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Queen Elizabeth Hospital announces investigation report on day surgery arrangement for patient
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The following is issued on behalf of the Hospital Authority:

     Queen Elizabeth Hospital (QEH) today (July 5) announced the investigation report regarding an incident relating to a day surgery arrangement for a patient. The hospital has accepted the investigation report and will follow up on the recommendations accordingly.

     According to the investigation report, a doctor and a nurse of QEH made the acquaintance of a patient at a social occasion in May this year. Subsequently, the nurse informed the patient on May 24 by phone of a medical appointment to be scheduled at the Surgery specialist clinic on May 31. In the morning of May 31, the patient accompanied by his wife attended the medical appointment accordingly. The doctor examined the patient and suggested him to undergo an excision biopsy procedure in view of his condition requiring urgent attention. The doctor then checked the schedule of the operating room on that day and arranged for the patient to have the surgery in the morning of the same day with the patient's consent.

     Subsequently, an arrangement was made for the patient to enter the Day Surgery Centre and the operating room through a staff passage. An arrangement was also made for his wife to enter the staff tea room of the Centre for waiting. The patient and his wife left the Centre through the staff passage in the same morning upon completion of the procedure.

     The hospital management learnt about the incident through an external source on June 2, and a panel was appointed for investigation. The panel interviewed the staff concerned and examined the workflows for arranging medical consultation and surgery for the patient. The investigation panel reached the following conclusions:

(1) According to the guideline on the arrangement for booking a new specialist out-patient clinic appointment, a patient or relative or any other person is required to present an identification document, a doctor's referral letter and proof of residential address (can be submitted at the date of consultation). Booking can be made by fax. Although the guideline does not say that the doctor concerned cannot issue a referral letter for the patient on his own initiative, the panel concluded that the outpatient appointment booking arrangement in this incident had departed from the usual and existing guidelines;

(2) The panel opined that the patient being classified as an urgent case on May 31 was justified based on the doctor's professional clinical judgement. The doctor hence exercised discretion to arrange for the patient to undergo the surgery, during which no other surgical operation had to be cancelled. The panel also understood that the doctor had considered the patient's surgical procedure to be a simple one that required the least amount of time. Therefore, he followed the common practice in arranging for the patient to be the first one to undergo the surgery during that session;

(3) The staff tea room of the Day Surgery Centre is not an aseptic area. The panel believed that the staff concerned allowing the patient and his wife to wait at the staff tea room was out of goodwill. The couple were wearing surgical slippers or shoe covers all along so the infection control of the operating room was not compromised;

(4) Considering that the patient was a public figure, the staff concerned arranged for the patient and his wife to enter the operating room through the staff passage to protect their privacy. However, the panel opined that this special arrangement was not necessary as the staff could have considered alternatives such as suggesting the patient wear a face mask or assigning him a more private corner for waiting; and

(5) The panel agreed that the doctor had the authority and competency to make a discretionary arrangement to prioritise operations.

     Based on the above findings, the investigation panel made the following recommendations:

(1) The hospital should remind staff to follow the Hospital Authority procedures and guideline on the specialist clinic appointment booking arrangement;

(2) If it is necessary to make a special arrangement for an individual patient, staff should balance the need for protecting the patient's privacy and the possible public perception that the arrangement may cause. In conclusion, staff should try to avoid the use of special arrangements and should seek advice from department heads or supervisors if needed;

(3) Staff should be prudent in exercising discretion in arranging patients for surgical operations and should base arrangements on the clinical needs of patients. Staff should seek advice from department heads or supervisors if needed; and

(4) In conclusion, staff should consider the public perception that their arrangement could possibly bring about during provision of services.

     In response to the report, the Hospital Chief Executive of QEH, Dr Albert Lo, stated that the hospital has accepted the investigation report and will implement the recommendations accordingly. He said, "In this incident, there was a deviation from the standard procedures. It has raised public concern on whether patients are fairly treated in QEH, and this has affected public trust in the hospital and our healthcare workers. I hereby express my apology to the public. We will study and implement the panel's recommendations to avoid the recurrence of similar incidents in future."

     For the staff involved in the incident, QEH will follow up according to Hospital Authority standard human resources policies and procedures. Dr Lo, on behalf of QEH, also expresses heartfelt appreciation to the chairman and members of the panel. Membership of the panel is as follows:

Chairperson:
Dr Ho Hiu-fai
Deputy Hospital Chief Executive (Professional Services), QEH

Members:

Mr Philip Choi
Cluster General Manager (Nursing), Kowloon West Cluster

Mr Emmanuel Kao
Member, QEH Governing Committee

Dr Leung Kin-ping
Recovered liver transplant patient

Ends/Tuesday, July 5, 2016
Issued at HKT 20:02

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