我从事儿科服务已超过20年，获委任为香港儿童医院的行政总监，令我可以全情贡献我最投入和熟悉的儿科服务，实在深感荣幸。不少人说香港儿童医院是儿科医生和病童家庭半世纪以来的梦想，如今梦想成真，下一步是如何将我们的满腔热诚推动儿科服务迈向国际顶尖水平。
香港儿童医院与全港儿科部门的愿景一致，要在儿科的临床服务、科研和培训精益求精。我们已进入服务筹备阶段，首项任务是要建立稳固和清晰的行政和临床管治架构，并订定健全制度，确保在2018年服务安全开展和顺利衔接。我们既要提供优质和家庭为本的服务，亦要确保服务模式持续可行，资源足以承担。我们当务之急是要建立一个实际可行的「轴辐模式」，包括制订统一临床指引，转介安排共识和后续治疗指引，确保病人在不同阶段在合适的医院得到适时治理。由于香港儿童医院日后会接收其他医院转院的危重病人，我们需要建立稳当的紧急运送团队。在今期通讯，不同的专科服务筹备专员会分享他们对于香港儿童医院安全开展服务的看法。
我们亦知道要为病童提供全人治理，病人组织和慈善机构发挥重要角色。他们一向以来贡献良多，我预见在医院投入服务之后，大家将会更紧密协作。
香港儿童医院仝人上下一心，我们不单要为病童和家长建造一个友善的环境，更将积极的信念和希望的种子植根于医院。让我们携手向前，一起迎接未来的挑战和机遇。
香港儿童医院行政总监李子良医生
照顾新生婴儿是一件令人兴奋和满足的事情。我们热切期待新生命的降临，同时亦会扶助他们踏上生命的旅程。这段出生的历程充满了挑战，小生命要经历前所未有而又极复杂的生理转变与适应，并不是每一位都能安然过渡。在危急关头，婴儿需要适时和适切的抢救、稳定、及紧随其后的辅助治疗，配备高质素的环境设施和医疗团队，才可平安回到父母身边，开展往后的生命之途。而香港儿童医院于服务开展初期，亦会像婴儿刚出生时一样面对各种的挑战。只有同事之间的良好协调、拥有共同的愿景及共建崭新的服务模式，香港儿童医院才可达到和谐无间的过渡。透过互相扶持、正向思维及员工的参与，香港儿童医院的发展基础便建立得更深厚更稳固，好让儿科的医疗水平与学术成就更加精益求精。
要安全地开展服务，香港儿童医院的新生儿科需要配备充足的人手、适当的工作时间规划、与地区医院共同制定并接纳的双向转介模式及完善的紧急病童转院运送系统，以满足患者的各种需要。此外，人才培训和发展、科研和经验分享，也要惠及到全港的儿科服务及病人。因此，我们需要共同努力，跨区简化临床服务、建立更强大的网络以优化临床管治及促进医护人员的团队合作。最后，我们的婴儿亦即我们的下一代，将会大受裨益。
我们只要谨记最初的抱负和愿景，携手努力，定能够克服过渡期间所带来的转变与挑战。
随著香港儿童医院在2018年开始投入服务，儿童医院的心脏内科及心脏外科届时会提供全面性的第三层架构医疗服务，包括了全港儿童心脏外科手术、在先进整合式心导管手术室内进行的心脏导管介入式治疗、不同形态心律不齐介入式治疗和治疗复杂先天性心脏病。要能够提供这样复杂和高端的医疗服务，精干的跨部门团队是必要的。团队成员包括心脏科医生、心脏外科医生、心脏科麻醉师、重症科专科医生和其他专科同事，大家将共同协力去为病童提供有效和高效率的服务。
一个安全的起步点不单止需要足够的人手、适切的培训和齐备的设施，还需要在准备阶段中与同事作出不同程度的沟通，以回应病人和同事的问题。当然，一个详细的运作计划书以及有关团队的分享和讨论尤其重要，而香港儿童医院的成功关键有赖卓越的领导和行政支持。
建立香港儿童医院，让许多儿科医生、护士、病童和他们的家庭真正能实现了一个50年的香港梦想。其实深圳市和乌鲁木齐早已有儿童医院，香港虽然迟了一点，亦即使我们决定不以「卓越中心」为名，我们仍感到自豪的，就是一班在不同岗位共同努力实现这个目标的同事。许多热心的同事已经贡献出无数年月去实践，使这梦想成真。其中经历一切一切都印象深刻，令人难以忘记。
香港市民和孩子享受高水准的公共医疗体系。事实上，死亡率和发病率是东南亚最低的地区之一。危重儿童疾病包括新生婴幼儿，先生和后天心脏病，肿瘤，外科和肾科等等。这些都是儿童医院投入服务时第一阶段将建立的重大分科。这些团队照顾的病童很需要儿科危重护理的支援。一个强大的儿科危重病急救医学（PCCM）服务是很重要，亦是这些重要的副专科安全运行成功的关键。
邝医生是我们新生婴幼儿科协调主任，他说得好：「具有良好的协作、共同的使命及愿景、重新设计工作流重以及协调的团队，才可以达到更卓越的临床疗效、学术进步」。就此我们的儿科肿瘤协调主任 ── 陈教授也确保本地儿童科血科及肿瘤科医生在儿童医院未落成前已合作无间，气氛良好。
