The outcomes of surgical procedures at public hospitals have deteriorated overall, an internal audit by the Hospital Authority shows, and there are some big variations between hospitals in performance. The audit, which covers all 17 surgical departments of Hong Kong's public hospitals from 2009 to last year, found that some hospitals, including Yan Chai Hospital in Tsuen Wan and Tuen Mun Hospital, continued to come low on the list. The authority regards the audit findings as sensitive information for internal use only, but some details were given to the South China Morning Post by people familiar with it. They show that Queen Mary Hospital in Pok Fu Lam - the University of Hong Kong's teaching hospital - continues to be the best performer. The Hospital Authority's 'surgical-outcomes monitoring and improvement programme' checks the results of more than 20,000 important operations, including elective and emergency procedures. It looks at the morbidity rate, meaning serious complications such as infections, acute kidney failure, strokes and other problems causing readmission, and the death rate. Last month the Post reported the findings of the first audit, covering July 2008 to June 2009. That report showed that one in 10 patients who underwent emergency operations in public hospitals died within 30 days, and nearly 40 per cent suffered complications. The authority said these outcomes were 'good' compared with health systems overseas. The second report will be shared among senior staff tomorrow. It shows that big variations exist between surgical departments and overall performance has declined. Some small hospitals registered better results than large ones. Princess Margaret Hospital, in Kwai Chung, which performed below average in the first audit, has caught up with the average. Since the last audit, Tuen Mun Hospital, in trying to improve its standards, has held several meetings between management and surgeons to find ways to improve outcomes. A Tuen Mun Hospital doctor said a number of factors led to its results, including management problems in the surgical department, which had lost several experienced doctors. 'Another problem is that Tuen Mun Hospital has to take care of a one million population but it has only two emergency operating theatres, a very low figure compared with other hospitals,' the doctor said. 'Sometimes doctors have to conduct emergency operations at night, and this affects quality.' It is understood that the hospital has requested the authority to increase the number of operating theatres in the coming year. Doctors from the hospital have visited counterparts at Queen Mary Hospital to exchange views. 'The teaching hospital has a very strong culture of quality assurance and audit, and this is something other hospitals can learn from,' a person familiar with the situation said. The authority has pledged to release more information when the audit has been in operation longer. The findings are shared among surgeons and senior staff only. But some health care workers say they can accept more transparency. One hospital executive said: 'I see no harm in the authority disclosing which hospital does the best and which the worst. Right now only the very senior staff know the rankings. If we make the information public, frontline staff will have an incentive to improve their standards.' A department head said he did not mind sharing the findings with other health care workers but had reservations about making them public. 'Disclosing the findings to the public may be demoralising to frontline staff,' he said. Tuen Mun Hospital has to take care of a one million population but it has only two emergency operating theatres Tuen Mun Hospital doctor Death's door Of every 10 patients who have emergency operations this many die within 30 days: 1
