There have been concerns over the quality of healthcare due to emergency room (ER) congestion in major hospitals and extended waits for ER beds.The Department of Health (DOH) and BNHI have been encouraging patients with mild injuries and diseases to avoid the ER. To further this goal, the BNHI budgeted approximately NT$320 million for a program designed to improve ER medical service quality beginning May 1, 2012. The budget will serve as effective incentives to 1) increase ER care quality for patients with major illness (NT$ 64 million), 2) encourage adequate transfers (NT$ 140 million), and 3) increase ER treatment efficiency (NT$ 116 million).

In terms of increasing ER care quality for patients with major illnesses, the NHI has listed four diseases--acute stroke, myocardial infarction, major trauma, and severe sepsis--for which ERs are encouraged to provide standard treatment to patients within a certain time period. For instance, patients with acute stroke should be given recombinant tissue plasminogen activators (r-tPAs) within the first three hours after the patient shows symptoms, patients with acute myocardial infarction should receive emergency invasive cardiac catheterization within 90 minutes after arrival at the hospital, and patients with major trauma requiring surgery should receive an operation within two hours after arrival at the ER. For each case that meets the above standards, the hospital will be given a 2000 point reward.A hospital will also be rewarded 1000 points for successfully giving a patient with severe sepsis the first dose of antibiotics within three hours and completing necessary treatment within six hours after arrival at the emergency room.

Proper transfers can provide patients with adequate medical care.If a hospital with normal or mid-rate emergency care or an area hospital does not have the proper medical personnel to treat patients with acute myocardial infarction, acute stroke, aortic dissection, or major trauma that requires emergency surgery, or patients with gastrointestinal bleeding or severe sepsis, it is suggested that the hospital transfers the patient to another hospital of a higher level, such as a hospital with first-rate capabilities, a medical center, or a regional hospital, for proper treatment after giving the patient adequate first aid.Similarly, in the case where a hospital with first-rate or mid-rate first-aid capabilities, a medical center, or a regional hospital is not able to admit patients with UGI bleeding, pneumonia, urinary tract infection, cirrhosis, hepatic coma, congestive heart failure, or soft-tissue cellulites, it is suggested that the patient be transferred to another hospital of a lower level, such as a hospital with normal first-aid capabilities or an area hospital, for further treatment after treating the patient in the emergency room and the patient’s condition has stabilized. Before a transfer can be carried out, the hospital should explain the reasons for transfer to the patient and the family, who will then sign a transfer consent form and a transfer form. Confirmation from the receiving hospital is also required.After treating the patient, the receiving hospital should report to the transferring hospital in writing the treatment and condition of the patient.Hospitals shall establish a service window to manage transfer related issues. Hospitals offering adequate and quality transfers will be rewarded 1000-2000 points (split evenly between the transferring and receiving hospital) for each case.

The third task is to increase ER treatment efficiency.To encourage hospitals to take the initiative in solving ER congestion and give patients proper medical arrangements in time, hospitals achieving the 75th percentile among hospitals of the same level in any of the following will be rewarded financial incentives. 1) less than 1% of ER patients stays are over 24 hours, 2) ER patients with major illness are transferred to the ICU within 6 hours after arrival, 3) ER patients on the first three levels of the emergency triage are hospitalized within 8 hours after arrival, 4) ER patients on level four or five of the emergency triage are discharged within 4 hours after arrival.If the first requirement is not met, a hospital can still be rewarded if there is an 8% improvement in the rest of the criteria.Moreover, in order to encourage area hospitals to promote ER services and prevent patients with mild injuries or diseases from flooding the ER in large hospitals, area hospitals are rewarded 500 points for every ER patient that it receives in addition to the total number of ER patients from the previous year.

The program is launched with an aim to reduce ER congestion and encourage more improvements in ER medical services.