随著「轴辐模式网络」制度，我们对香港市民服务只会走得更好。在香港儿童医院将作为枢纽而所有地区医院儿科部门如辐条，各自发挥功效和特性，使车轮转动，让儿童医院运作畅顺。轮辐必须共同努力，没有轮辐，就没有轮子运行。如果没有轮轴，我们就像一盆散沙。现时全港有八所公立医院设有儿童深切治疗病房（PICU）。香港情况与海外截然不同，我们只需要数分钟内前往附近地区医院就可以得到紧急和危重护理。现有儿科重症监护专家及许多已受训员工都团结起来，准备为香港儿童医院提供这项服务。为了确保安全启动和过渡的服务，首先，我们必须保留这些表现卓越的同事，不要让他们渐渐流失。建立适当的就业岗位和专业认可实在刻不容缓。现在距离香港儿童医院投入服务已迫在眉睫，我们应该立即招募及整合PICU团队，保证我们有足够的专科及资深同事维持现有水准的服务，支援其他亚专科，共同服务病情危重的儿童。
对于香港儿童医院这个大型项目来说，服务安全和质素是两个最关键的因素。根据「轴辐模式」，我们将特殊的肾病个案，如血液透析、器官移植和难以医治的肾小球性肾炎症，集中在香港儿童医院进行治疗；而一般的肾病个案，如尿道感染和简单的肾小球性肾炎，保留在各区医院进行治疗。儿童医院和其他医院会加强紧密的联系以确保肾儿获得适切无缝治疗，这包括儿童肾科医生的交换及受训医生的轮调、肾病共同医治指南及其他有效的沟通方式等。这个联系对保证服务的安全和质素尤为重要。儿童肾科服务要做到安全启动和过渡，保证人手的充足亦不容掉以轻心，特别是儿童肾科医生、肾科受训医生和肾科护士。同时，他们亦需要规划完善的设施和其他专科提供充分的支援 （例如放射科、儿童外科、麻醉科、儿童深切治疗）及专职医疗部门（包括临床心理学家、营养师、社工、职业治疗师和物理治疗师）。此外，儿童肾科服务的安全启动和过渡也需要不同部门的共同规划。除了儿童肾科的临床工作小组以外，儿肾部门管理委员会亦已成立并于2016年6月举行第一次筹划会议。
还有不足两年的时间，我们将见证香港儿童医院投入服务。当中一个艰巨的挑战就是如何安全和无缝地过渡及实现我们的临床服务。正如诗人约翰‧多恩说：「没有人是在大海上独踞的孤岛……」，持份者之间的团队精神是首要的。这合作无间的气氛早在落实香港儿童医院之前已在本地儿童血液科／肿瘤科医生之间存在了，这点可以透过共同制订的临床治疗方案和常规指引中反映出来，我们并且有一个准确的本地病人数据库，可共同分享临床数据。此外，我们更定期举办合并临床审计会议。在筹备香港儿童医院工作其间，我们也协调了电子处方表格和护理工序。再者，我们鼓励各单位之间医务人员的交流，借以促进彼此的理解和经验分享。然而，我们明白到在与其他专业服务融合过程中，仍然存在着困难。如临床支援服务来说，在香港儿童医院将暂未能提供放射治疗服务；因此，我们要规划好可行的病人转介计划来应付将来香港儿童医院的需要。本着专业精神和各参与者的无私奉献，我们对解决大部分问题仍抱乐观的态度。
香港儿童医院的成立对于众多的儿科服务来说，是一个令人振奋的进步，它能集中和提供优质的专业医疗服务，这正是孩子们及其家庭所需要的。在香港特别行政区政府及医院管理局的通力合作下，经过不断的艰苦和挑战，成立儿童医院的梦想终于实现了。医院管理局辖下的七个医院联网耳鼻喉专科部门将会结集人力资源去提供全面耳鼻喉专科服务。除了复难和罕见的疾病将因多个专业领域投入而得到有效的品质管理，一般个案也能因而得到所有适当的儿科配套设施，以及专注的照料。此外，国际及本地大学的伙伴合作，以及基本及临床研究亦将会成为我们服务的核心目标中不可或缺的一环。
将于2018年投入服务的香港儿童医院，标志著香港医疗发展的一个重要里程碑。这将会是香港第一间致力为儿童谋福祉的医院。
神经外科将会是香港儿童医院提供的其中一项医疗服务。目前，患有神经外科疾病的儿童分散在各区医院接受治疗。由于每个地区医院的病人数量不多，任何一区的医院都难以有足够数量的病例为基础，来提升小儿神经外科的医疗技术水平。
有见及此，香港儿童医院的神经外科将根据临床需要分阶段提供服务。将来，除了个别需要立即接受治疗的急症病人（如头部创伤者）外，全港七个神经外科中心将会转介患有神经外科疾病的儿童到香港儿童医院接受治疗。
此外，各地区医院的儿童神经外科医生将会合作并组成团队，在小儿神经外科的各个领域，例如肿瘤科、功能性手术及癫痫手术，发挥各自的专长为病人提供综合性和高素质的医疗服务。
我们希望打破不同专科之间的隔阂，以相辅相成的服务模式为其他儿科副专科服务提供一个参考，为特殊病患者打造一个能够获得最佳治疗的医疗环境。
不消两年的时间，我们将会见证到香港儿童医院开幕并投入服务。对于我们这群服务儿童的医护人员，能够参与这所医院的协调及筹备工作是一个千载难逢的机会。小儿眼科实在有幸成为团队当中的一分子。
