Replies to LegCo questions

LCQ20: Patients refusing to be discharged

Following is a question by the Hon Li Kwok-ying and a written reply by Secretary for the Environment, Transport and Works, Dr Sarah Liao, (in the absence of the Secretary for Health, Welfare and Food) in the Legislative Council meeting today (May 18):


Question:


It has been reported that quite a number of beds in public hospitals are occupied for a long time by some patients who have been diagnosed by doctors as having no need to stay in hospital for treatment but who have refused to be discharged from the hospital. In this connection, will the Government inform this Council:


(a) of the total number of patients, in the past five years, who stayed in public hospitals for over a week after being diagnosed as having no need to stay in hospitals any longer, together with a breakdown of the figure by the hospitals where they stayed and the departments to which the wards concerned belong;


(b) whether it has studied the reasons for these patients' refusal to be discharged, and how the Hospital Authority and the relevant government departments have followed up these cases; and


(c) whether it has assessed the impact of such a phenomenon on the quality of medical services in public hospitals and the workload of frontline staff; if so, of the assessment results; if not, the reasons for that; and


(d) of the measures to improve this situation?


Reply:


Madam President,


The Hospital Authority (HA) has a set of well-established procedures for assessing patients' suitability for discharge from a hospital after the completion of treatment. The assessment is made by relevant doctors, nurses and allied health staff, including medical social workers. These hospital staff will determine whether the patients are ready to make a return to the community or need to be cared for in a residential home. A determination will also be made on the support that the patients may need after their discharge from hospital (e.g. community nursing service, financial assistance, etc). This arrangement has worked well for the vast majority of the patients and their families, although there are cases where patients have refused to be discharged.


(a) The situation in respect of patients refusing to be discharged varies from hospital to hospital and changes constantly. The HA does not have a consolidated record on the number of such patients at this time.


(b) While some patients have refused to be discharged on personal grounds, the majority of such cases are because of family reasons. For example, some families would reject that hospital's assessment that the patient is ready for discharge because they thought that the patient still required medical treatment and that it would be better for the patient to remain in a hospital than to be discharged back into the community. Some families would even simply refuse to discuss post-discharge arrangements for the patient with the hospital.


The hospital staff will follow-up these cases with care and compassion. They will try to understand the specific difficulties faced by the families and work closely with relevant Government departments (e.g. the Social Welfare Department) in arranging for the appropriate support and assistance for them to facilitate the discharge of the patient from hospital.


(c) Patients refusing to be discharged would of course add to the workload of frontline staff in public hospitals, which include the efforts for resolving the refusal cases and the continued provision of care to these patients in the hospital. However, given the limited number of such cases, the quality of medical services in public hospitals have not been adversely affected.


(d) The HA will continue to communicate with patients and their families to ally the concerns that they may have regarding their discharge from hospitals. In addition, in respect of individual cases, the HA will continue to work out the issues impeding the patient discharge with the patients, their families and related social service providers and Government Departments to ensure that discharged patients are provided with the necessary support and assistance for their integration back into the community.





Ends/Wednesday, May 18, 2005

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