Authors (including presenting author) :
LAM Kin-kwan (1), LEUNG Lok-hang (2), LI Kai-ming(1)
Affiliation :
(1) A&E Department, United Christian Hospital, (2) Department of Family Medicine & Primary Health Care, KWC
Introduction :
Special Honorarium Scheme (SHS) of the Accident & Emergency Department (AED) is a scheme to address manpower need by financial incentives. Participating staff take up SHS duty voluntarily up to their own availability. Each Department would have its own pool of SHS staff. SHS duty sessions were usually assigned prospectively in advance on an intranet calendar e.g. by the end of month, the next month’s SHS roster would be available.
The existing practice of “SHS allocation-in-advance” may not address the “real-time factor” i.e. could not accurately allocate extra manpower into a day which had a service peak, as AEDs face various unpredictable challenges daily e.g. multiple casualties or an unexpected large number of semi-urgent cases; and the surge pattern is not homogenous or predictable as not all days in winter are on a surge.
In contrast, real-time manpower allocation could be considered with the use of technology e.g. smartphone or app. The ad-hoc SHS request could be launched if certain objective criteria were met e.g. the 95-percentile longest waiting time from AEIS, the actual number of urgent, semi-urgent or non-urgent patients waiting etc. SHS participant would be able to report to the AED within a reasonable time frame (e.g. arrive in 1.5 hours) to perform the ad-hoc SHS duty in order to address the real-time service demand.
Instead of a mobile app, Whatsapp group was chosen for the pilot scheme given its availability and financial implication in designing or running an app. A pool of interested SHS Doctors, who are on the Department SHS list, could enroll into the whatsapp group voluntarily. The responding decision would be up to the participant either accepting the whatsapp request or ignoring the message with total autonomy. Ad-hoc SHS activation message would be sent by operator i.e. the Controller or the onsite Physician i/c to the group for participant’s response. The responding criteria, mechanism and logistics would be decided at the designing stage with involvement of the Department staff.
Objectives :
Through the real-time ad-hoc SHS "UBER" activation trial, unused SHS hours could be better utilized to furnish "manpower" to cope with the dynamic increase in service demand at AED.
Methodology :
During a 15-day pilot period in 2nd half of June 2018, scheduled activation of real-time adhoc SHS allocation was launched twice a day in order to test the logistics and assess the response rate from participants. At the current pilot trial, the activation did not take into account the activation criteria e.g. the waiting time or the number of waiting patients etc. as the primary interest of pilot was the activation logistics. Whatsapp group “Pilot SHS@UCH” was set up created on 16/6/2018, 42 medical staff joined ranked from Resident to Consultant. Real-time activation trial performed with focus on activation logistics
Result & Outcome :
During 14 days of trial, 8 days had unused SHS hours with adhoc SHS activation. 3 out of these 8 days with unused SHS hours had activation response. Among the 6 SHS hours utilized, 26 patients were seen including 11 triage category 3 patients and 15 semi-urgent and non-urgent patients. The trial period was short as limited by reduced number of SHS hours available in July 2018 due to regular manpower replenishment. Through the ad-hoc SHS activation trial, unused SHS hours would be better utilized to cope with the dynamic increase in service demand at AED. In the long run, we believe a "corporate mobile platform" for all HA staff could create a large pool of SHS manpower to cope with the territory-wide service surge, as it facilitates better matching of SHS manpower supply with the service demand.
