The accident and emergency departments of all public hospital groups in Kowloon and the New Territories last year failed to meet their pledge of seeing 90 per cent of urgent cases within half an hour.
The problem was particularly acute in the Kowloon Central, Kowloon East and New Territories West groupings, where the percentages plunged to 71, 79 and 80 per cent, respectively.
Dr Simon Tang Yiu-hang, chairman of the Hospital Authority's accident and emergency central co-ordinating committee, said that each hospital faced different problems.
"Queen Elizabeth is the only hospital with accident and emergency services in Kowloon Central. It receives many ambulance cases because of the accessibility of its location and many [urgent] patients," he said.
Over the past two years the hospital has seen an 8 per cent increase in urgent patients - those in the third of five categories with the highest being critical - to 93,607 between April 2012 and March last year. The hospital received more than 194,000 patients in total that year.
The hospital, in Jordan, was built in the 1960s. Its emergency department was too small and its design unsuitable to cope with present-day demand, Tang said.
Tuen Mun Hospital in New Territories West, where Tang is deputy chief executive, has similar design problems.
The waiting area and the consultation areas are separated by several doors, unlike at the new Pok Oi Hospital, where all sections are grouped in one large space.
"There may be many patients waiting outside but the doctors inside wouldn't know. This is a major limitation," Tang said.
It takes longer for patients to go from one point to another and for doctors to be notified when there is a sudden surge of emergency patients, such as when several ambulances arrive at once.
Such design issues would be a major consideration when new hospitals are built, he said.
The Prince of Wales Hospital in New Territories East had a serious manpower shortage, Tang said. Its inpatient wards were often so full that patients requiring admission accumulated in the emergency department, where they could remain for hours before a bed became available.