Replies to LegCo questions
LCQ11: Measures to assist interns
Following is a question by the Dr Hon Kwok Ka-ki and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (December 8):
Question:
It is learnt that in the report of the panel which investigated an incompatible blood transfusion incident at Prince of Wales Hospital, published by the Hospital Authority (HA) on October 6 this year, an intern who had taken up his post in PWH for less than three months was held responsible for the incident. Nevertheless, the report did not concurrently examine the problems faced by interns, especially those relating to their training, supervision and workload. In this connection, will the Government inform this Council:
(a) whether it is aware if HA has assessed whether other experienced staff, the departments and the people in charge of the hospital concerned should also be held responsible for the incident, and whether there are any inadequacies; if HA has, of the assessment results;
(b) whether HA and the Government departments concerned have measures to tackle immediately the difficulties currently faced by interns after the occurrence of the incompatible blood transfusion incident, and whether they will put forward proposals to improve the situation; if they will, of the details; and
(c) whether HA and the Government departments concerned will work out the training objectives, methods of assessment, a supervision system and the appropriate workload for interns; if they will, of the details?
Reply:
Madam President,
(a) Apart from the responsibility of the concerned intern in the incident, the Investigation Panel commissioned by the Hospital Authority (HA) has examined other factors which might have contributed to the incident, including the training provided before and during internship on blood transfusion procedure, the actions taken by other clinical staff in response to the patient's reaction to the incompatible blood transfusion, and the relevant risk management system put in place by the hospital for blood transfusion.
After a thorough review of all the relevant facts, the Investigation Panel found that the intern concerned had made an error in the cross matching procedure and mistaken the blood specimen of another patient, who were staying in the same cubicle as the incident patient, as the blood specimen of the incident patient. The Panel concluded that this was the key factor leading to the incompatible blood transfusion incident. As for the other hospital staff involved in the incident, the Panel was also of the view that the clinical assessment of the patient and the subsequent interventions were reasonable and that the hospital has put in place a sound risk management system for blood transfusion. In addition, it found that the hospital has communicated with the family of the patient about the incident in a timely manner.
The IP has made a number of recommendations, which are aimed at further enhancing the safety of blood transfusion in public hospitals. To implement these recommendations, the HA has already promulgated updated guidelines on blood transfusion and organised a briefing workshop to promote greater awareness among its staff of issues relating to the risks and safety in blood transfusion. In addition, the HA would review the results of its two trial programmes on using information technology (e.g. the use of a Bar Code system and scanning devices) to improve the accuracy of patient identification. If the results confirm that the new system is effective in reducing the chance of human errors by medical staff (including interns) in the cross matching procedure, then the HA would explore the feasibility of introducing the new system in all public hospitals. Furthermore, the HA would focus on risk management and risk reduction as far as possible to improve patient care systems and processes. The HA would also continue with its efforts in preventing and reducing errors through staff education and experience sharing.
(b) & (c) All matters relating to internship training are overseen by the Central Internship Committee (CIC) set up by the HA. The membership of the Committee comprises the Chairman of the Internship Sub-committee of the Licentiate Committee of the Medical Council of Hong Kong, representatives of the medical school of the two universities, HA executives and senior doctors in public hospitals.
One of the major responsibilities of the CIC is to monitor and improve the quality of internship training. To meet the evolving needs of the community and to ensure that the standards of medical training are met, the CIC appraises the working and training arrangements of interns on a regular basis and advises the HA and the two medical schools on changes that need to be made to those arrangements. In addition, the CIC is responsible for drawing up the eligibility criteria for intern training sites. These criteria form the basis on which all hospitals and hospital departments are assessed for the purpose of training post accreditation. The CIC also maintains close communication with training hospitals and collects feedback from the interns regularly, so as to ensure the compliance of the standards and requirements of internship training.
As regards the workload of interns, the CIC has established standards on the frequency of on-call duties and compensated time-offs. In general, interns should not be scheduled for on-call duties more than once every three days. In addition, it is a mandatory practice at HA hospitals that doctors, who have worked for seven consecutive days, should be given a day off. Furthermore, the HA provides interns with 24 days of full-pay leave during their 12-month internship.
The CIC would continue to monitor and review the training arrangements for interns with a view to striking an appropriate balance between the benefits of clinical exposure and the risk of excessive workload.
Ends/Wednesday, December 8, 2004
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