For information


Purpose

This paper informs Members of the proposal of the Hospital Authority (HA) to set up family practice-type clinics next to the Accident and Emergency (A&E) departments of public hospitals.

Background

2. The key functions of A&E departments of public hospitals are to provide emergency life support and emergency care for critically ill or injured patients and to provide emergency management for massive casualties during occurrence of major accidents and disasters. Since the establishment of HA, there has been increasing public reliance on the A&E service. This is evident by the significant increase of 78% in A&E attendance from 1.29 million in 1991 to 2.3 million in 1998, compared to the population growth of 17% from 5.8 million to 6.8 million during the same period.

3. To cope with the rising demand on A&E services in public hospitals, HA has established a triage system in all A&E departments to prioritize patients for treatment according to their medical conditions. Patients are triaged into five categories - Critical, Emergency, Urgent, Semi-urgent and Non-urgent. The waiting time for medical attention for patients attending A&E departments depends on their triage categories.

4. Past statistics have shown that a significant proportion of patients attending A&E departments are not suffering from urgent or emergency medical conditions. In 1998-99, semi-urgent and non-urgent cases comprised about 63% and 11% respectively of the total A&E attendance of about 2.3 million (statistics on the number of A&E attendance of 1997-98 and 1998-99 are at Annex). From the clinical perspective, most of these patients could be managed in family practice clinics or primary care clinics.

Proposal for establishment of family practice-type clinics next to A&E departments

5. To cater for the needs of patients with semi-urgent or non-urgent conditions and to manage the rising demand for A&E services, HA is exploring the feasibility of setting up family practice-type clinics next to A&E departments of public hospitals. The objectives of setting up the clinics are -

1. to offer an alternative choice for patients with semi-urgent or non-urgent conditions to have easy access to appropriate health care facilities for prompt medical attention; and
   
   
2. to help ease the service demand at A&E departments and ensure their effective functioning in the provision of quality care to patients with more urgent and critical conditions.

6. HA plans to collaborate with the private sector in setting up the pilot clinics next to the A&E departments of acute hospitals. It is proposed that the clinic service be run by private general practitioners, groups or organizations. The clinics would be independent of the public hospitals and the private practitioners running the clinics would be responsible for the staffing and medicine supplies.

7. To ease the service demand at A&E departments, the clinics would be expected to operate during peak hours of weekdays, weekends and public holidays. The peak hours of A&E attendance are mainly 9am - 12 noon, 1pm - 4pm and 8pm - 11pm. In March 1998, the number of A&E attendance during peak hours took up about 51% of the total attendance. Out of the 51% of total attendance during peak hours, 73% are patients of semi-urgent and non-urgent conditions.

8. Patients who are triaged to be semi-urgent or non-urgent would be informed of the estimated waiting time for treatment and advised of the alternative choice of service provision at the clinic next to the A&E department. Given the relatively long waiting time for patients categorized as semi-urgent and non-urgent, which is targeted at less than 90 and 180 minutes respectively, patients might choose to go to the clinics next to the A&E departments for prompt medical attention. The level of fees charged at the clinics will be subject to future discussion between HA and the private practitioners.

Way Forward

9. HA has already initiated discussions and sought views from the public hospitals, professional bodies such as the Hong Kong Medical Association, private practitioners and other health care providers on the proposal of setting up clinics next to A&E departments. The concerned parties are receptive to the proposal, with more than one public hospital having expressed interest in joining the scheme. Subject to the approval of the HA Board, HA aims to implement the scheme in 2000.


Health and Welfare Bureau
September 1999

Annex

	Triage categories*
	Critical	Urgent	Semi-urgent	Non-urgent	Unclassified #	Total
1997-98
Total no. of 1st attendance	15,297	486,325	1,275,095	243,202	60,895	2,080,814
% of total no. of 1st attendance	0.7%	23.4%	61.3%	11.7%	2.9%	100%
1998-99
Total no. of 1st attendance	13,306	529,137	1,419,420	239,846	60,929	2,262,638
% of total no. of 1st attendance	0.6%	23.4%	62.7%	10.6%	2.7%	100%

*Since April 1999, the number of triage categories have been increased from 4 to 5.

#"Unclassified" category mainly includes those cases in which patients who had undergone the triage system left the A&E department without having received any treatment, and cases where the triage category of patients had not been properly recorded.