Protocol for A&E Doctors in Ordering Diagnostic Tests and Safeguards to Prevent Critical Signs Being Missed

Ms Carrie Tan asked the Minister for Health (a) what are the current guiding principles for how doctors in the accident and emergency (A&E) departments of public hospitals treat patients and decide on the diagnostic tests to order; and (b) what are the safeguards in place to prevent incidents where the conservative ordering of diagnostic tests can lead to critical health situations being missed out and treatment delayed.

Mr Ong Ye Kung: Our public hospitals’ Emergency Departments (EDs) handle a large number of patients, some urgent, others less so. They have to triage patients to prioritise the urgent cases, provide initial treatment and decide if patients require life-saving interventions, admission, further diagnostic tests or outpatient treatment.

ED physicians, in particular, play an important role in guiding these decisions. They assess and manage patients based on established treatment protocols, guidelines and clinical judgement.

EDs are, therefore, a critical touchpoint. That said, not all tests leading to a definite care plan need to be performed in the ED; they can be performed later during the inpatient hospital stay based on the clinical assessment by the inpatient care team. The operations of ED are complex, high paced, deal with a wide range of patients and are constantly in flux.

Treatment protocols are, therefore, regularly reviewed, taking into account the available clinical evidence and established best practices. Relevant process and outcome indicators are closely monitored to ensure clinical quality and patient safety.