许多小儿眼疾都是系统性疾病的一部分，大大超越了眼科专家所接触的范畴。我们需要一个集不同专业的团队支持，以提供高质素的服务给我们的儿科病人。
如果没有良好规划和团队合作，在香港儿童医院提供优质的眼科服务只会是一个空想。在世界级医院开展一个全新的服务从来都不是一件容易的事，但我们有幸得到筹划组及其他持份者的鼎力支持，此乃成功的关键。
要安全地启动和过渡，我们需要将所有持份者团结起来。幸运的是，香港的小儿眼科医生都愿意于香港儿童医院提供最好的眼科服务。我们亦已得到各大学和整个医院管理局团队的支持。香港眼科医院亦将会于香港儿童医院起步阶段提供强大的支援。加上来自不同专业的专家共同支持，我相信小儿眼科团队将会有美好的发展。
小儿外科是其中一项发展得最快的外科专科。随著近年微创手术、内窥镜治疗和介入放射学的进步，复杂的手术个案都能取得良好的治疗成果。
成立副专科专门诊治罕见的外科疾病已成为全球性的趋势。本港的小儿外科转介网络已于2003年成立，而快将投入服务的香港儿童医院则会成为第三层及第四层的外科转介中心，使我们能够为复杂的小儿外科手术个案提供专业的服务。
香港儿童医院的小儿外科临床工作小组已决定于2018年起，集中处理由现时的三个儿童外科中心转移至香港儿童医院的外科服务，包括新生儿外科、肿瘤外科、初次性唇颚裂及与肾脏移植有关的复杂泌尿外科手术。与此同时，香港儿童医院还会负责为九龙中和九龙东联网提供紧急的小儿外科服务。我们还会加强与其他儿童专科的合作，例如麻醉科、放射科、新生儿深切治疗科及儿童深切治疗科，使外科服务能够顺利和安全地过渡到香港儿童医院。
儿童麻醉科将提供广泛并覆盖全医院的服务，包括临床麻醉、手术室服务、围手术期跟进方案、急救复苏、镇静以及急、慢性痛症处理。香港儿童医院的儿童麻醉科专科服务将紧密结合质量保证、培训和研究三大要素。
香港儿童医院将在2018年投入服务，首先集中全港的儿童癌症、心脏和肾科的服务。儿童麻醉科配合开启服务计划，主要为支援对新生婴幼儿手术、肿瘤手术、儿童心脏手术、心脏介入治疗、唇颚裂手术和相关的肾脏移植的复杂泌尿科病例，以至九龙中及九龙东联网的普通小儿外科服务。
香港儿童医院配备现代的手术设施。在主手术室楼层内分别设有先进的综合心脏及血管治疗中心，内有心脏手术室及混合心脏导管室；并有两所全方位数码影像微创手术室，以及不同种类专科手术室：包括脑外科、骨科、眼科、耳鼻喉、头颈科、牙科、皮肤激光及日间手术等等。
综合围手术期服务将以家庭为中心，为预备手术及术后病人提供「无压力」入院及出院服务，促进能够成功进行手术疗程及康复。
手术室以外，例如放射科和肿瘤科的镇静和痛症管理问题，将由麻醉科医生支援，以确保儿童接受不同的侵入性手术的安全性和舒适度。放射治疗包括断层放射治疗会在香港儿童医院以外处理，医疗团队将为这些孩子制定一个可行的镇静支持计划。
目前儿童麻醉科在香港是一个规模比较小的副专科，极需要发展人才以提供服务、培训和研究。我们致力推展共融的模式，鼓励协同参与领导，促进合作交流，希望通过良好管治，建立完善的人力资源网络，好让全职和兼职的同事们，在同一屋簷下精益求精，尽展所长。
尽管极具挑战性，能够有这样的机会去进一步发展这一副专科，并能与地区医院，大学院校及各方持分者协作，我们将有一个扎实的开端。
管理一间多元化的病理学化验室并不容易，更甚的是要推动不同机构管治下的中央遗传基因服务。我的工作包括管理香港儿童医院的遗传基因化验室，特别是要协调先进技术平台（例如DNA微阵列和新一代基因测序系统）的临床应用、SafeT21非侵入性产前检测计划及衞生署辖下的医学遗传科遗传化验服务。此外，还可能包括在商议中的初生婴儿代谢病筛查计划（化验部分）。这个任务虽然有趣，但却是既艰巨及带有挑战性。相信只有透过各部门的合作、人与人之间的紧密联系和建设性的对话，才能实现我们的目标，那就是让我们的儿童在香港儿童医院里有一个安全和无忧的旅程。
放射科技的进步为我们开拓了更多与时并进的诊断和治疗方法。在放射科，我们必须谨守两个辐射防护的基本原则：正当的理由与优化的程序。
正当的理由 — “做正确的程序” — 权衡潜在风险与预期得益。
优化的程序 — “将程序做得正确” — 将辐射剂量降至最低的合理水平（ALARA）。
虽然现时有其他不含放射性的造影技术（例如超声波和磁力共振），但该等造影技术也有潜在的风险。因此，放射性检查要先严格遵守相关的原则、规章和政策，才可适当及安全地进行。
我们致力透过与各部门的交流、合作及协调，为医护人员提供最大的支援。与医院管理层的紧密合作是保障辐射安全和质量的重大要诀。其中包括采用成像设备技术以优化辐射防护、共创舒适的环境、确保质量、持续推行质量改进和临床审计程序及严格遵守安全标准和规章。
