2 (WS5A Isolation Room) 8 (WS5A) 2 AC + 6 MO + 12 RN YCH 4 (B5S) NTEC PWH 22 (3AB ICU) 8 (3AB) 2 AC + 6 MO + 2 APN + 38 RN + AHNH -- 4 (CCMU) -- NDH 6 (ICU) 4 (ICU) + 2 (ICU) ICU internal deployment NTWC TMH 12 (B8) 4 (D8) + 8 (D8) ICU internal deployment

7 Version: 1 Page 7 of 8 Stage III: Additional ICU contingency measure for the pandemic Cluster Hosp ICU Bed for other ICU Bed for HSI cases specialty cases Mobilization of Extra Manpower HKEC PYNEH 8 (E11) Tentative 4 Anaes MO + Anaes on site senior + 34 RN RH HKWC QMH KEC UCH TKO KCC QEH 16 (G9) 1 AC + 1 MO + 12 RN PMH 4 (S11) Deployment from PMH surgical KWC KWH 10 (N11 HDU) 3 MO + 51 RN CMC YCH PWH 4 (CCU) 1 APN + 19 RN + 1 AC + 3 MO NTEC AHNH 4 (CCU) NDH NTWC TMH

8 Version: 1 Page 8 of 8 Trigger of mobilization of PICU beds and the bed distribution Annex 2 45 Number of beds for PICU services When there are 8 HSI PICU occupied the isolation beds + 10 PICU beds for non-hsi cases Combined ICU beds for PICU HSI cases PICU beds for HSI cases 0 Stage I Stage II Stages of PICU Bed Mobilization Plan Stage I Stage II Hospital Official no. of PICU beds PICU beds for HSI cases PICU beds for non- HSI cases PICU beds for HSI cases PICU beds for non- HSI cases QMH PWH * 2 QEH PMH UCH PYN 3 2* 1 2* 1 KWH 5 2* * 2 TMH 5 1* 4 1* 4 Total * * 17 *HSI PICU bed in combined adult and paed ICU