Standard Procedure for Patients to Get Access to Original Attending Surgeon at Public Hospitals
Ministry of HealthSpeakers
Summary
This question concerns the procedure for patients to access their original attending surgeons and the communication lapses surrounding a catheter insertion surgery at SGH. Dr Lim Wee Kiak questioned why a patient’s preferred placement side was ignored and why no explanations were provided before or after the surgery. Minister for Health Gan Kim Yong explained that a handover failure occurred when a covering surgeon took over to avoid delays, leaving the patient's preference unknown. He noted that SGH has apologized and will now implement pre-operative site marking for this procedure to ensure patient requests are visually confirmed. SGH is also improving handover protocols and documentation requirements to ensure specific patient concerns and instructions are clearly communicated to covering surgeons.
Transcript
72 Dr Lim Wee Kiak asked the Minister for Health with regard to the recent incident on a catheter insertion surgery in SGH that was done on a different side from that previously agreed with the patient, (a) what is the standard procedure for a patient to get access to the original attending surgeon; (b) why was the patient’s request not followed up on and with no pre-surgery or post-surgery explanation given to her; and (c) why was there a lapse in communication for such a critical procedure.
Mr Gan Kim Yong: SGH has conducted an internal review on the incident and has apologised to the patient.
Preliminary investigations by SGH revealed that the patient’s preference for the placement of the catheter on the right side of the abdomen had been discussed with the original surgeon but it was not made known to the surgeon who took over the procedure, due to a lapse in the communication process. On the day of the surgery, the original surgeon was unavailable as surgery for a preceding case of his was unexpectedly prolonged. Another surgeon then performed the procedure so that the patient would not have her surgery delayed further. This resulted in the catheter being placed on the left side of the abdomen which is routinely done.
When a patient requests to see the attending doctor, the attending doctor will attend to the patient as soon as he is available. However, if a particular doctor is unavailable, a member of his medical team will attend to the patient on his behalf as part of team-based care.
In this case, the patient was seen daily by the surgical team and subsequently by the consultant-in-charge at the outpatient clinic. SGH acknowledged that the patient’s request to see the surgeon who performed the procedure for her during her inpatient stay was not conveyed to the surgeon and had issued an official letter of apology to the patient. The original surgeon had also met the patient and explained the situation to her. SGH has also reassured the patient that as the position of the catheter inside the abdomen remains the same, the siting of the exit site will not affect the proper functioning of the access tube. SGH will continue to engage the patient.
SGH regrets that this incident has occurred. Steps are being taken to improve communications and hand-over procedures between doctors to improve patient care. SGH will also be implementing pre-operative site marking for this procedure moving forward. Doctors have been instructed to document and communicate the concerns and the associated risks to the patient, as well as communicate specific instructions to the covering surgeon.