Post-Procedure Complications Monitoring Programme 29th Review Meeting Friday, 24 May 2013 4:00-6:00pm, 4/F, Arthur K C Li Surgical Library Lui Che Woo Clinical Sciences Building, PWH

Attendance Present Dr. Simon Wong (Chairman) Prof. Paul B S Lai Team 1 – Dr. Anthony Fong Team 2 – Dr. Sally Luk Team 3 – Dr. Hon Sok Fei PRAS – Dr. David Wong & Dr. Teresa Tan PSU – Dr. Bess Tsui & Dr. Jennifer Mou URO – Dr. C K Chan CTS – Dr. Rainbow Lau & Dr. Calvin Ng Mr. Alfred Chan Ms Eunice Tam

Items discussed Complications report – March 2013 AOB

1. Complications Report – March 2013

Team 1 – Hepatobiliary & Pancreatic Surgery Likely related to haematoma All major complications in pancreas operation happened in this patient Add : anastomotic leakage Should be counted as mortality of PWH Surgery despite the patient died in PYNEH (since no ICU bed available in PWH)

Team 1 – Hepatobiliary & Pancreatic Surgery (Cont’d 2/2) Add : Aspiration pneumonia Note 1. The case MO should have checked the Ryle’s tube need 2. Need to remind medical staff that it is surgeons’ responsibility (not nursing staff) to check the Ryle’s tube.

Team 2 – Upper Gastro-intestinal Surgery Dr. Sally Luk to review the case with Dr. Tommy Yip

Team 3 – Colorectal Surgery M & M Case

Team 4 – Vascular Surgery MRSA infection in perm cath insertion : very rare Actions Patient cohort Surgeon to perform nasal swab Skin prep with alcoholic cholhexidine

Plastic, Reconstructive and Aesthetic Surgery Same patient was operated twice with same complication Team should review management logistic especially in the use of anti-coagulant

Neurosurgery Became an organ donor

Paediatric Surgery and Paediatric Urology Gap wound Should consider alerting patient’s parent on the potential impact on fertility

Cardiothoracic Surgery Should change to primary operation leading to complication

Cardiothoracic Surgery (Cont’d 2/3) CTS team to revise principle dx before the end of May 2013 14

Cardiothoracic Surgery (Cont’d 3/3) 15

2. AOB

Department SOMIP Sharing Session Date : Sat, 29 Jun 2013 Time : 10am Venue: Auditorium, Level 1, New Block

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