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Following is a question by the Hon Lau Kong-wah and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (February 8):
Question:
It has been reported earlier that the public's demand for medical services is keen, the accident and emergency (A&E) departments and specialist outpatient clinics of public hospitals are always full, and the waiting time of the patients is too long. It has also been reported that some A&E patients of public hospitals had to wait for three days before they were admitted to the wards, and an unfortunate incident of a patient passing away while awaiting admission to the ward even happened. In this connection, will the Government inform this Council if it knows:
(a) whether the Hospital Authority (HA) has compiled statistics on the average waiting time at present at the A&E departments of public hospitals in various districts; whether the existing pledged performance targets are achieved; the respective longest waiting times among the cases of patients seeking consultation at the A&E departments in various districts last year; if HA has not compiled such statistics, the reasons for that;
(b) the average waiting time at present at specialist outpatient clinics of public hospitals in various districts, as well as respective details of the cases with the longest waiting time among the cases of patients seeking consultation at the specialist outpatient clinics in various districts last year (set out in table form); and
(c) during peak seasons of influenza each year when the problem of patients having to wait too long for consultation at the A&E departments and for admission to the wards frequently occurs, whether HA will flexibly deploy its healthcare manpower to alleviate the problem; the strategies taken by the authorities to solve the problem of long waiting time for consultation at the A&E departments and specialist outpatient clinics of public hospitals in the long run?
Reply:
President,
(a) To ensure that patients in serious conditions will receive timely treatment, patient triage measures have been implemented in the Accident and Emergency (A&E) Departments under the Hospital Authority (HA). Healthcare personnel will triage patients into five categories, namely critical, emergency, urgent, semi-urgent and non-urgent, according to their clinical conditions. According to HA's performance pledges, all patients who are triaged as critical patients will be treated immediately, 95% of patients triaged as emergency patients will be treated within 15 minutes and 90% of patients triaged as urgent patients will be treated within 30 minutes.
In 2010-11, A&E Departments under HA were able to provide immediate treatment services for all critical patients and the waiting time for emergency patients and urgent 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. The performance pledges and the actual performance of the A&E Departments under HA are at Annex 1.
As for non-urgent cases, the HA overall average waiting time in 2011-12 (April to December) was 101 minutes, which is similar to that in 2010-11. The average waiting time of A&E Departments under each hospital cluster for the past three years is at Annex 2.
(b) HA has put in place a triage system at its specialist out-patient (SOP) clinics. Healthcare personnel will arrange the date of medical appointment for new patients on the basis of the urgency of their clinical conditions at the time of referral, which is determined with regard to various factors including the patients' clinical history, the presenting symptoms, the findings from physical examination and investigations, as well as information provided by other healthcare personnel at the time of referral.
Under the triage system, new SOP cases are classified into three categories: priority 1 (urgent), priority 2 (semi-urgent) and routine categories. To ensure that patients with urgent conditions are given appropriate medical attention in a timely manner, HA will arrange doctors to attend to priority 1 and priority 2 cases as soon as possible. The current median waiting time for these two categories of cases are one week and five weeks respectively. The triage system benefits patients with urgent conditions by shortening their waiting time. Nevertheless, the waiting time for patients with non-urgent conditions would be longer.
Referrals of new patients to SOP clinics under HA are usually first screened by a nurse and then by a specialist doctor of the relevant specialty. To ensure that no urgent medical conditions are overlooked at the initial triage, all new patients that have been classified as routine cases would be reviewed by a senior doctor in the relevant specialty within seven working days of the initial triage. If a patient's condition deteriorates before the date of appointment, he may contact the SOP clinic concerned and request for an earlier appointment. However, if the condition is acute, the patient can seek treatment from an A&E Department. Depending on the patient's needs, the healthcare staff may arrange an earlier appointment for the patient.
The median waiting time and the waiting time at the 90th percentile of the three categories of new cases in 2011-12 (April to December) of major SOP clinics under each hospital cluster is set out in Annex 3.
(c) Since Hong Kong has now entered the peak season for influenza, HA anticipates that there will be a sudden surge in service demand during this period. Various contingency measures have been implemented at HA hospitals, including provision of additional beds; increase of manpower through provision of special overtime allowances to staff not taking leave; enhanced provision of outreach medical services at Residential Care Homes for the Elderly to reduce hospital admission of elderly people; enhancement of virus testing service; expansion of ambulatory services to facilitate early discharge of more patients; as well as enhanced monitoring of A&E attendances, emergency hospital admissions and occupancy rates so that appropriate manpower can be deployed for providing services. In addition, HA will also continue to call on the public to maintain personal hygiene, receive influenza vaccination for prevention of infection, and avoid using A&E services under non-emergency situation, which would affect other patients who are in genuine need of A&E services.
For SOP services, HA has implemented a series of measures to further improve the waiting time at SOP clinics. These measures include setting up of family medicine specialist clinics as gatekeeper for SOP clinics and for follow up on patients triaged as routine cases; updating clinical protocols for referring medically stable patients to receive follow-up primary healthcare services; collaborating with private practitioners and non-governmental organisations (NGOs) to launch shared care programmes for the private sector and NGOs to follow up on medically stable patients; disseminating referral guidelines to clinicians to reduce unnecessary referrals; and piloting the use of e-platform for SOP referrals to enhance the provision of referral details and facilitate the exchange of information.
Ends/Wednesday, February 8, 2012
Issued at HKT 16:32
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