Our colleagues’ support and participation are the keys to the development of the Hong Kong Children's Hospital. A staff forum was held successfully on 17 May 2016 at the HAHO with the participation of over our advanced recruited colleagues and 120 medical, nursing and supporting staff from various service units to be translocated to HKCH upon service commencement in 2018. Our Hospital Chief Executive (HCE), HKCH Commissioning Service Co-ordinators and the Commissioning Team took the opportunity to meet with our frontline colleagues. HCE began the staff forum by sharing the vision of achieving excellence in clinical, research and training in HKCH together with the paediatric community across HA. There was also a sharing of latest development, colleagues were so excited to see the vivid presentation of the features of HKCH and the plans of our future "hardware" and "software" of different services including nursing, pharmacy, laboratory, radiology, integrated rehabilitation centre, allied health, human resources and hospital administration. Thank you to EVERY participant who contribute to make the HKCH dream possible and it will only be successful because of YOUR support!
Dr T L Lee, Hospital Chief Executive, HKCH
Dr Lily CHIU, Consultant (Commissioning / Hong Kong Children's Hospital)
Dr Niko TSE, Hong Kong Children's Hospital Commissioning Service Co-ordinator (Paediatric Nephrology)
Dr Jennifer KHOO, Hong Kong Children's Hospital Commissioning Service Co-ordinator (Radiology)
Dr AU Cheuk-chung, Resident (Paediatrics), Hong Kong Children's Hospital
Dr CHAN Yu Hin Eugene, Resident (Paediatrics), Hong Kong Children's Hospital
Ms Cynthia CHAN, Manager (Corporate Communication/Communication & Publications
Ms Miscelle KWOK, Chief Hospital Administrator (Commissioning / Hong Kong Children's Hospital)
Ms Vicky LEE, Senior Hospital Manager Administrator (Commissioning / Hong Kong Children's Hospital)
Copyright @ 2016 Hospital Authority.
