Emergency Department Overcrowding

For the past two decades in Hong Kong, serious misuse of the service and high volumes of attendance had resulted in critical overcrowding in emergency departments (ED). With the introduction of charges in 2002 and the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003, temporary improvement of the problem occurred. Cheng et al showed that charging the ED visits resulted in a significant drop (19.1%) in total attendance, and 81.9% of the drop was accounted for by Category 4 (semi-urgent) and Category 5 (non-urgent) patients, which was also statistically significant. However, it seems that the issue of ED overcrowding has now resurfaced, aggravated by the restructuring of hospital beds to meet infection control requirement in the post-SARS era which mandates a space of at least 3 feet in-between hospital beds (Table 1). The recent prolonged surge in influenza-like illness (ILI) in Hong Kong have stretched hospital beds in medical departments beyond their limits, as admitted febrile patients with ILI symptoms have to be cleared of influenza A and SARS virus before discharge. In the New Territories East Region, "trolley-wait" for patients requiring admission has become a new form of ED overcrowding. Once again, the quality and timeliness of the emergency Editorial Hong Kong Journal of Emergency Medicine