Internships to ease strain on Hong Kong's accident and emergency departments

Staff shortages and increase in patients have left A&E departments struggling to meet targets

PUBLISHED : Wednesday, 05 February, 2014, 4:04am
UPDATED : Wednesday, 05 February, 2014, 5:04am

Public hospital emergency departments are trying to attract more new graduates to combat a shortage of doctors.

The shortage, compounded by an increase in both the number of patients treated and procedures offered, has left the city's 15 major accident and emergency departments struggling to meet their targets for urgent care.

In response, the Hospital Authority asked the city's two medical schools to consider including accident and emergency training in the graduate internship year.

"Our department is not so attractive to fresh graduates compared to other specialties," the chairman of the authority's accident and emergency central co-ordinating committee, Dr Simon Tang Yiu-hang, said. "We do not offer internships to graduates, and they do not have many chances to get in touch with us."

The proportion of urgent cases being seen within 30 minutes last year fell below the 90 per cent pledged by the authority.

Tang said that this was not only due to the manpower shortage, but that the city's ageing population, an increase in the variety of procedures emergency departments were expected to perform and a "fragmented patient flow" were also to blame. The number of accident and emergency doctors fell to 410 last year from 423 five years ago.

Tang said he hoped providing internships would ease the mounting pressure on emergency departments.

The number of people visiting accident and emergency departments tends to increase during cold weather, the flu season and holiday periods, especially the Lunar New Year. On Saturday, the second day of the Lunar New Year, 6,578 patients visited emergency departments at the 15 hospitals, up from 5,021 the day before. This rose to 6,704 on Sunday, prompting Tang to appeal for people with minor illnesses to consider outpatient clinics. The number fell to 5,813 the next day.

"Making an appeal through the media really works, but the effect lasts only for a few days," Tang said.

Patients are divided into five categories based on the urgency of their conditions, with service promises for the first three categories.

The first category, "critical" patients, should be seen immediately; 95 per cent of the second category, "emergency", should be seen within 15 minutes; and 90 per cent of the third category, "urgent", within 30 minutes.

"We have no problem with the first two categories, but we're concerned that category three has been showing a worsening trend," Tang said.

The percentage of these patients seen within half an hour fell from 91 in the year 2011 to 2012 to 84 the following year - the lowest in a decade.

Category three includes patients suffering from ailments such as chest pain or shortness of breath due to asthma.

Tang said the longer waits did not have a serious effect on patients' conditions.

The Hospital Authority has been offering extra pay to doctors, including those from other specialties, who volunteer for shifts at the emergency departments. It has recruited about 30 to work part-time.

Emergency units are expected to carry out a greater variety of treatments than previously, which has also put pressure on waiting times.

For example, emergency patients with chest pains may now be given an electrocardiogram, blood test, and X-ray scan. Previously such treatments would have been carried out by other hospital departments.

Five to 10 years ago, a doctor was able to see on average 40 patients in an eight-hour shift but the number had now fallen to about 25, Tang said.

"Our standard of care has risen. Waiting times are increasing [as a result] but this is not something on which we would compromise," he said.

Tang said the pressure should ease with the opening of the Tin Shui Wai and Kai Tak hospitals and an expected increase in medical graduates from about 300 a year to 420 in 2018.

In the meantime, he is hopeful that more overseas trained doctors will plug the gap.

He said public education was important in the long run.

"We can't say that people are abusing the service. Sometimes they just can't tell what's mild and what's serious. They see the accident and emergency department as the most secure choice - it's always open."