Hospital at Night – Hong Kong and Liverpool

In 2009 the Yan Chai Hospital became the first in Hong Kong to introduce an out of hours team based on the Hospital at Night (HaN) model, after training links were established with the Royal Liverpool and Broadgreen University Hospitals NHS Trust.

The hospital began a pilot of the out of hours clinical management unit (CMU) in April 2009, which will run until April 2011.

Yan Chai Hospital is an 800 bed facility providing both emergency and elective care with medical, surgical, orthopaedic, paediatric, accident and emergency and intensive care departments. The Royal Liverpool and Broadgreen University Hospitals NHS Trust, twice awarded pilot site status for the introduction of HaN and for its extension to 24:7 consists of the 850 bed Royal Liverpool and 300 bed Broadgreen Hospital.

After Angela Lee On-kei, an advanced practice nurse from Yan Chai Hospital visited Liverpool to study the HaN model, she asked Edge Hill University (which provides knowledge transfer courses) if they could offer a training package for her hospital staff.

Nurse practitioner Maria Somaroo, part of the Liverpool HaN team for nine years, spent two weeks in Hong Kong in both 2008 and 2009, training staff in the role of nurse practitioner and helping to establish the out of hours team.

Dr Patrick Chu, the former project director of HaN when it was first established in 2003, now medical director for core clinical services, also visited Hong Kong.

The Yan Chai Hospital operates the first out of hours clinical management unit (CMU) in Hong Kong, staffed by specially recruited senior nurses and representing a culture shift in the traditional roles of hospital nurses.

The unit, consisting of seven nurses, trained specifically for the role, operates between 4pm and 8am on weekdays and 8am to 8am at weekends and public holidays.

Angela Lee On-kei explains that Hong Kong's Hospital Authority, established in 1991 to run all public sector hospitals, aims to reduce doctor working hours to 65 a week to improve patient safety. At the same time the authority was exploring possible ways of extending the role of nurses.

After Angela visited Liverpool and studied the HaN model in action, she advised on the recruitment process for nurses to establish the first CMU, she said: "In Hong Kong, nurses do not have much of an extended role, so we wanted nurses with specific experience. Of the seven, five are from intensive care, one from A&E and one from coronary care.

"This is a new type of culture in the hospital and it still has a long way to go."

The handover system used in HaN in the UK is not normal practice in Hong Kong, but the doctor who heads the CMU has introduced an electronic handover system which the nurses can access if necessary. Ward staff call the CMU if a patient meets certain criteria. Angel said: "They will present us with the patient problem and if we know we cannot handle it, we will ask them to page a doctor directly. Otherwise we will go to the ward and assess the patient against our agreed clinical protocols."

She says the nurses, who now have 18 months experience, will triage the patient and are able to prescribe some medication, but will page a doctor of necessary.

Angela feels the system still needs more time to become embedded and to overcome inherent resistance from some clinicians, she said: "If doctors and nurses could work hand in hand it would be a win win situation. Some doctors are happy for us to share the workload and nurses enjoy the extended, more varied role in patient care. In a survey of a patient group, 99% said they felt comfortable with the nursing care."