Intensive use of intensive care

PUBLISHED : Saturday, 23 April, 2011, 12:00am
UPDATED : Saturday, 23 April, 2011, 12:00am


An audit of private hospitals has found that some of them are sending newborn infants to neonatal intensive care 10 times more frequently than others, a finding that is prompting the government to place those hospitals with higher incidences of maternal complications under a closer watch.

The finding comes as the government seeks to relieve the pressure on public obstetrics resources as expecting mainland mothers increasingly visit the city to give birth. Public hospitals recently analysed referrals by 10 private hospitals to the eight public neonatal intensive care units over the past five years, discovering the 10-fold difference in their referral rates.

Private hospitals perform Caesarean sections much more frequently than public hospitals do - from an average of 50 per cent to up to 75 per cent of deliveries, versus a needs-only basis in public hospitals, which means in 20 per cent of deliveries.

People familiar with the city's obstetrics practices said it is not unusual for private hospitals to conduct elective Caesarean sections at 36 or 37 weeks, creating so-called 'man-made' premature babies that require intensive care. Yet elective Caesarean sections performed too early are risky to the babies, according to international medical research. The American College of Obstetricians and Gynaecologists recommends that elective Caesarean sections should occur at 39 weeks or later, if no medical concerns are present.

Secretary for Food and Health Dr York Chow Yat-ngok has said that the limited capacity of NICUs is the bottleneck in the city's delivery of maternity services. A key strategy, therefore, is to lower the number of referrals from private hospitals.

Statistics collected from the eight public units last year found that about 18 per cent of the service's capacity was used to care for babies referred by private hospitals.

Health officials will negotiate with private hospitals next week to work out a cap on the total number of deliveries for next year. They have also been meeting with public-hospital doctors.

A person familiar with the discussions said health officials would try to address this thorny issue through 'quality assurance': if the complications rate at private hospitals can be cut, fewer babies will need intensive care.

'The big difference in the NICU referral rate does not necessarily mean private hospitals have any serious quality problem, because there could be a different case mix at different hospitals,' the person said. 'But certainly the government needs to take a closer look at these figures, and the professionals should address this through quality assurance.'

Hong Kong's neonatal care units are all in public hospitals, which means these more difficult cases become matters of taxpayer expense.

Private hospitals will be asked to reduce referrals by raising their professional standards, while the Department of Health will strengthen its regulatory role over private hospitals. The Hong Kong College of Obstetricians and Gynaecologists is responsible for making sure maternity services are up to the standard.

The government also wants private hospitals to avoid taking in mainland mothers with high-risk pregnancies. As of yesterday, the public NICUs have begun recording details of private-hospital referrals, to audit the practices and quality of individual hospitals and doctors. People familiar with private obstetric practices said many of the 'man-made' premature babies suffer from 'wet lungs' syndrome - fluid being retained in the lungs. These newborns need intensive care for their breathing difficulties.

'Such practices have been quite widespread for a while, and now the burden on the NICUs has been made public ... but it has been an open secret in the field,' one of those people said.

A few months ago, some private hospitals issued guidelines to doctors asking them to stop performing elective Caesarean sections before the 37-week mark.