Accident & Emergency (A&E)

Introduction

The Accident and Emergency (A&E) services are provided at 18 public hospitals under the Hospital
Authority (HA). They deliver a high standard of service for critically ill or injured persons who need
urgent medical attention. They also provide medical support for victims of disasters.

To ensure that patients with more serious conditions are accorded higher priority in medical treatment,
HA adopts a triage system which classifies patients attending the A&E Departments into five categories
according to their clinical conditions: critical, emergency, urgent, semi-urgent or non-urgent. Patients
who do not require emergency attendance should seek medical treatment in public or private clinics.

Triage System

What is Triage? Triage - French word meaning "to sort" or "to choose". It is a process of setting priorities
for treatments for a patient or a group of A&E patients. The sorting of patients into priority categories is
performed by an experienced registered nursing staff. They use systemic and scientific methods to assess
patients' condition to interpret the clinical features and then exercise interventions in the early phase to
prevent deterioration and death.

The triage system has already been implemented in all A&E Departments to help determine the relative
priority of individual patient needs. Emergency patients will be given immediate treatment, while those
with non-acute symptoms should expect a longer waiting time.

When patients arrive at the A&E Department, they will first be assessed by an experienced and specially
trained triage nurse according to the severity and nature of their medical conditions, and priority will be
given to urgent cases.

Patients are divided into five categories according to their medical condition -

 critical
 emergency
 urgent
  semi-urgent
 non-urgent

For critical patients who are dying or in life-threatening condition, they are accorded top priority and
attended immediately by a team of medical and nursing staff without waiting.

Objectives of Triage

 Ensure early recognition and assessment of patients' condition and prioritize the treatment
according to severity of the conditions
 Reduce unnecessary delay of treatment
 To give brief First-Aid advice
 Initiate immediate diagnostic tests, intervention and nursing treatment
 Allow effective utilization of staff and resources by allocating patients to appropriate
treatment area according to their conditions
 improve patient-staff relationship and departmental image through greeting and
communication during process of triage
 Promote public relationship by immediate interview with patient
 Enable direct communication with pre-hospital care provider
 Provide documentation patients' condition, time of triage and preliminary treatment given in
triage
 To provide staff training and decision making

Service Targets

For patients whose clinical conditions are triaged as Category I to III, HA has set performance pledges on
the waiting time for their treatment.

 Triage Category I (critical cases): Immediate treatment

 Triage Category II (emergency cases): 95% of patients triaged as emergency will be treated
within 15 minutes
 Triage Category III (urgent cases): 90% of patients triaged as urgent will be treated within 30
minutes

Fee
Triage is one of the essential services provided by A&E Department. Patients who decide not to use the
service after triage service before consultation are required to pay the A&E charges.

 List of all Accident & Emergency Departments

 Accident & Emergency Waiting Time

An emergency department (ED), also known as an accident and emergency

department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a
medical treatment facility specializing in emergency medicine, the acute care of patients who present
without prior appointment; either by their own means or by that of an ambulance. The emergency
department is usually found in a hospital or other primary care center.

Due to the unplanned nature of patient attendance, the department must provide initial treatment for a
broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate
attention. In some countries, emergency departments have become important entry points for those
without other means of access to medical care.

The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be
varied in an attempt to reflect patient volume.

History

Accident services were provided by workmen's compensation plans, railway companies, and
municipalities in Europe and the United States by the late mid-nineteenth century, but the world's first
specialized trauma care center was opened in 1911 in the United States at the University of Louisville
Hospital in Louisville, Kentucky. It was further developed in the 1930s by surgeon Arnold Griswold, who
also equipped police and fire vehicles with medical supplies and trained officers to give emergency care
while en route to the hospital.[1][2]

Today, a typical hospital has its emergency department in its own section of the ground floor of the
grounds, with its own dedicated entrance. As patients can arrive at any time and with any complaint, a
key part of the operation of an emergency department is the prioritization of cases based on clinical need.
 This process is called triage.
[3]
Triage is normally the first stage the patient passes through, and consists of a brief assessment, including
a set of vital signs, and the assignment of a "chief complaint" (e.g. chest pain, abdominal pain, difficulty
breathing, etc.). Most emergency departments have a dedicated area for this process to take place and may
have staff dedicated to performing nothing but a triage role. In most departments, this role is fulfilled by a
triage nurse, although dependent on training levels in the country and area, other health care professionals
may perform the triage sorting, including paramedics and physicians. Triage is typically conducted face-
to-face when the patient presents, or a form of triage may be conducted via radio with an ambulance
crew; in this method, the paramedics will call the hospital's triage center with a short update about an
incoming patient, who will then be triaged to the appropriate level of care.

Most patients will be initially assessed at triage and then passed to another area of the department, or
another area of the hospital, with their waiting time determined by their clinical need. However, some
patients may complete their treatment at the triage stage, for instance, if the condition is very minor and
can be treated quickly, if only advice is required, or if the emergency department is not a suitable point of
care for the patient. Conversely, patients with evidently serious conditions, such as cardiac arrest, will
bypass triage altogether and move straight to the appropriate part of the department.

The resuscitation area, commonly referred to as "Trauma" or "Resus", is a key area in most departments.

The most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and
staff required for dealing with immediately life-threatening illnesses and injuries. In such situations, the
time in which the patient is treated is crucial. Typical resuscitation staffing involves at least one attending
physician, and at least one and usually two nurses with trauma and Advanced Cardiac Life
Support training. These personnel may be assigned to the resuscitation area for the entirety of the shift or
may be "on call" for resuscitation coverage (i.e. if a critical case presents via walk-in triage or ambulance,
the team will be paged to the resuscitation area to deal with the case immediately). Resuscitation cases
may also be attended by residents, radiographers, ambulance personnel, respiratory therapists,
hospital pharmacists and students of any of these professions depending upon the skill mix needed for any
given case and whether or not the hospital provides teaching services.

Patients who exhibit signs of being seriously ill but are not in immediate danger of life or limb will be
triaged to "acute care" or "majors", where they will be seen by a physician and receive a more thorough
assessment and treatment. Examples of "majors" include chest pain, difficulty breathing, abdominal pain
and neurological complaints. Advanced diagnostic testing may be conducted at this stage, including
laboratory testing of blood and/or urine, ultrasonography, CT or MRI scanning. Medications appropriate
to manage the patient's condition will also be given. Depending on underlying causes of the patient's chief
complaint, he or she may be discharged home from this area or admitted to the hospital for further
treatment.

Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with
them, and these areas might typically be termed as a prompt care or minors area. Such patients may still
have been found to have significant problems, including fractures, dislocations,
and lacerations requiring suturing.

Children can present particular challenges in treatment. Some departments have

dedicated pediatrics areas, and some departments employ a play therapist whose job is to put children at
ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction
therapy for simple procedures.

Many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed
by psychiatrists and mental health nurses and social workers. There is typically at least one room for
people who are actively a risk to themselves or others (e.g. suicidal).

Fast decisions on life-and-death cases are critical in hospital emergency departments. As a result, doctors
face great pressures to overtest and overtreat. The fear of missing something often leads to extra blood
tests and imaging scans for what may be harmless chest pains, run-of-the-mill head bumps, and non-
threatening stomach aches, with a high cost on the health care system