The role of the Emergency Department: beyond gatekeeping.

In Hong Kong, the first casualty department was established in 1947 at Queen Mary Hospital, at which time its main roles were to take care of three patient groups: accident victims, police cases, and civil servants.1 In the 1950s, local casualty departments might have been regarded as first-aid stations. As population grew, in the 1970s hospitals as well as their casualty departments became very overcrowded. In the government white paper for the Further Development of Medical and Health Services for Hong Kong in 1974, the role of the casualty departments as gatekeepers was stressed.2 The first batch of consultants was appointed to head these departments in 1981. In 1983, the archaic name ‘casualty department’ was dropped in favour of the ‘Accident & Emergency Department’ (ED). In the Scott’s Report on further development of hospital services in 1985,3 additional observational beds and investigation tools were recommended in the ED, and eventually materialised after the establishment of the Hospital Authority in 1991. Despite the change in name and additional resources, the traditional image of the ED as a gatekeeper has become entrenched.