Page 100 - HA Convention 2015

Special Topics

ST7.1 Management of Accident and Emergency Services 16:15 Theatre 2

Monday, 18 May Physician Workforce in the Emergency Department
Ducharme J
Department of Medicine, McMaster University, Canada

To identify proper staffing requirements, one must first define what emergency medicine is for Hong Kong. As healthcare
budgets are constrained, the population ages and overcrowding worsens, the definition of emergency medicine becomes
fluid and cannot be easily defined. Increasing lack of long term beds and proper home care as society ages will further
aggravate emergency department conditions. Substandard working conditions will push away many potential candidates.
Resulting inadequate physician numbers will further worsen a downward spiral. Increased risk of infection from overcrowded
working conditions, inadequate response from hospitals to the needs of the department, inadequate physician coverage,
and shift work: together they paint a bleak picture for any potential specialist in emergency medicine. The work environment
must be made to attain minimal norms of safety and functionality. No other area of a hospital is asked to act at 125 to 150%
of occupancy — and the area of greatest unpredictability should be the last area to be asked to do so.

Physicians with expertise in emergency medicine are an expensive human resource — the most expensive in emergency
healthcare. It has become essential for emergency systems to modify their models to limit physician activities to being
physicians. Time spent on documentation, laboratory ordering or reviewing, and other lower level work can be accomplished
more effectively by someone earning a fraction of the salary paid a physician. Emergency medicine specialists should be at
the bedside to assess, diagnose and manage those patients that require their unique core abilities, while spending additional
time communicating with families. Patients identified through triage as not needing that skill set could be seen by physicians
without emergency medicine certification, nurse practitioners or physician assistants. Techs and scribes can be hired to
provide medical doctor (MD) support. These steps can double specialty MD output while decreasing frustration and stress.

ST7.2 Management of Accident and Emergency Services 16:15 Theatre 2

HOSPITAL AUTHORITY CONVENTION 2015 Emergency Medicine Ward – More than Gatekeeping of Hospital Services
Ong KL
Accident and Emergency Department, Pok Oi Hospital, Hong Kong

The concept of managing certain targeted group of patients in Emergency Medicine (EM) wards has been well established
and accepted in Hong Kong for many years since the opening of the first two EM wards in Queen Elizabeth and Tuen Mun
hospitals in January 2007. There are currently 12 hospitals with EM wards and patients admitted to these wards are managed
by emergency physicians. By 2016, two more hospitals will provide EM wards.

The idea of EM wards evolved from the observation wards which many Accident and Emergency departments have to
allow a short period of monitoring after treatment or procedure, and for reviewing patient’s clinical progress within a short
period of time. However, to label EM wards as “more advanced” observation wards offering more options and higher level
of management is a misnomer. EM wards have their unique roles in the practice of EM and can be tailored for the different
needs of individual hospital.

What exactly are the roles of EM wards? Some would consider them as gatekeepers of hospitals, reducing emergency
admissions to the inpatient wards of other specialties, while others consider them to be part of risk management, providing
effective care for certain groups of patients. In practice, EM wards’ roles are flexible and are more than just gatekeepers; they
can be adapted to address the changes and needs of the emergency medicine and have impacted the overall patient care
over the past decade. Their presence as part of the hospital services have been accepted by other specialties, who now can
concentrate their efforts in managing other patient groups or time demanding complex conditions.

With EM wards becoming an integral part of our hospital services, it is imperative for EM specialists to identify performance
indicators that can truly reflect the unique roles that EM wards play. These indicators will enable us to identify our strengths
and weaknesses, guiding us in enhancing the efficiency and effectiveness of our service models.

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