'The rush to specialists has to stop'
In the third of a series on burdens facing hospitals, Ella Lee looks at steps being taken to cut admissions
Hospital chiefs are looking for ways to cut unnecessary admissions and referrals to specialists as a way of reducing the financial burden on the cash-strapped Hospital Authority.
Patients who can be cared for by general practitioners should not be referred to the more expensive specialist care, says Hung Chi-tim, the chief executive of the authority's Kowloon Central Cluster.
'Some patients who complain of chest pain may not have heart problems; it is unnecessary to refer them to cardiologists,' Dr Hung said.
'Another example is diabetes. Many [diabetics] can be taken care of by a general practitioner instead of a specialist in internal medicine. Experts at the general outpatient clinics can help doctors there make decisions on patients' referrals.'
The cluster runs Queen Elizabeth Hospital, Hong Kong's biggest public hospital, with 1,850 beds.
To augment finances, Dr Hung said he was also looking for new sources of funding, such as leasing hospital space for commercial advertisements.
He said the cluster introduced a new patient referral scheme last year to reduce demand on consultations with specialists.
At present, patients have to wait for at least nine months for the first consultation at the Queen Elizabeth Hospital's internal medicine specialist clinic, one of the busiest specialities.
Under the new procedures, senior doctors are placed at the cluster's Yau Ma Tei general outpatient clinic to screen the referrals.
About half of the clinic's referrals to specialists last year were found to be unnecessary.
The scheme will be expanded to the Central Kowloon clinic later this year.
The cluster is also trying to cut the demand on hospital admissions by sorting out some cases at the accident and emergency departments.
Elderly homes in the region, including those in Kowloon City and Mongkok, are a main source of patients for Queen Elizabeth Hospital, but many are not urgent cases.
The hospital's accident and emergency department takes care of more than 500 attendances a day, of which 160 to 170 are admitted to the hospital.
Patients from elderly homes accounted for more than 10 of these daily admissions.
Since January, members from the outreach medical team have been seeing elderly patients in the accident and emergency department to decide if they can be taken care of in the community.
Dr Hung said that to reduce the demand on hospitals 'we hope we can direct the patients back for community care'.
He said the $100 fee introduced for consultations at public accident and emergency departments in 2002 had had little impact on the number of attendances.