LCQ11: Services of the accident and emergency departments of public hospitals

     Following is a question by Dr the Hon Chiang Lai-wan and a written reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (April 21):
 
Question:
 
     It has been reported that in October last year, a male patient who had been suffering from anti-phospholipid syndrome and taking anticoagulant Warfarin for a long period attended the accident and emergency (A&E) department of a public hospital for treatment and was triaged as a patient of the "semi-urgent" category. After waiting for about two and a half hours for diagnosis and treatment at the A&E department, he was found by his family members to have stopped breathing. He was immediately given emergency treatment by healthcare personnel, but he eventually died from severe intracranial haemorrhage. In this connection, will the Government inform this Council if it knows:
 
(1) the overall average time for which patients waited for diagnoses and treatments at the A&E departments of public hospitals, and set out the relevant average waiting time by hospital and triage category, in each of the past two financial years;
 
(2) whether the Hospital Authority (HA) will step up the training for those nurses responsible for triaging patients at A&E departments, so as to assist them in making triage decisions that are more accurate; if HA will, of the details; if not, the reasons for that;
 
(3) whether HA will stipulate specifically in the guidelines for the triage system those clinical presentations requiring attention when triaging patients who are taking Warfarin, so as to avoid underestimation of their conditions; if HA will, of the details; if not, the reasons for that;
 
(4) whether HA will, through (i) deploying nurses to conduct regular reviews and (ii) connecting patients to monitoring devices, monitor if the conditions of those "urgent" and "semi-urgent" patients waiting for diagnoses and treatments have worsened; if HA will, of the details; if not, the reasons for that; and
 
(5) the current establishment of healthcare personnel at each A&E department of public hospitals; whether HA has assessed if such manpower is sufficient to ensure that all patients at A&E departments can receive timely diagnoses and treatments?
 
Reply:
 
President,
 
     My reply to the various parts of the question raised by Dr the Hon Chiang Lai-wan is as follows:
 
(1) The tables below set out the average waiting time for Accident and Emergency (A&E) services by triage category in each hospital under the Hospital Authority (HA) in 2018-19 and 2019-20.
 
2018-19

 
2019-20

Note:
(1) TSWH has commenced A&E services since March 2017 in phases, initially with eight-hour A&E services daily (from 8am to 4pm), then extended to 12-hour daily (from 8am to 8pm) since March 2018. The operating hours have been further extended to 24-hour since November 2018.
 
(2) and (3) To ensure that patients can be diagnosed and assessed as early as possible, the HA has established triage guidelines, under which an experienced and specially trained nurse will first assess patients' conditions and set priorities for treatment according to the severity. Patients are classified into five categories based on their clinical conditions, namely Triage I (critical), Triage II (emergency), Triage III (urgent), Triage IV (semi-urgent) and Triage V (non-urgent). The HA has set performance pledge to ensure that patients who need urgent medical attention are treated within a reasonable time. Patients triaged as critical will be treated immediately by healthcare staff without having to wait, while those with non-urgent conditions may have to wait longer.
 
     According to the HA's triage guidelines, a triage nurse will classify patients into the five categories based on objective (e.g. vital signs of patients) and subjective (e.g. major symptoms reported by patients) information as well as findings of targeted assessments (e.g. electrocardiogram, blood glucose or urine test, etc). Triage nurses at the A&E departments must be specially trained and experienced in A&E work. The A&E Nursing Development Sub-committee under the HA's Central Coordinating Committee (A&E) will also conduct triage audit at A&E departments of all public hospitals on a regular basis to ensure the quality of triage services.
 
(4) Healthcare staff of A&E departments will put patients under appropriate monitoring and care in different designated areas of the A&E departments according to their triage categories, clinical conditions as well as the stage of medical examination and treatment. In general, the healthcare staff would also arrange patients to rest on stretchers subject to their conditions. They will regularly attend to patients waiting in the A&E departments and provide appropriate care based on patients' needs. Family members are encouraged to accompany the patients where possible, and maintain communication with the healthcare staff while waiting in the A&E departments to ensure that appropriate assistance could be given to the patients.
 
(5) A&E departments under the HA will deploy manpower having regard to their operational needs, while the deployment arrangements may vary between hospitals depending on various factors such as the sizes, service needs and provision of individual A&E departments. The HA is committed to improving the overall quality of A&E services by implementing various measures, including increasing manpower of doctors, nurses, allied health professionals and supporting staff in A&E departments, as well as further augmenting A&E manpower through the provision of special honorarium and leave encashment. The HA has also launched the A&E Support Session Programme to recruit additional healthcare staff to assist in handling urgent, semi-urgent and non-urgent cases, with a view to relieving the pressure and workload of the A&E healthcare staff, thus allowing them to focus on the more urgent cases.
 
     The numbers of A&E doctors and nurses in each hospital under the HA in 2020-21 (as at February 2021) are set out below:
 
Doctors

Note:
(1) The manpower figures are calculated on a full-time equivalent basis including permanent, contract and temporary staff in the HA. Individual figures may not add up to the total due to rounding.
(2) Doctors exclude Interns and Dental Officers.
(3) The A&E department of TSWH has commenced services in phases since March 2017.
 
Nurses

Note:
(1) The manpower figures are calculated on a full-time equivalent basis including permanent, contract and temporary staff in the HA. Individual figures may not add up to the total due to rounding.
(2) The A&E department of TSWH has commenced services in phases since March 2017.
(3) Nursing manpower in SJH is calculated on hospital basis.
# Including a Nurse Consultant employed by the HKEC Office.
 
Abbreviations:
 
Cluster
HKEC – Hong Kong East Cluster
HKWC – Hong Kong West Cluster
KCC – Kowloon Central Cluster
KEC – Kowloon East Cluster
KWC – Kowloon West Cluster
NTEC – New Territories East Cluster
NTWC – New Territories West Cluster
 
Hospital
AHNH – Alice Ho Miu Ling Nethersole Hospital
CMC – Caritas Medical Centre
KWH – Kwong Wah Hospital
NDH – North District Hospital
NLTH – North Lantau Hospital
PMH – Princess Margaret Hospital
POH – Pok Oi Hospital
PWH – Prince of Wales Hospital
PYNEH – Pamela Youde Nethersole Eastern Hospital
QEH – Queen Elizabeth Hospital
QMH – Queen Mary Hospital
RH – Ruttonjee Hospital
SJH – St. John Hospital
TKOH – Tseung Kwan O Hospital
TMH – Tuen Mun Hospital
TSWH – Tin Shui Wai Hospital
UCH – United Christian Hospital
YCH – Yan Chai Hospital