Provisional Legislative Council

Panel on Health Services

Review on Clinical Audit and Monitoring

A. Established Clinical Audit and Monitoring Systems in the Hospital Authority (HA)

The following systems and/or mechanisms are in place in HA hospitals to ensure proper monitoring of clinical services and safeguard professional standards, practices and accountability:

(i) Clinical audit and quality assurance systems

These systems have been established in clinical departments of all hospitals to ensure professional standards and accountability. Compliance with these systems has been documented in the annual plans of the hospitals as follows :

- A mechanism is in place for the surveillance, prevention and control of infection in all clinical departments.

- Clinical guidelines and protocols are in place and practised, information on clinical outcome indicators are collected and reviewed to ensure quality of clinical care.

- Regular clinical audit meetings are held in all clinical departments to monitor mortality, morbidity and clinical practices, and there is documentation of improvement processes and outcome in the form of regular reports.

- A mechanism is in place to ensure timely response of doctors to emergency calls and attendance to patients.

- Safety of drug administration is ensured with continuous improvement.

(ii) Critical incident reporting system

This system is established to ensure the reporting of all incidents relating to patient care with medico-legal implications. Hospitals are asked to inform and discuss with patients and their families these incidents and where appropriate to report cases to the coroner. All reported incidents are investigated and required remedial actions taken. Staff disciplinary action is initiated if warranted by investigation findings.

(iii) Clinical systems monitoring and guidelines

Systems and procedures have been established in public hospitals to monitor professional practices and standards as well as clinical and non-clinical incidents that may happen in the public hospitals. Such reporting systems and procedures are both reactive and proactive. Since 1993, blood transfusion committees have been established in public hospitals to monitor blood transfusion service. A set of blood transfusion guidelines was comprehensively revised in August 1997, with requirements for reporting blood transfusion incidents relating to blood transfusion. A medication incident reporting system was established in 1994 to register and report untoward incidents arising from drug administration.

(iv) Clinical practice monitoring and guidelines

At the hospital level, the monitoring of professional practices and standards of individual staff is the responsibility of the respective chiefs of service and hospital chief executives. Clinical guidelines/protocols and clinical audit systems are the tools that they can utilize and these are implemented in all major hospitals. To safeguard professional standards, measures are taken to ensure new staff are educated on, and existing staff are frequently reminded of, the clinical and procedural guidelines.

(v) Professional education and training

Maintaining the pre-requisite competence and codes of practice of professional staff are the cornerstone in ensuring professional standards in patient care. Professional competence in HA is assured through recruitment of clinical staff with appropriate professional and specialist qualifications, and more importantly through extensive programmes of post-graduate medical education and continuing medical education. Post-graduate training for HA doctors is structured and meets the requirements of the Hong Kong Academy of Medicine. Continuing education and training for nurses is provided by the Institute of Advanced Nursing Studies and by tertiary institutions. Post-graduate training programmes are also organised for allied health professionals.

(vi) Clinical supervision

There is a well-developed and structured system of supervision of junior medical and nursing staff. Qualified senior clinicians are available to supervise the work of junior clinical staff in hospitals and ambulatory service settings during daytime and off hours.

(vii) Complaint management system

There is a range of channels whereby patients, their families and members of the public can lodge complaints, air grievances and make suggestions on patient care and hospital services. Designated officers dealing with public complaints at both HAHO and hospitals report to the Public Complaints Committee which consists of members of the HA Board and the public to ensure all complaints are properly handled. Although reporting and public complaint systems are by their nature reactive, the Hospital Authority has always striven to proactively monitor and improve its services through proper complaint management.

B. Review of Clinical Audit and Monitoring Systems

Due to rapid advances in technology and increasing complexity of clinical procedures and treatment, clinical audit and monitoring systems are being regularly reviewed in HA.

In the light of the recent clinical incidents, HA will conduct comprehensive reviews on the following aspects on clinical audit and professional accountability :-

1. Clinical Audit
   Current Clinical Audit Systems will be reviewed to examine methods of enhancing its effectiveness. It is proposed to seek input from members of the HA Expert Panel comprising overseas expert professionals.

2. Risk Management
   A study on risk management in public hospitals is currently underway. Phase I, which is an overall review of our system has been completed by two overseas experts. Phase II by the same overseas experts will provide greater insights into methods to minimize and manage clinical risks.

3. Review of clinical supervision
   A review has been initiated to examine how clinical supervision of junior doctors and nurses including trainees can be better enhanced. Meetings with Chiefs of Service and Nursing Managers have already started. A review will be conducted to examine the involvement of clinical staff in management and administrative duties with a view to determining the optimal contribution of clinicians in clinical supervision and patient care services.

4. Review of Workload
   Work processes and workloads in pressure clinical service areas will also be examined to ensure quality patient care services.

5. Professional accountability structure
   The current mechanism for judging professional standards of care in cases of patient complaints and in clinical incidents will be reviewed to enhance accountability of professional staff.

Hospital Authority
4th September, 1997