Anaesthetic
Meeting
Tuesday, 4th
April 2000
| Venue: | Anaesthetic Room, NT OT, SJMC |
| Time: | 19:15 h to 20:05 h |
| Present: |
Dr.
Bachan Singh Dr.
Charlie Chan Dr.
Ngun Kok Wah Dr.
Radha Krishna Dr.
Tan Poh Hwa Dr. Anne Wong |
| Absent: |
Dr.
Dalina Ahmad Dr.
Robert Liew Dr. Mary Samuel |
Dr.
Ngun brought to the attention of those present that the problem faced by the
anaesthetists was that even though we may have submitted our charge vouchers
well before the patient is discharged, which was usually at the end of the
procedure, if the operator is late in submitting his charges, our charges will
also be considered as late activity
charges.
Dr.
Ngun also revealed that his investigation into the bad debts written off in
the recent exercise showed that in his case, all the charges written off were
classified as late activity charges.
Obviously, as the uncollected debts were late
activity charges due to the doctor, the hospital had no interest in
expending further time, energy and money to collect these debts.
There
have even been instances whereby the operator may have completely forgotten to
submit his vouchers, the staff has lost the anaesthetists' vouchers or the IT
staff have forgotten to enter the anaesthetic charges after the surgeon has
submitted his charges. There was, therefore, a need to improve the current
system.
Dr.
Chan pointed out that there were 2 issues here.
1.
The
hospital must accept the principle that once the anaesthetist has submitted
his voucher, the onus was on the hospital to ensure that the patient was duly
billed and that the charges would not be considered late activity charges as long as the anaesthetist had submitted his
vouchers before the patient was discharged, even if the surgeon subsequently
submitted his voucher late.
2.
We
had to develop a system to prove to the hospital that we had indeed submitted
our vouchers on time, i.e. before the patient was discharged.
Members
felt it was incumbent on the hospital to contact the surgeon immediately when,
on discharge, the surgeon had not yet submitted his voucher. If the surgeon is
uncontactable or elects not to charge the patient, the anaesthetist must be
informed immediately so that he may either try to contact the surgeon himself
or to enter his own codes if necessary. In this regard, the hospital must try
all means to contact the doctors involved to avoid any problems later.
Dr.
Tan proposed that special voucher books be printed for the anaesthetists being
the only specialty affected in this fashion. The special voucher books would
have carbon copies so that we could keep copies either from the staff to whom
we have submitted the vouchers after they have countersigned it or from the IT
Department after they have time stamped it. In the former, we would receive
our "proof" immediately while in the latter, the stamped vouchers
would be returned to us together with our Daily Revenue Lists the next working
day. This proposal was accepted by all. Dr. Ngun was asked to present our proposals
to Ms. Elaine Cheong. They should then work out a solution agreeable to
both sides (not necessarily the one proposed here).
Surgeon/Operator
Not Charging Patient
Occasionally,
the operator may, for various reasons, decide either to give a discount to the
patient or not to charge the patient for the procedure. In this instance, the
anaesthetist has the option to either follow the surgeon or to charge the
patient as he deems fit. Ideally, the surgeon should indicate the anaesthetic
fee in his voucher. However, if this has not been done, the accounts staff
discharging the patient must contact the anaesthetist to ensure that his
charges are entered if he so desires. Our views will again be presented
to Ms. Elaine Cheong.
Provision
of Anaesthetic to Patients Already Under the Care of an Anaesthetist (e.g.
Patients Ventilated in ICU for
Tracheostomy)
In
keeping with our decision made on 1 November 1999, Dr. Anne Wong reiterated
that the anaesthetist already taking care of the patient should endeavour to
provide the anaesthetic for the patient. If necessary, he should speak to both
the primary physician and the surgeon undertaking the procedure to arrange for
a time that was convenient for both the anaesthetist and the surgeon taking
into account the clinical condition of the patient.
Dr.
Ngun will inform the MAB of our decision and ask them to issue a memorandum to
all doctors and relevant areas including OT, ICU and CCU so that all those
involved will be cognisant of our decision and there will be less
misunderstandings (Update:
At the 12 April 2000 MAB meeting, the MAB while agreeing with our
proposals, decided against issuing the memorandum requested) . It was stressed
that the coordinator for OT must be made
fully aware of our decision to facilitate the implementation of this decision.
Planned
Extension of Morning OT List into the Afternoon
Dr.
Anne Wong brought up the issue of instances where a long elective case slotted
into the morning list was expected to extend into the afternoon. It was
unanimously agreed that in this case, an anaesthetist should be sought to
cover the afternoon list normally covered by the anaesthetist involved in the
long morning case. In the event that the morning case finishes early, the
anaesthetist asked to cover the afternoon list should continue to provide the
anaesthesia unless he prefers to ask the morning anaesthetist to "take
back" his list. This will be brought to the attention of the coordinator
for OT.
Dr.
Radha updated the group with regards to the reallocation of lists that were
underutilised by the surgeon slotted for the list. The surgeons involved were
Dr. Leong Y. P., Dr. Lee F. C. and Dr. Lyou Y. T. Those lists that have been
surrendered will be converted to open lists although preference may be given
to cases from the same specialty in the case of the vascular and neurosurgical
lists. Review of all lists would continue to further identify any
underutilised lists.
Dr.
Ngun told those present that the proposal
had been submitted to Dr. Charles David, the OT Subcommittee Chairman. Dr.
Radha, our representative at the OT Subcommittee, added that since then, the
matter had not been brought up at the OT Subcommittee Meetings and no action
had been taken but he would bring it up at the next OT Subcommittee Meeting.
Dr.
Ngun informed the group that the distributors for the above have managed to
reduce the price from $190 to $155 and were trying to reintroduce
the product to the hospital. Dr. Chan felt that we should get a new cost
estimate for the current items used for comparison purposes. Dr. Ngun also
pointed out that the current items would still be available for those who
preferred them.
As
the number of cases in Sunway Medical Centre were still relatively low, Dr.
Bachan had still not given up any of his lists here in SJMC. He was, however,
getting the other anaesthetists to cover him on an ad
hoc basis whenever he had a case to do in the Sunway Medical Centre.
Non-attendance
by Consultants Called in to See Patients
Dr.
Chan complained that at times, he was called in to attend to patients who had
not been seen by any other consultants because the patient were for transfer
to another hospital. This had legal implications should we be called to
testify in any legal proceedings. If no other consultant has seen the patient,
we would be the most qualified doctor to have seen the patient and it would
not be inconceivable for us to be called to give an expert opinion on the
medical condition of the patient.
He,
therefore, insisted that the primary physician should see the patient before
we were involved in the management of the patient. Dr. Ngun and Dr. Radha,
however, pointed out that if something happened to the patient because we
delayed management while waiting for the primary physician we would be exposed
to accusations of negligence. We, therefore, had to do our part regardless of
whether the primary physician had seen the patient or not.
Dr.
Ngun also pointed out that the Medical Advisory Board had just reviewed this
very scenario and had reached the decision that consultants on call were
obliged to attend to patients whether or not the patients were for transfer to
another hospital.
The decision was that the Medical Officer should document into the patient's notes the details of when the primary physician was called, the orders he had given over the phone and his estimated time of arrival.
Update:
At its 12 April 2000 meeting, the MAB agreed that the physician was obliged to
see the patient once he was called in regardless of whether the patient was
for transfer to another hospital. However, the MAB felt it more appropriate
for details of action taken to contact the physician be noted in the nursing
notes rather than in the medical progress notes.
There being no other matters, the meeting was a closed at 20:05 h.