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Following is a question by the Hon Albert Ho and a reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (February 3):
Question:
The Hospital Authority (HA) has implemented the Surgical Outcomes Monitoring and Improvement Programme (SOMIP) in 17 public hospitals since 2008. SOMIP benchmarks the performance of a surgical department with other participating surgical departments by measuring their surgical outcomes after full adjustment with the patients' preoperative risk factors. It has been reported that the SOMIP Report of 2014-2015 released last month by HA indicated that the performance of Tuen Mun Hospital (TMH) in elective surgeries was rated, for the third time, as the most unsatisfactory. It has also been reported that after conducting analyses and site inspections, the expert panel of HA was unable to identify the causes of TMH's unsatisfactory performance. On the other hand, at a meeting of the Panel on Health Services of this Council held in February 2014, the representatives of Tuen Mun Hospital Doctors' Association considered that heavy workload and medical manpower constraints in TMH were the root causes that had affected its performance in surgeries. In this connection, will the Government inform this Council if it knows:
(1) the criteria for calculating the mortality rates of elective surgeries in public hospitals; whether HA has revised such criteria since the implementation of SOMIP; if HA has, of the details; if not, whether HA has reviewed if the mortality rates of elective surgeries calculated by using such criteria can accurately reflect the performance of various hospitals in elective surgeries;
(2) whether, following the aforesaid expert panel's making its conclusion in respect of the SOMIP Report of 2014-2015, HA has considered the areas in which TMH can make improvements; if HA has, of the details; if not, the reasons for that; and
(3) whether HA has assessed the correlation between the manpower constraints of TMH and its performance in elective surgeries being repeatedly rated as the most unsatisfactory; if HA has, of the details; if not, the reasons for that?
Reply:
President,
The Surgical Outcomes Monitoring and Improvement Programme (SOMIP) of the Hospital Authority (HA), commenced in 2008, is a quality improvement programme set up to monitor surgical outcomes and identify improvement opportunities in public hospitals. It makes reference to the National Surgical Quality Improvement Programme of Veterans Affairs Hospitals in the United States of America. An independent steering committee oversees the data collection, methodology and reporting of the programme. The steering committee is led by clinical experts from the specialties of Surgery and Anesthesia, and is supported by statisticians and executives. The methodology of SOMIP adopts a risk-adjusted model to establish a valid comparison of surgical outcomes amongst the 17 hospitals with departments of surgery in HA.
The findings of HA's SOMIP in 2014-15 shows that over 25 000 major and ultra-major operations were conducted in 17 public hospitals. The crude mortality rate of emergency surgery was 6.6% and that of elective surgery was 0.4%. The overall mortality rate was the lowest since the implementation of the programme in 2008.
My reply to the question is as follows:
(1) Under SOMIP, the calculation of the mortality rate is based on the number of deaths within 30 days of surgery. This is the standard in calculating the mortality rate after surgery and has been in use since the implementation of SOMIP in 2008.
(2) and (3) The findings of HA's SOMIP in 2014-15 shows that there were 10 patients who had died after elective surgery in Tuen Mun Hospital (TMH) in 2014-15. Having examined these 10 cases one by one, the expert panel of HA found out that some cases involved terminal cancer patients, and in some cases the cause of patient death was not related to the surgery. However, since all patient deaths within 30 days of surgery have to be counted, these cases were included in the calculation of the mortality rate as well. For the remaining cases, fellow surgical experts examined all procedures before, during and after the surgeries and could not find any irregularities. Nor could they find any systemic or structural problems with the elective surgeries in TMH. Even though TMH, like other public hospitals, faces the challenges of an increase in service demand and a shortage in manpower, the statistical analysis of the findings of SOMIP does not show any direct relationship between the surgical outcomes and manpower problem.
