Emergency Department Misuse and Administrative Interventions

Abstract

IntroductionNotwithstanding the primary mission of managing sudden unexpected illnesses, major injuries and life‐threatening conditions, emergency departments have been forced to deal with primary care and even social problems nowadays. Emergency department (ED) overcrowding is a worldwide problem. Hong Kong is not immune, although the causes may be somewhat different. Excessive and unlimited patient volume threatens quality and timely emergency care. A review of the epidemiology of local ED attendance, causes of ED overcrowding and possible solutions may guide the future direction of healthcare in Hong Kong.MethodsMedical literature on ED overcrowding and ED misuse were searched from the Medline, HealthSTAR and EMBASE. Relevant full text articles were retrieved through hospital library network. Local emergency medicine publications including the Hong Kong Journal of Emergency Medicine and Emergi‐News were reviewed. Local statistics were obtained from the Hong Kong Government information website, Hospital Authority Executive Information System (EIS) and Hospital Authority Accident & Emergency Service data files.ResultsThere has been a steadily rising trend of ED attendance per thousand population. Causes of ED overcrowding include easy access, quality emergency care, barriers to primary care, barriers to specialist care, patient education, human right and free service. There are two approaches to the problem ‐ decreasing the demand or increasing the funding. Usual administrative measures aim at reducing inappropriate use of ED service. These include improved community and primary care, improved specialist support, patient education, financial barriers, patient refusal and even lowering ED service standard. Another approach is augmenting the resources and productivity of emergency departments to cater for the increasing demand.ConclusionsThere is no single effective solution that will apply in all circumstances. Broadly speaking, overcrowding is the result of inadequate funding for emergency health care services during a period of increasing demand.