We welcome comments and suggestions, please email to us at hkch@ha.org.hk
Read the Hong Kong Children's Hospital Newsletter online at www.ha.org.hk/hkch/
Being a paediatrician for more than 20 years, I feel truly blessed with the opportunity to be appointed as Hospital Chief Executive and dedicate myself to where I am most devoted and versed in - the paediatric services. Many said Hong Kong Children's Hospital (HKCH) is a 50 year dream comes true for both paediatricians and families of sick children. Now the dream is becoming a reality. How do we prepare ourselves to move forward from streams of profound affection to world-class paediatric services?
In HKCH, we share the vision of achieving excellence in clinical, research and training in Paediatrics together with Paediatrics Departments over the territory. We are now at the commissioning phase, and our first task is to build up strong and clear corporate and clinical governance with robust systems so as to ensure safe start and transition of service in 2018. Whilst providing quality and family-centred care, the service model should also be affordable and sustainable. To reach this destination, we have to fulfil a few imminent tasks. We have to build a pragmatic and realistic Hub-and-Spoke model which consists of protocol-driven care, consensus referral as well as successive care guidelines. This ensures patient is being cared in the right places at the right time. Since HKCH is admitting critically ill children transferred from other hospitals, we need to build up a competent emergency transport team. In this Newsletter, the commissioning service coordinators of different disciplines will share their views of how to assure a safe service commencement in HKCH.
We will also be mindful of the roles of patient groups and other charitable foundations in ensuring a holistic care for our sick children. They have been contributing all along and we will work even more closely with them in the years to come when HKCH is in operation.
HKCH provides a congenial environment for sick children and parents, nevertheless, the positive energy and seeds of hope are beyond a physical premise. It is planted in the hearts of everyone who join hands to build HKCH. Let's forge ahead with passion to tackle new challenges and embrace new opportunities.
Dr TL Lee
Hospital Chief Executive, HKCH
Taking care of babies is always exciting and rewarding. We welcome them and help them embark on their life journeys. Sometimes, illness falls upon them and their lives are at stake. This is especially when they are just born, because of complex transitory physiological adaptation required. Timely, well-organized resuscitation, stabilization and subsequent individualized care are critically important. Most of them survived well, sometimes miraculously. Learning from these, we are meticulously cautious with the inception of HKCH coordinated service. Transition involves good coordination, vision sharing, work flow design re-engineering and orchestrated teamwork. Mutual support, positive thinking and staff engagement help in solidarity, jointly contributing and molding the future network, tightening the link, broadening and deepening the foundation. With these, we can achieve better performances, clinical outcomes, medical care advancements and academic pursuits.
To have safe start, HKCH neonatal services (as part of the network) need to have safe level of staffing, safe working hour arrangements, and mutually agreed reciprocal referral system with all regional hospitals, empowerment program and strong transport team, to meet the needs of patients handled. Opportunities and resources for professional development and reflective learning and experience sharing, in form of research, audit, and education, are vital, to benefit the whole of HK. We can thus work together and streamline our clinical services across HK territory wide, to build a stronger network with tighter support, better clinical governance and collaboration, and fostering the team working among health care professionals. At the end, our babies, and thus our future generation, will benefit from our concerted effort with their health and welfare being our focus.
Let's share our vision and work together. Dedication always trumps perceived problems during early transition.
With commencement of service in 2018 at the HKCH, the paediatric cardiology and cardiac surgery program will provide a territory-wide comprehensive tertiary service including all paediatric cardiac surgery, catheter-based interventional catheterization in a state-of-art hybrid catheterization laboratory, intervention for various forms of cardiac arrhythmias and management of complex congenital heart disease. To provide such a complex and high risk clinical service, a multidisciplinary team including highly specialised cardiologists, cardiac surgeons, cardiac anaesthetists, intensivists, and other specialists are needed. The cooperation and collaboration of all relevant specialists are essential to provide an effective and efficient service.
