Replies to LegCo questions

LCQ18: Specialist out-patient services

     Following is a question by the Hon Tam Yiu-chung and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (October 27):

 

Question:

 

     I have received complaints from members of the public about the long waiting time for the first appointment at specialist out-patient clinics operated by the Hospital Authority (HA).  In this connection, will the Government inform this Council whether it knows :

 

(a)  the respective average waiting times for the first appointments with the medical, surgical, paediatric, obstetric and gynaecological, ophthalmological and oncological specialist out-patient clinics operated by HA over the past three years;

 

(b)  the specialist out-patient service operated by HA with the longest waiting time for the first appointment, and the reasons for the longer waiting time required for such service; and

 

(c)  if there were any patients whose clinical conditions deteriorated over the past three years due to the excessively long waiting time; if so, the measures taken by HA to solve this problem?

 

Reply:

 

(a)  Earlier this year, the Hospital Authority (HA) revised the triage system in Specialist Out-patient clinics (SOPC).  These clinics now arrange for the first appointment of consultation for new patients on the basis of the urgency of their clinical conditions at the time of referral, taking into account various factors including the patients' clinical history, the presenting symptoms and the findings from physical examination and investigations.  Referrals of new patients are usually screened first by a nurse and then by a doctor in the relevant specialty and classified into one of the following categories: Priority 1 cases for patients with the most urgent medical needs; Priority 2 cases for patients with comparatively less urgent medical needs; and routine cases for patients where medical needs do not appear to be urgent.  In order to ensure that patients with urgent medical needs are attended to within a reasonable time, the HA has targeted to keep the median waiting time for Priority 1 and 2 cases within two weeks and within eight weeks respectively.  If necessary, the waiting time can be as short as a few days.  In addition, to ensure that no urgent medical conditions are overlooked at the initial triage, all referrals that have been classified as routine cases would be double-checked by a senior doctor in the relevant specialty within seven working days of the triaging. 

 

     The following table lists the average waiting time for major specialties in the past three years under the old triage system :

 

Average waiting time for new cases (weeks)

 

                              2001      2002      2003

Internal medicine                 9         12         13

Surgery                         7          8         11

Paediatrics                       3          2          2

Gynaecology                     4          5          6

Obstetrics                        1          1          1

Ophthalmology                    2          2          2

Oncology                         0          0          0

 

Note : "0" means less than one week. 

 

(b)  At present, the waiting time for new cases is relatively longer for internal medicine and surgery owing to increasing demand.  In addition, with advancement in medical technology, a lot of treatment procedures that required the patient to be hospitalized can now be done in the out-patient setting.  This has added to the workload of SOPCs.  Furthermore, the SARS outbreak last year had caused a standstill to SOPC service for some time, resulting in the accumulation of considerable workload and longer waiting times.  As infection control measures cannot be relaxed after SARS and as the HA has to be mindful of the requirement posed by statutory working hours for medical staff, there has not been any decrease in the workload of SOPC.

 

(c)  The revised triage system mentioned above ensures that patients of SOPCs with urgent medical conditions would be attended to in a timely and appropriate manner.  The HA will continue to refine the triage system, in particular the prioritization criteria to enhance the screening of referral letters by doctors.  The HA will also facilitate the sharing and learning of triage experience, and will remind specialist doctors to provide holistic care to patients to minimize unnecessary referrals.  Furthermore, SOPCs also actively provide information on different out-patient services to patients and their carers to enable them to make decisions and arrangements that suit them best. 

 

     The HA has also devised a standard referral letter for doctors in public primary care and private practice to ensure the necessary information are available and relevant investigations are conducted before the referral.  This will enhance more appropriate referral to specific specialties and more accurate triage.

 

Ends/Wednesday, October 27, 2004

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