For emergency surgery, the improvement measures adopted by TMH in the past two years, including increasing surgical beds and operating theatre sessions, recruiting additional staff and strengthening training of healthcare staff to cope with different conditions of patients before and after surgery, have shown preliminary effective results. The performance of TMH on emergency surgery has been comparable to other public hospitals in two consecutive years.
Generally speaking, all HA hospitals, including TMH, face the problem of manpower shortage arising from increase in service demand and attrition of staff. In future, the New Territories West Cluster (NTWC), to which TMH belongs, will continue to recruit additional healthcare staff and increased surgical beds and operating theatre sessions with a view to alleviating the overcrowding problem of operating theatres and surgical beds. Separately, Pok Oi Hospital (POH) has in recent years helped divert some patients from TMH. With the continuous efforts of HA in providing additional operating theatre sessions in POH and the extension works of the Operating Theatre Block of TMH, the overcrowding problem of the wards in TMH will be further improved.
Aware of the public concern over surgical outcomes and performance, NTWC has met with the expert panel of SOMIP earlier and analysed one by one the fatal cases of patients who had undergone elective surgeries in the past year. NTWC will continue to study in detail the analytical data and findings of SOMIP with a view to improving the surgical outcomes of TMH. At the same time, HA has adopted a series of short, medium and long-term measures to improve the surgical service of TMH. The short-term improvement measures that HA has implemented include:
(i) adding four high dependency surgical beds in TMH in 2014-15;
(ii) increasing the operating theatre sessions of POH in 2014-15;
(iii) opening a mixed specialty ward with 38 beds providing specialty service including surgery in POH in 2014-15 and increasing the number of surgeons, nurses and allied health professionals accordingly;
(iv) enhancing out-of-hour emergency clinical supervision in the Department of Surgery progressively from January 2014, and appointing a specialist surgeon to undertake out-of-hour clinical supervision work from 2015 so as to better monitor changes in patients' conditions;
(v) providing training for junior surgeons/the department of anaesthesia /the intensive care unit on the way to handle different patient conditions;
(vi) expanding the service capacity of POH for elective surgery in 2015-16 and commencing the provision of emergency surgery in POH in stages, with a view to alleviating the burden on TMH;
(vii) providing additional beds in POH in 2015-16 to ease the overcrowding problem in the surgical ward of TMH and improve the quality of post-surgical care for patients and their rehabilitation progress; and
(viii) continuing to recruit healthcare staff as well as part-time and retired healthcare professionals so as to alleviate the workload of staff and enhance the quality of medical service and care.
The improvement measures that HA will implement in the medium to long-term include:
(i) providing four operating theatres in phases after Tin Shui Wai Hospital comes into operation in 2016-17; and
(ii) exploring the construction of an annex to TMH as the extension of the Operating Theatre Block to provide more operating theatres in the long term.
Moreover, the Steering Committee on Review of HA set up by the Government released its report and made 10 recommendations last year. One of the recommendations is that HA should adopt a refined population-based resource allocation model by reviewing the present approach and taking into consideration the demographics of the local and territory-wide population. This recommendation aims at enhancing transparency, consistency and fairness in resource allocation of HA.
By developing such a resource allocation model, HA can understand more accurately the healthcare needs of the population in different geographical locations. At the same time it can cater for the disparity in services across clusters arising from the provision of special and relatively complicated cross-cluster or territory-wide services, and cross-clusters utilisation of services initiated by patients. As the formulation of the resource allocation model involves complicated academic discussions and data analysis, HA will commission an independent consultant to assist in establishing the model. It will also maintain close communication with stakeholders. HA plans to implement this recommendation within three years.
Moreover, the Government has allocated an additional $300 million time-limited funding to HA for three years from 2015-16 as extra funding for the three clusters which require special needs (namely NTWC that covers TMH, New Territories East Cluster and Kowloon East Cluster). The objective of this arrangement is to enhance the existing services of these clusters as early as possible before the implementation of the above resource allocation model.
Thank you, President.
Ends/Wednesday, February 3, 2016
Issued at HKT 18:25
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