A safe beginning of the service will necessitate not only provision of adequate manpower with welltrained staff and good facilities, but also staff engagement at all levels during preparation and being ready to address to problems that arise for both patients and staff. A detail operation plan has to be drawn up and good communication and understanding among all involved teams is of utmost importance. Indeed, good leadership and unfailing support from the administration are key to success of the HKCH.
To many paediatricians, doctors, nurses, sick children and their families, it is truly a realization of a 50-year Hong Kong dream to have our own children 's hospital. Given that Shenzhen and Urumqi have their own children’s hospitals, we are certainly a bit late in kicking off. Although no longer called a “Centre of Excellence”, we pride ourselves in being able to work together in concerted efforts to achieve this. It is impressive that many enthusiastic colleagues have put in endless hours, weeks and even months to make this possible.
Hong Kong citizens and children enjoy a public health care system with high standards. Indeed, mortality and morbidity are among the lowest in our region. Critical childhood illnesses include neonatal, congenital and acquired cardiac diseases, oncological, surgical and renal conditions, among others. These are major subspecialties to be established in the first phase at the Children’s Hospital. Children cared by these teams are likely to be critically ill and call for paediatric intensive care support. A strong Paediatric Critical Care Medicine (PCCM) service is pivotal to the success and safe running of all these important subspecialties.
Dr Kwong, our neonatology coordinator, says it well: better performance, clinical outcome, medical care advancement and academic pursuit can only be possible with good coordination, vision sharing, work-flow design re-engineering and orchestrated teamwork. Prof Chan, our paediatric oncology coordinator, assures us that a collaborative atmosphere has been formed among local paediatric haematologists / oncologists long before the beginning of HKCH.
With the "Hub-and-Spoke" system, our service to the Hong Kong people can only go better. The HKCH will serve as the Hub and all regional hospitals being the spokes to enable the wheel to turn. The Hub and Spokes must work together. Without the spokes, there is no wheel to run. Without the hub, we are like a pile of sand (一盆散沙). There are 8 existing Paediatric Intensive Care Units (PICU) that have been serving Hong Kong. Unlike overseas, we only have to travel within minutes to a nearby regional hospital to receive immediate emergency and critical medical care. The existing paediatric intensivists and many trainees are united and prepared to provide this service for HKCH. To have a safe start and transition, first and foremost, we must retain these great colleagues and not to allow them to drift away to the private sectors. Employment posts and recognition must be created now. Time is running short. The PICU team must be formed now, and not one year later, in order to rest-assure all our subspecialty colleagues.
HKCH is a mega-project. Safety and quality are of prime concerns. We follow the hub and spokes model with management for special nephrology, such as dialysis and transplantation and difficult glomerulonephritis, being concentrated at HKCH and general nephrology, such as urinary traction infection and simple glomerulonephritis, being localized at other Hospitals (OH). Tight links between HKCH and OH will be strengthened through exchange of paediatric nephrologists (PN) and rotation of trainees, common management protocols and other communication means. The links contribute much to safety and quality. To have a safe start of paediatric nephrology service, sufficient manpower especially PN and nephrology trainees and nephrology nurses are essential and they should be working in a well-planned infra-structure and are adequately supported by other specialties (such as Radiology, Paediatric Surgery, Anaesthesiology, PICU) and allied health disciplines (such as clinical psychologists, dietitians and social workers as well as OT and PT). To ensure safe start and transition, planning with input from different parties are necessary. In addition to the Clinical Work Group of Paediatric Nephrology, the newly established "Commissioning Department Management Committee" had held the first meeting in June 2016.
In less than 2 years time, we will witness the commencement of service of HKCH. How to achieve a safe and seamless transition of our specialty is a daunting challenge. We all know that "No man is an island entire of itself...." (John Donne), a united team spirit among all the stakeholders is a must. A collaborative atmosphere has been formed among local paediatric haematologists / oncologists long before the beginning of HKCH. It can be reflected by our common treatment protocols and practice guidelines. We share our clinical data and have an accurate local data base. Furthermore, combined auditing meetings of all units have been held at regular period. In preparing for the HKCH, we harmonize our electronic prescription forms and nursing practice. We also encourage exchange of medical staff between units so we can facilitate mutual understanding and exchange of experience. However, the difficulty remains in our amalgamation with other specialties. Since some of the supportive services such as radiation therapy will not be available in the HKCH, a feasible logistic plan has to be established before the starting of the HKCH. With the professionalism and selfless devotion of all involved parties, we are optimistic that most problems can be solved.
