Accident

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Emergency Medicine
Sum Lam Forest PWH
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Content

• Hospital Authority
• Structured Basic Surgical Training Program in
  Hospital Authority
• Hong Kong College of Emergency Medicine
• StudyLight
• Questions

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Hospital Authority

• www.ha.org.hk

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HA

• Background

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Background

• The Hospital Authority is a statutory body
  established on 1 December 1990
• under the Hospital Authority Ordinance to manage
  all public hospitals in Hong Kong
• It is an independent organization which is
  accountable to the Government through the
  Secretary for Health and Welfare,
• who is responsible for the formulation of health
  policies and monitoring the performance of the
  Authority.

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Background

• The Hospital Authority formally took over the
  management of all the 38 public hospitals and
  institutions, and their 37,000 staff on 1
  December 1991.
• It currently manages a Head Office, 44 public
  hospitals/institutions, and 49 specialist
  outpatient centres.
• At the end of 1997, the Authority managed a total
  of 26,400 hospital beds which represented 4.06
  public hospital beds per 1,000 population. It
  employs 48,452 full-time staff and operates under
  a recurrent budget of 26,022 million in 1998/99
  .

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Background

• The Authority is mainly responsible for
  delivering a comprehensive range of secondary and
  tertiary specialist care and medical
  rehabilitation through its network of health care
  facilities.
• The Authority also provides some primary medical
  services in 10 primary care clinics providing
  750,765 general outpatient attendances.
• In 1997, there were a total of 966,000 inpatient
  discharges, 7,111,000 specialist outpatient
  attendances and 2,129,000 accident and emergency
  attendances representing an increase of 0.3,
  11.3 and 2.6 respectively

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HA

• Mission

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Mission

• The Government's health care policy is
• to safeguard and promote the general public
  health of the community as a whole and
• to ensure the provision of medical and health
  services for the people of Hong Kong,
• including particularly that large section of the
  community which relies on subsidised medical
  attention, so that no one should be prevented
  through lack of means from obtaining adequate
  medical attention.

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Mission

• To meet the different needs of the patients for
  public hospital services, and to improve the
  hospital environment for the benefit of the
  patients
• To serve the public with care, dedication and
  efficiency, and to encourage community
  participation in the system, resulting in better
  care and more direct accountability to the
  public
• To provide rewarding, fair and challenging
  employment to all its staff, in an environment
  conducive to attracting, motivating and retaining
  well-qualified staff

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Mission

• To advise the Government of the needs of the
  community for public hospital services and of the
  resources required to meet these needs, in order
  to provide adequate, efficient and effective
  public hospital services of the highest standards
  recognized internationally within the resources
  obtainable
• To collaborate with other agencies and bodies in
  the health care and related fields both locally
  and overseas to provide the greatest benefit to
  the local community.

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HA

• Vision Strategies

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Vision Strategies

• The Hospital Authority has established the
  following corporate vision
•  The Hospital Authority will collaborate with
  other healthcare providers and carers in the
  community to create a seamless healthcare
  environment which will maximise healthcare
  benefits and meet community expectations.

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Vision Strategies

• Five Corporate Strategies
• Developing Outcome-focused Healthcare to maximise
  health benefits and meet community expectations
• Creating Seamless Healthcare by restructuring and
  reorganising medical services in collaboration
  with other providers and carers in the community
• Involving the Community as Partners in Health in
  the decision-making and caring process
• Cultivating Organisation Transformation and
  Development through a multi-disciplinary team
  approach to holistic patient care and continuous
  quality improvement
• Promoting Corporate Infrastructure Development
  and Innovation to support service improvement

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Vision Strategies

• The annual planning process translates the
  corporate vision and strategies of the Authority
  into specific initiatives, which are then
  incorporated in the Annual Plan as programmes,
  key result areas and targets to be achieved.
• The planning process is also broadly
  participative with extensive input from
  healthcare professionals, Government policy
  directives and the community to reflect different
  perspectives of health service priorities.

