Workloads linked to patient deaths
A heavy workload for doctors and insufficient post-operation support for patients is linked to a high death rate among patients after surgery, a Hospital Authority preliminary investigation has found.
Tuen Mun Hospital and Yan Chai Hospital recorded the highest patient mortality rate following surgery in two consecutive annual clinical audits. A team of senior surgeons is investigating the cause.
But instead of individual doctors' skills and experience, experts said the poor surgical results were more related to hospital resources, the surgeons' workload and support from other departments.
At Yan Chai, a second-tier acute hospital in Tsuen Wan, surgeons are so busy that there have been occasions when a surgeon operating together with another one has had to leave the theatre to take care of other patients in wards.
The audits, under a surgical outcomes monitoring and improvement programme, measures the performance of all 17 public surgical departments in the city.
Programme director Dr Albert Yuen Wai-cheong said the surgeons' workload at Yan Chai was a key factor affecting surgical outcomes.
'In some cases, one of the two doctors in the operating theatre had to leave in the middle of an operation to take care of newly admitted patients. This may affect the overall surgical results,' Yuen said.
The authority's team also found that a lack of 'interventional radiology' support at the hospital also leads to unsatisfactory post-operation patient care. Interventional radiologists have the skills to stop internal bleeding or manage surgical wounds by using advanced imaging and minimal invasive procedures.
For example, they can image blood vessels in a process called angiography to look for any abnormalities, then insert tubes into the blood vessels to stop bleeding or remove blockages.
The radiologists can also place tubes in different body parts to drain fluids or remove infected areas.
All these procedures can greatly reduce post-operation complications and mortality, according to Dr Francis Mok Pik-tim, the authority's head of a central co-ordinating committee in surgery.
But such interventional radiology support is insufficient at Yan Chai.
Dr Seamus Siu Yuk-leung, vice-president of the Frontline Doctors' Union, who worked in the intensive care unit at Yan Chai, said the hospital often had to transfer patients with severe complications to Princess Margaret Hospital, a bigger acute care hospital in Kwai Chung, because of insufficient support of interventional radiology. Patients may suffer cardiac arrest during an operation but Yan Chai had no resources to conduct balloon surgery to open up narrowed blood vessels of the heart for those patients, Siu said.
The hospital did not have enough blood supplies. 'In some cases, the laboratory staff had to rush to a Red Cross blood station in a taxi to get blood for patients suffering severe bleeding,' Siu said.