Newsletter No. 99

CUHK Newsletter No. 99 19th December 1996 3 On Its Way to Becoming the Pace-Setter for the Asia-Pacific Region Head of Department of Anaesthesia and Intensive Care Recounts Its Achievements Department Update Prof. Teik E. Oh joined the Department of Anaesthesia and Intensive Care in 1988, and has been its chairman since. He was dean of medicine from July 1989 to June 1992, and is currently a sub- dean of the faculty. W hen you see a friendly and composed Prof. Teik E. Oh sitting in his tastefully done-up office in which the official blends naturally with the personal, it is difficult to imagine him as one of the most distinguished anaesthetists and intensivists 一 rushing around, ER style, in some life-saving emergency. And yet, as he eloquently portrays plans for the Department of Anaesthesia and Intensive Care, it is easy to sense the thoroughness, competence and professionalism in the man. ‘I would like to see this department become the pace-setter for the whole Asia Pacific, which is presently led by Australia and New Zealand. Our aim is not only to outperform the western countries in clinical practice, teaching, and research, but also to provide training to the less-developed countries. I can see this happening in the next 15-20 years, if not earlier. I think we in Asia have the drive, as well as the resources....' These words could sound like wishful- thinking, were they not backed up by tangible accomplishments achieved in eight short years. Upon joining the Department of Anaesthesia and Intensive Care in 1988, Prof. Oh divided it into two distinct specialties of anaesthesia and intensive care, each with its own team of experts to pursue excellence in their endeavours. Only six months afterwards, the Prince of Wales Hospital, in which the department is based, secured intensive care accreditation in training from the Australian and New Zealand College. The College itself is widely recognized as the world leader in the field and the first to run an intensive care training programme. 'We were the only hospital in the world outside of Australia and New Zealand to have achieved full accreditation,' says Prof. Oh proudly. 'Only this year has Queen Elizabeth Hospital been recognized for partial accreditation.…’ And then, in the establishment of the Hong Kong College of Anaesthesiologists in 1989, faculty members in the department played a key role by providing the first elected president 一 Prof. Oh himself, and many of the College's council members and office holders. 'We are also key people in setting up the examinations for the college.' All this could not have been achieved without conscious and painstaking efforts. The department chairman explains how they have adopted a six-pronged approach to achieve quality performance and service. 'We hold weekly case review sessions to analyse anaesthesia-related topics, departmental performance, and all deaths in the operating theatres. 'There are also monthly peer review sessions in which the management of two to three patients is closely and anonymously scrutinized. Good practice is praised, and constructive criticismencouraged where errors of judgment or poor management are identified. 'For seven years now, a totally voluntary critical incident reporting system has been in place to identify the cause of any major errors that could have led to patient harm, be they equipment failure or human oversight. For instance, if there are repeated reports of gas- supply hoses being accidentally knocked off, we will try to minimize the possibility of recurrence by finding a device that can lock the hose securely. We are always looking for improvement. Quality assurance is by the department, for the department and the patients. It was another departmental "first" when we issued the first Asian report in the area. 'Weare committed to quality teaching, and our programmes have been evaluated by the Continuous Quality Improvement (CQI) committee of the Prince of Wales Hospital set up in 1993—94. The CQI principles of"Plan", "Do","Check", and "Act" are practised. 'We attach great importance to continuing medical education, and try to supply it through case review sessions, monthly journal club meetings, and continuing medical education seminars. 'We conduct quality research on a wide range of topics. Current efforts are focused on the pharmacokinetics of anaesthesia drugs, quality assurance in anaesthesia, the use of intravenous drugs as the total anaesthesia agents, and computer modelling in administering intravenous anaesthesia. We published the first studies in Asia on critical incident reporting and on mechanical ventilation and scoring of critically ill patients.' To ensure the high quality of graduates they produce, the department introduced the Objective Structured Clinical Evaluation of undergraduates about six years ago to replace the traditional written examinations. In this, in addition to completing a multiple-choice questionnaire, students are tested for 2-3 minutes in the practice of individual areas of expertise, like clinical skills and x-rays. Prof. Oh feels that the new format is a more realistic, hands-on way of evaluating a trainee doctor. The department now runs a 20-bed ICU in the Prince of Wales Hospital. 'In general, it is a good estimate that 2 per cent of every hospital's beds should be in the ICU. Since this hospital has 1,400 beds, we should, logistically speaking, have 28 ICU beds. We have 20, but in reality we are operating only about 18 due to a shortage of nurses .' Prof. Oh points out that the recruitment of experienced nurses for the ICU has been a long-standing problem for local hospitals. Prof. Oh hopes to see more anaesthetists and intensive care specialists receive their training locally in Hong Kong, and more intensivists running the ICUs in the territory. He was recently elected as councillor and executive member of the Australian and New Zealand College of Anaesthetists, and feels that 'it is of extreme significance to have someone from Asia feed the Asian input into the College.' After his election, he was successful in getting rescinded a clause that disadvantaged Asians as they trained to attain professional qualifications from the College. Having spent eight years in Hong Kong, Prof. Oh believes that there is a need for local hospitals to consolidate pain management for patients who are in acute, chronic, and debilitating pain, like those in labour or post- operative wards, or those suffering from cancer. He would also like to seemore research in anaesthesia, not only in the University but all over Hong Kong. He points out that psychiatry, anaesthesia, radiology and pathology are not perceived as the 'more glamorous fields of medicine', making it more difficult for them to attract the brighter students. 'We need to project ourselves more firmly not only as clinicians but also academics, and this is where good, top quality research comes in,' says the professor. The situation is much changed already. Back in 1988, positions for training anaesthetists at the hospital were lying vacant; now, there are waiting lists of eager hopefuls. The department sure seems to be going in the right direction. 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