Accident and emergency services in public hospitals

14/12/2016

 

Following is a question by the Professor Hon Joseph Lee and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (December 14):

Question:

     It has been reported that the consultancy firm commissioned by the Hospital Authority (HA) recommended earlier to raise the charges for the services of the accident and emergency (A&E) Departments of public hospitals. However, some members of the public have pointed out to me that while raising A&E charges will increase the financial burden on low-income people, it may not be effective in reducing the number of persons seeking consultation in the A&E Departments in the long run. Those members of the public have also pointed out that the pressure on the services of A&E Departments should be alleviated through improving the triage system for patients and encouraging private medical institutions to strengthen their outpatient services. In this connection, will the Government inform this Council:

(1) whether it knows if HA has regularly reviewed (i) the triage system of A&E Departments and (ii) the target waiting times for patients under the various triage categories; if HA has, of the details; if not, the reasons for that;

(2) whether it knows, among the patients under the various triage categories in each of the past five years, the respective percentages of patients who were treated within the relevant target waiting times; whether HA has explored the reasons why some patients were not treated within the target waiting times; if HA has, of the details; if not, the reasons for that;

(3) as it has been reported that some patients triaged as non-urgent were not treated until they had waited for nearly 10 hours, whether the Government knows if HA will allocate additional resources and manpower to increase the quota for general outpatient clinics and extend their service hours, so as to alleviate the pressure on the services of A&E Departments; if HA will, of the details; if not, the reasons for that; and

(4) whether it knows if HA will discuss with private doctors and private hospitals to encourage them to expand the scale of their operations and extend their service hours, particularly those of evening outpatient services, in order to reduce the demand for the services of the A&E Departments of public hospitals; if HA will, of the details; if not, the reasons for that?

Reply:

President,

     My reply to the question raised by Professor Hon Joseph Lee relating to the accident and emergency (A&E) services of public hospitals is as follows:

(1) and (2) To ensure that patients in serious conditions will receive timely treatment, Hospital Authority (HA) adopts a triage system which classifies patients attending the A&E Departments into five categories, namely critical, emergency, urgent, semi-urgent and non-urgent, according to their clinical conditions.

     For patients triaged as critical, emergency and urgent, the HA has set performance pledges on their waiting time for treatment. According to the performance pledges, all patients who are triaged as critical patients will be treated immediately, 95 per cent of patients triaged as emergency patients will be treated within 15 minutes and 90 per cent of patients triaged as urgent will be treated within 30 minutes. The table below sets out the percentage of patients received treatment within the target waiting time in A&E Departments under the HA over the past five years.

Triage categories Target waiting time 2011-12 2012-13 2013-14 2014-15 2015-16
Triage I (Critical)  Immediate 100% 100% 100% 100% 100%
Triage II (Emergency) 15 minutes 98% 97% 96% 97% 97%
Triage III (Urgent) 30 minutes 91% 84% 75% 75% 78%

     The above table shows that in the past five years, the A&E Departments under the HA were able to provide immediate treatment for all critical patients and the waiting time of emergency patients also met the performance pledges. This shows that the majority of patients with pressing medical needs received timely medical treatment under the triage system. As regards patients triaged as urgent, their vital signs are relatively stable as compared with those triaged as critical and emergency. Nevertheless, the HA will continue to improve the service quality of its A&E services, with a view to offering treatment to all A&E patients within the target waiting time. Measures being taken include inviting doctors who are about to leave the HA or who have retired to work part-time in the A&E Departments to increase manpower, implementing the A&E Support Session Programme and deploying additional staff to rationalise patient flow and crowd management when long waiting time for patients is required.

     The Coordinating Committee (COC) in A&E of the HA is responsible for reviewing the triage system of A&E Departments on a regular basis for continuous improvement to the system. In August this year, the COC in A&E updated the internal guidelines for the triage system according to the service needs. The areas updated include the clinical symptoms and triage procedures for different categories of patients. In addition, the HA's Key Performance Indicator (KPI) Review Working Group and COC in A&E regularly review the KPIs of the HA, including the target waiting time of different triage categories of patients for A&E services.

 (3) The general out-patient (GOP) services provided by the HA are primarily targeted at the elders, the low-income individuals and patients with chronic diseases. Patients under the care of GOP clinics comprise two major categories: chronic disease patients in stable medical condition, such as patients with diabetes mellitus or hypertension, and episodic disease patients with relatively mild symptoms, such as those suffering from influenza, cold or gastroenteritis. Patients with severe and acute symptoms should go to A&E Departments of hospitals where necessary staffing, equipment and ancillary facilities are in place for appropriate treatment and comprehensive care.

     To meet the rising service demand, the HA endeavours to improve the GOP services, including renovating and modernising the facilities of ageing clinics to streamline patient flow, improve clinic environment for waiting patients and increase clinical space. The HA also actively recruits staff to enhance service capacity. With the implementation of various measures, the total GOP attendances increased by nearly 600 000 between 2012-13 and 2015-16, and the consultation quota of GOP clinics will be further increased in 2016-17. To cope with increasing public demand for GOP services, the HA will take into account the actual operation and service demand and continue to seek resources through its annual planning exercise under the established mechanism, so as to increase the overall consultation quota of GOP clinics.

     The HA will continue to closely monitor the operation and service utilisation of its clinics, and flexibly deploy manpower and other resources to ensure that primary care services could be appropriately provided for the target groups.

(4) To offer more choices to patients and facilitate the continuous development of our primary care services, the Government and the HA attach great importance to private out-patient services. The HA maintains contact with various doctors' associations such as the Hong Kong Medical Association (HKMA). For example, it has appealed to private practitioners via the HKMA to open their clinics during long holidays and extend their daily clinic hours to meet the possible upsurge in service demand during the winter influenza surge this year. The relevant information is displayed on the HKMA's website, which will be linked to the HA website for public reference.

     The HA has also launched public-private partnership (PPP) programmes proactively, which provide choice for a part of suitable patients to receive treatment from service providers in the private sector and thus relieve the pressure on public hospitals. As one of the clinical PPP programmes currently managed by the HA, the General Outpatient Clinic Public-Private Partnership Programme was extended to 12 districts in phases in the third quarter of 2016. It will be gradually extended to all 18 districts from 2017/18 to 2018/19. Under the programme, each eligible patient can select a participating private doctor as his family doctor. Each patient will receive up to 10 subsidised consultations per year, including medical consultations covering both chronic and episodic illnesses.

 
Last Updated 2016-12-14