For the many in Paediatric services, the HKCH is an exhilarating advancement for the focused and quality care which our children and their families are in need of. It was a dream but is now made reality via the hard and challenging work of HA's and the HK Government’s. For ENT, with a central core manpower, all seven cluster departments will be contributing their specialist expertise in Paediatric ENT to the service at HKCH. Aside from the improved management of difficult and rare cases requiring multidisciplinary input, the routine cases too can receive better focused care with all the appropriate paediatric supporting facilities which would translate into improved quality management. International partnership, partnership with our local universities and basic and clinical research would be very much part of the core objectives in our service.
HKCH, which will be opened in 2018, is a significant milestone for Hong Kong. This will be the first hospital in Hong Kong dedicated to the well-being of children.
The neurosurgical community is excited to be part of this big project. Currently, children with neurosurgical conditions are being managed in regional hospitals, scattered in various clusters. Because of the small number of patients in each cluster, it is difficult for any regional hospital to have the require critical mass to excel in the field of paediatric neurosurgery.
Neurosurgical service at the HKCH will be provided in phases, depending on the clinical needs. All seven neurosurgical centres in Hong Kong have agreed to transfer patients requiring neurosurgical interventions to the HKCH, except emergency conditions that require immediate interventions such as head injuries.
Furthermore, paediatric neurosurgeons from regional hospitals will cooperate and work as a team, contributing expertise in various areas of paediatric neurosurgery such as oncology, functional and epilepsy surgeries.
We hope this can set a model for other sub-specialties in breaking down barriers between different centres, so patients with a particular problem is treated in a place with the best experience.
In less than 2 years' time, we will witness the opening of HKCH. To many of us who work with children, this is a once in a lifetime opportunity to take part in the commissioning project of this hospital. Our group is privileged to be part of the team.
Many paediatric eye diseases are part of different systemic problems beyond the understanding of an ophthalmologist. We need a team of experts in different specialties to support us in delivering a high quality service to our patients.
Dream will not come true without good planning and teamwork. Starting a new service in this world class hospital has never been an easy task, but we feel at ease to have the backup from the commissioning team and other stakeholders. Their tremendous support is the key to success.
To start safe with safe transition, we have to line up all stakeholders. Fortunately, the desire to deliver the best paediatric ophthalmology service in HKCH is unanimous among paediatric ophthalmologists in the territory. We have received support from the Universities and all HA teams. Hong Kong Eye Hospital will provide a strong back up for the future ophthalmology department in HKCH during its infancy and service will be introduced in phases. Together with the support from dedicated experts of different specialties, I am confident that the development of Paediatric Ophthalmology team will achieve an excellent development.
Paediatric surgery is one of the fastest growing surgical specialties. With recent advances in minimal invasive surgery, endoscopic therapy and interventional radiology, better treatment outcome can be achieved for complex surgical conditions.
Sub-specialization development is the global trend for management of rare surgical diseases. In Hong Kong, the paediatric surgery referral network has been established since 2003. The opening of HKCH as a tertiary and quaternary surgical referral centre enables us to provide expertise services to children with complex surgical problems.
For transition of surgical services from current three paediatric surgical centres to HKCH, the Clinical Work Group of Paediatric Surgery in HKCH decided to concentrate operations on neonatal surgery, oncological surgery, primary cleft surgery and complex urology related to renal transplantation to HKCH in 2018. HKCH is also responsible to provide emergency paediatric surgery service in Kowloon Central and Kowloon East Cluster. Collaborations with other paediatric specialties, e.g. anaesthesia, radiology, NICU/PICU are essential for smooth and safe transition of surgery services in HKCH.
Paediatric anaesthesia is a hospital wide provision covering clinical anaesthesia, operating room services, perioperative programme, resuscitation, sedation, acute and chronic pain management. Quality assurance, training and research are tightly bound to the subspecialty service in HKCH.
The current service plan for HKCH is to centralize children cancer, cardiac and renal services upon its service commencement in 2018. As such, anaesthesia at the start will support operations on neonatal surgery, oncological surgery, primary cleft surgery and complex urology related to renal transplantation, and paediatric general surgery service in Kowloon Central and Kowloon East Cluster. Paediatric open heart surgeries and cardiology interventional procedures will also be performed in the state of the art operating theatre and the hybrid catheterization laboratory which together form an integrated cardiac and vascular complex within the main operating theatre suite.
An integrated perioperative programme will be developed for a family centered and stress free admission and discharge after enhanced recovery from surgery.