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HA- Vision

• Motto

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Quality Patient-Centred Care Through Teamwork
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HA

• Structure

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Structure

• Under the Hospital Authority Ordinance, the
  Hospital Authority is responsible for the
  following
• advising the Governement of the needs of the
  public for hospital services and of the resources
  required to meet these needs managing and
  developing the public hospital system
• recommending to the Secretary for Health and
  Welfare appropriate policies on fees for the use
  of hospital services by the public

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Structure

• establishing public hospitals promoting,
  assisting and taking part in education and
  training of HA staff and research relating to
  hospital services
• To carry out this role effectively, the Hospital
  Authority Board has developed a functional
  committee structure which allows it to make more
  efficient use of Board members' time and
  expertise to focus more specifically on pertinent
  issues.
•  Organisation Structure
• Committee Structure

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Structure

• The Hospital Authority is of the view that in
  order to serve the goal of improving the health
  of the community
• a health care system should consider the
  objectives of
• equity, where patients can have access to
  appropriate services regardless of financial
  means
• efficiency in the use of resources
• effectiveness in the provision of quality care
  and
• choice, where patients have a choice of service
  providers at affordable cost.

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Structure

• It is noted that sometimes these objectives
  compete against each other, and health care
  systems of different countries suggest that they
  value some objectives above others.
• For example, in a public health care system
  providing universal access, equity is very highly
  valued, but choice may be limited. Trade-offs
  need to be made to enable the system to be
  affordable to the community.

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Intranet ha.home
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Structured Basic Surgical Training Program in
the Hospital Authority

• Intranet ha.home
• Then Contract MO and Resident Column
• Then Annoucement Messages
• Then scroll down

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Background
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Background

• The Basic Surgical Training program involves
  surgically-related clinical departments of
• Surgery,
• ENT,
• Orthopaedics Traumatology,
• Neurosurgery,
• Cardiothoracic Surgery
• and AE
• (not including Ophthalmology and Obstetrics and
  Gynaecology).

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Background

• These departments are currently providing
  training for nine specialties including
• General Surgery,
• Cardiothoracic Surgery,
• Urology,
• Paediatric Surgery,
• Plastics Surgery,
• Neurosurgery,
• Otorhinolaryngology,
• Emergency Medicine,
• and Orthopaedics Traumatology.

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Background

• The program involving these nine specialties are
  currently
• under the auspices of the Hong Kong
  Intercollegiate Board of Surgical Colleges
• under the Hong Kong Academy of Medicine.

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Implementation of the Basic Surgical Training
Program - from July 2003 onwards
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BST program

• Under the new program, basic specialist trainees
  (BST) aspiring to pursue specialist training in
  these nine specialties need to go through a
  structured two-year Basic Surgical Training
  program in a cluster comprising at least four
  6-month rotational training units.
• They will not be attached to a particular
  department continuously until they enter their
  higher training at least 2 years later.

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BST program

• The structure of the typical rotational training
  program is composed of a combination of modules
  of specialty training as illustrated below

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Selection Arrangement
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Selection

• Currently, surgically related departments in
  effect conduct their selection process in
  conjunction with participating in central
  selection interviews to arrive at a priority list
  of candidates for their own departments.
• Under the new scheme, the new recruits may also
  be rotated to any surgically-related departments
  within a cluster during the course of their Basic
  Surgical Training.
• It is proposed that, starting from July 2003, the
  selection arrangement is moving from a totally
  department-based approach to a more
  program-based, cluster-coordinated one.
• To this end, a cluster-based selection mechanism
  will be devised by the respective clusters in due
  course.

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Selection

• Successful applicants in each Joint Recruitment
  Exercise will be invited to indicate their
  preferred training modules and preliminary
  preferred specialty in which they aspire to
  pursue higher specialist training in the future
  in order to facilitate placements that best meet
  their training needs

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More

• Intranet

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HKCEM

• www.hkcem.com

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Emergency Medicine
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Emergency Medicine

• Emergency medicine is a discipline of medicine
  that
• Deals with the acute and life threatening aspect
  of medical care
• Emphasize the recognition, evaluation, care and
  disposition of patient with acute illnesses and
  injuries

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Emergency Physicians
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Emergency Physicians

• Who has the following characteristics
• Has undergone training and assessment in
  emergency medicine
• Major part of practice is in emergency medicine
• Currently of good standing in the specialty of
  emergency medicine

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Role of AE service in Hong Kong
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Role of AE service in Hong Kong

• To provide emergency life support for the
  critically ill patients
• To direct patients to appropriate sources of
  continuing care
• To provide disaster management when there are
  massive casualties in the community
• To provide continuous accessible AE services for
  the general public

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??? Abuse ???
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? abuse

• Indeed more than 50 of the workload of the
  emergency department is not of an urgent nature
• Lay public will define what is an emergency to
  him or her
• There are people who are genuinely alarmed by
  symptoms we as doctors believe to be trivial
• Not our job to pass value judgment
• We are there to relieve acute sufferings
• It is a fact of life that we have to live with

