LCQ21: Arrangements of the Hong Kong Children's Hospital for receiving patients
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Question:
It has been reported that in July this year, a five-year-old boy with congenital heart disease sought consultation at the Accident and Emergency Department (AED) of Tin Shui Wai Hospital (TSWH) due to fever. During that time, his family members expressed the hope that the boy could be referred to the Hong Kong Children's Hospital (HKCH) for consultation where his heart problems were being followed up. However, the boy was eventually transferred to Tuen Mun Hospital before he could be referred to the HKCH to receive consultation. It took a total of 19 hours from the time the boy sought consultation at AED of TSWH to the time he was conveyed to the HKCH. In this connection, will the Government inform this Council:
(1) whether it knows if the Hospital Authority (HA) has conducted any investigation into the reasons why it took 19 hours to convey the patient to the HKCH in the aforesaid case; if the HA has, of the details; if not, whether the HA will conduct such an investigation;
(2) given that patients are currently required to be referred by public hospitals or private doctors before they can receive treatment at the HKCH, whether it knows the respective general and emergency referral procedures concerned;
(3) whether it knows the respective numbers of patients conveyed to the HKCH through general and emergency referral procedures in the past two years;
(4) whether it knows if the HKCH will accept cases directly referred by AEDs of hospitals; if the HKCH will, of the referral procedures and the conditions to be met; if not, the reasons for that; and
(5) whether it knows if the HA will review and enhance the referral procedures for receiving patients at the HKCH, such as considering the provision of special arrangements for children who underwent surgery or received treatment at the HKCH by allowing them to attend consultation at the HKCH without referral within a specified period of time; if the HA will, of the details; if not, the reasons for that?
Reply:
President,
In response to the question raised by Hon CHAN Hoi-yan, the reply in consultation with the Hospital Authority (HA) is as follows:
Paediatric service of the HA is operated on a hub-and-spoke model. As a tertiary referral centre, the Hong Kong Children's Hospital (HKCH) specialises in complex, serious and uncommon paediatric cases requiring multi-disciplinary management, providing diagnosis, treatment and rehabilitation for patients with relevant clinical needs from birth to 18 years of age. The paediatric departments of regional public hospitals are mainly responsible for delivering secondary, emergency and community care services. Given this positioning, there is no Accident and Emergency department (A&E) in the HKCH. Indicated patients can be admitted into the HKCH through the hospital's clinical departments. Depending on the situation, admissions may also be referred by other public hospitals (wards or A&E) or private hospitals / doctors.
For patients who are already under active treatment at the HKCH (e.g. patients who have recently underwent complicated surgery or need to visit the hospital frequently for medical procedures), the HKCH has set up contact channels for parents to directly reach the relevant clinical teams / wards for enquiry in case the patients develop physical discomfort after discharge or have any questions about their health conditions. Clinical staff will assess patients' clinical conditions at the time and make appropriate recommendations according to their imminent medical needs, e.g. seeking medical consultation with private doctors first, or visiting nearby A&E to stabilise their condition in case of emergency. If their conditions warrant management by the HKCH, direct admission into the HKCH could be arranged without the need to be referred by other hospitals.
As for other children who seek medical care in A&E of HA hospitals, if doctors consider it necessary to arrange admission based on their clinical conditions, per current practice, the patients concerned will normally be transferred to the paediatric ward or other related specialty wards of relevant hospitals (unless a patient requires treatment by specialists in Paediatric Surgery and the corresponding hospital does not provide such specialist service, which in this case requires direct transferral to the HKCH Paediatric Surgery ward for treatment). During patients' hospitalisation in various hospitals, if there are clinical indications, doctors may contact the relevant clinical teams of the HKCH to discuss the patients' management plan. If necessary, the patients could be transferred to the HKCH for further treatment. Both parties will maintain close communication on the patients' conditions throughout the process.
As mentioned above, under the hub-and-spoke model of paediatric services, the HKCH and the paediatric departments of other public hospitals have their respective roles to play in accordance to the patients' clinical situation and needs at the time. Therefore, not all patients who have been treated in the HKCH need to be admitted back into the HKCH whenever they require hospitalisation.
Figures in relation to the patient admission pathways of the HKCH in the past two years are set out below:
| 2021/22 (number of admissions) |
2020/21 (number of admissions) |
|
| Admission arranged through clinical departments of the HKCH | 15 984 | 13 995 |
| Admission via referral when staying in other public or private hospitals | 756 | 500 |
| Admission via direct referral by A&E of other public hospitals | 960 | 627 |
As for the case mentioned in the question, according to the report by the HA, a five-year-old boy who had previously undergone surgeries at the HKCH attended the A&E of Tin Shui Wai Hospital in July this year. He was having fever at the time. Based on the boy's clinical condition at the time and various laboratory results, the A&E doctor considered the boy's status as relatively stable and recommended him to be transferred to the paediatric ward for observation. Therefore, he was arranged for observation in the Paediatric Ward of Tuen Mun Hospital (TMH) that night. Subsequently, the paediatricians in the TMH and the HKCH jointly made a further assessment based on the latest clinical conditions of the patient, and decided to transfer him to the HKCH. Clinical staff had been providing necessary support to the patient while he was pending transfer. The HA had explained the situation to his parents and reviewed the procedures, and would continue to closely follow up his clinical needs.
Ends/Wednesday, November 9, 2022
Issued at HKT 15:30
Issued at HKT 15:30
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