Sedation and pain management outside operating theatres e.g. radiology and oncology procedures will be supported by anaesthetists to ensure safety and comfort of children undergoing different invasive procedures. As radiation therapy including tomotherapy will be outside HKCH, a feasible sedation support plan will be formulated for these children.
Currently, paediatric anaesthesia is a small subspecialty in Hong Kong. Manpower and talents are greatly needed for service, training and research. We would favour an inclusive model with participative leadership and good governance to foster collaboration exchanges and networking. Full time and part time colleagues altogether will strive for excellence under the same roof.
It is challenging to develop this subspecialty further; yet with this opportunity, and with the support and collaboration from regional hospitals, universities and various parties, we would have a solid beginning.
It has never been an easy job to operate a multi-disciplinary pathology laboratory, but even more so is to run a centralised genetic service with different governance. I have been given the task to supervise and in particular, to coordinate the operation of the genetic/genomic laboratory which houses the advanced technology platforms (e.g. DNA microarray and massively parallel sequencers) for clinical application, the SafeT21 programme for non-invasive prenatal testing and the Clinical Genetics Services under the Department of Health. Furthermore, there is the possibility that the newborn screening programme (laboratory part) for inborn error of metabolism may also be located in the hospital under the Department of Pathology. The task is formidable and challenging, albeit interesting. Only through multi-disciplinary cooperation and inter-personal liaison, and constructive dialogue are we able to achieve our goal, i.e. to provide a safe and worry-free journey for our children in the HKCH.
Advances in radiological technologies have led to an ever-increasing number of applications in both diagnosis and treatment. In Radiology, we observe two basic principles of radiation protection: Justification and Optimization.
Justification - "Do the right procedure" - Weighing the expected benefits against the potential risks.
Optimization - "Do the procedure right" - Keeping doses "as low as reasonably achievable" (ALARA)
Alternative techniques that do not involve exposures to radiation (e.g. Ultrasound and MRI) also have their benefits and risks. Safe and appropriate use of radiological investigations requires stringent adherence to principles, protocols and policies. We aim to provide support to our clinical colleagues through multidisciplinary communication, collaboration and coordination. Partnership with hospital management is also the key to safeguarding radiation safety and quality, such as employing imaging equipment technologies for optimization of radiation protection, creating a non-threatening environment, ensuring that appropriate quality assurance, quality improvement and clinical audit programmes are in place, and adhering to safety standards and protocols.
Our colleagues' support and participation are the keys to the development of the Hong Kong Children's Hospital. A staff forum was held successfully on 17 May 2016 at the HAHO with the participation of over our advanced recruited colleagues and 120 medical, nursing and supporting staff from various service units to be translocated to HKCH upon service commencement in 2018. Our Hospital Chief Executive (HCE), HKCH Commissioning Service Co-ordinators and the Commissioning Team took the opportunity to meet with our frontline colleagues. HCE began the staff forum by sharing the vision of achieving excellence in clinical, research and training in HKCH together with the Paediatric community across HA. There was also a sharing of latest development, colleagues were so excited to see the vivid presentation of the features of HKCH and the plans of our future "hardware" and "software" of different services including nursing, pharmacy, laboratory, radiology, integrated rehabilitation centre, allied health, human resources and hospital administration. Thank you to EVERY participant who contribute to make the HKCH dream possible and it will only be successful because of YOUR support!
Dr T L Lee, Hospital Chief Executive, HKCH
Dr Lily CHIU, Consultant (Commissioning / Hong Kong Children's Hospital)
Dr Niko TSE, Hong Kong Children's Hospital Commissioning Service Co-ordinator (Paediatric Nephrology)
Dr Jennifer KHOO, Hong Kong Children's Hospital Commissioning Service Co-ordinator (Radiology)
Dr AU Cheuk-chung, Resident (Paediatrics), Hong Kong Children's Hospital
Dr CHAN Yu Hin Eugene, Resident (Paediatrics), Hong Kong Children's Hospital
Ms Cynthia CHAN, Manager (Corporate Communication/Communication & Publications
Ms Miscelle KWOK, Chief Hospital Administrator (Commissioning / Hong Kong Children's Hospital)
Ms Vicky LEE, Senior Hospital Manager Administrator (Commissioning / Hong Kong Children's Hospital)
Copyright @ 2016 Hospital Authority.
We welcome comments and suggestions, please email to us at hkch@ha.org.hk
Read the Hong Kong Children's Hospital Newsletter online at www.ha.org.hk/hkch/