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AE
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AE

• Fifteen public hospitals under HA
• Mission to provide a high standard of emergency
  care to those in the community who perceive the
  need for or are in need of acute care

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AE Information System

• Intranet hoit.aeis

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Triage
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Triage

• French word meaning 'to sort' or ' to choose'.
• Process of setting priorities for treatments for
  a patient or a group of AE patients
• Exercise interventions in the early phase to
  prevent deterioration and death
• Effective utilization of staff and resources
• Improve patient flow
• Improve patient-staff relationship through
  greeting and communication

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5 categories

• Critical a team of medical and nursing staff
  without waiting
• emergent
• urgent
• semi-urgent
• non-urgent treated in the order of their arrival
  and should expect a longer waiting time

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Why AE?
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Why AE?

• Challenging
• Lifestyle
• New Specialty

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Challenging

• See a large number of patients with various
  presentations in a short period of time
• New to doctor, past medical history often unknown
• Clinical gtgt Ix H-stix, H-cue, blood gas
  electrolytes, ECG, CXR

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Challenging

• Risk Management / Stratification
• high risk cases
• e.g. Child lt 3 months old with any complaint,
  subtle signs and symptoms
• ask for current medication, drug allergy,
  pregnancy in female of reproductive age

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Challenging

• Medico-legal disaster
• good communication skill - address the concerns
  of the patients and relative
• adequate clinical assessment - consider potential
  serious conditions
• careful documentation

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Why AE?

• Challenging
• Lifestyle
• New Specialty

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Lifestyle

• Shift work
• With adequate rest, optimize our condition for
  work
• Efficient time management, fully utilize working
  hours
• Adaptive, not affect performance

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New Specialty

• emerging, good prospect
• Hong Kong College of Emergency Medicine
• Previously known as Hong Kong Society for
  Emergency Medicine Surgery
• Formed in February 1996, newest among all
  colleges of the Academy
• Admitted as the 15th constituent specialist
  college of the Hong Kong Academy of Medicine on
  16th January 1997
• President Wong Tai Wai
• Council Members Ong Kim lian

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www.hkam.org.hk
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Why me?
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Why me?

• In view of
• the chaotic workload,
• undifferentiated symptoms,
• completely new patients and
• on the spot decision despite uncertainty is
  required

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Why me?

• I think I am suitable to be a Resident in AED
• Set priorities
• Organize activities flexibly
• Handle several cases at a time (multi-tasking)
• Adjust speed and style of evaluation and
  treatment to suit the particular presentation at
  hand
• Good interpersonal communication skills
• Clinical sense (acumen) for a focussed approach
  to clinical evaluation
• tolerate uncertainty
• Assess probability of serious pathology
• Exposure to medicine, surgery, OG and pediatrics
  during internship

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Training Program

• FHKAM ( Emergency Medicine)

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Training Program

• Basic Specialist Training
• Part I exams MRCP, MRCS or PEEM
• 1 year in an accredited AE centre
• plus 6 month elective to general surgery and 6
  months elective to internal medicine
• before eligible for attempting intermediate exam
  of emergency medicine IEEM
• alternative MRCP, FRCS/MRCS or equivalent
  compulsory elective training

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Training Program

• Advanced Specialist Training
• At least 2 year training in an accredited AE
  centre after IEEM
• Plus optional rotation terms making up to total
  of 6 years prior to exit exam

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Training Program

• Part I of MRCP or MRCS or PEEM
• Then IEEM / MRCS
• Then EEEM

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Worry ?
www.studylight.org
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Everyone worries!

• Consultant
• SMO
• Permanent MO
• Contract MO
• Resident with increment
• Resident without increment
• Temporary Resident
• You ??

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The Serenity Prayer
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The Serenity Prayer

• GOD, grant me
• the serenity to accept the things
• I cannot change
• Courage to change the things
• I can
• and the Wisdom to know the difference
• By Reinhold Neibuhr

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Worry

• Matthew 634
• So never worry about tomorrow, for tomorrow will
  worry about itself. Each day has enough trouble
  of its own.
• 1 Peter 57
• Throw ALL your worry on him, because he cares
  for you.

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Questions ??
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Forest

• Mobile [phone]
• Email forest_at_alumni.cuhk.net
• Homepage www.geocities.com/forestsum36

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Thank You