Overcrowding of A&E in Hong Kong
Dr Sam SM Yang
The life expectancy of local Hong Kong people is renowned to be the longest among regions across the world. The life expectancies of male and female people in Hong Kong increased from 68 and 76 years old in 1971 to 83 and 88 years old respectively in 2021. With increase in life expectancy, so is there increase in the proportion of the elderly in the population. From 2011 to 2021, the ratio of the population older than 65 years increased from 14 to 20 %. Although the number of attendances to A&E service at public hospitals only increased modestly over the years from 2008 to 2017(3%), there was an increment of 18% of attendance for those aged 65 and above. The high and rising demand for A&E services is attributed to a lack of access to primary healthcare services and shortage of out-of-hours services, convenience and accessibility of A&E departments and the relatively cheap service at public A&E sector.
Besides, data also reveal that number of critical, emergency and urgent nature (i.e. Triage1 to Triage3) that required more complicated and speedy treatment increased markedly in the period(+27%), posing added pressure on the tight A&E resources.
Lastly, access block further worsens the issue of A&E overcrowding by making patients planned for admission boarding at A&E. It is particularly serious during the influenza winter surge. Most hospitals' medical inpatient bed occupancy rate was over 100% during the winter surge in early 2019 and some even reached 125%.
Various measures were adopted to mitigate the problem of overcrowding over the years. A major strategy adopted was to strengthen the staff manpower through measures such as enhancing medical and nursing staff career prospects to retain them, provision of Special Honorarium Scheme to provide extra service session and recruiting part-time staff and rehiring retired staff. On the other hand, ways were also sought to reduce avoidable hospitalization by establishing Emergency Medicine Ward to provide short stay for those patients who need temporary stay for diagnostic purpose and acute short-term therapy, enhancing multidisciplinary support to the A&E departments e.g., geriatric assessment, medical social worker input and psychiatric consultation to expedite patient management. Besides, patient flow has been enhanced by facilitating transfer of stable patients from acute hospital to convalescent hospital, and adding extra senior doctors ward rounds during weekends and public holidays to facilitate discharge of patients.
Even with all those measures adopted, the waiting time at A&E and the access block have been continuously worsening. This was due to prioritizing of resources into dealing with rising number of Triage 1-3 group of patients and ongoing redevelopment projects in a number of hospitals.
The government is projecting a decrease in demand for A&E manpower in the coming 5 to 10 years according to its latest report. However, with the life expectancy projected to further increase in the coming years and the loss of manpower due to the wave of migration in recent years, the problem is not expected to improve and a decrease in manpower supply in A&E will make the situation even worse.
Centre for Health Protection, Department of Health - life expectancy at birth (male and female), 1971 - 2021. Centre for Health Protection. (n.d.). Retrieved March 2, 2023, from https://www.chp.gov.hk/en/statistics/data/10/27/111.html#
O'Neill, A. (2023, January 26). Hong Kong - age distribution 2011-2021. Statista. Retrieved March 2, 2023, from https://www.statista.com/statistics/604594/age-distribution-in-hong-kong/
Research Office selected places - legco.gov.hk. (n.d.). Retrieved April 9, 2023, from https://www.legco.gov.hk/research-publications/english/1819in05-emergency-care-services-in-selected-places-20190131-e.pdf
LC paper no. CB(2)1632/18-19(05) - SC.LEGCO.GOV.HK. (n.d.). Retrieved April 9, 2023, from https://sc.legco.gov.hk/sc/www.legco.gov.hk/yr18-19/english/panels/hs/papers/hscb2-1632-5-e.pdf