Blood Taking Procedure

28 February 2012

Question No. 279

Name of person: Ms Penny Low

Question

To ask the Minister for Health whether the Ministry can review (i) the blood-taking procedure in hospitals whereby patients are subjected to repeated blood takings within a span of 1-2 weeks because they are admitted under different departments within the same hospital; and (ii) the need for patients to stay as inpatients while waiting for blood culture results that may take up to three days and the patient is well enough to return home. 

Answer

1     Blood investigations are conducted for various purposes, ranging from routine health assessment, monitoring of a chronic condition to the clinical management of an acutely ill person. The type and frequency of blood investigations are determined based on clinical needs after assessment of the patient’s condition.

2     With increasing complexity of cases and specialisation in medicine, we need to ensure that care is better coordinated between different clinical departments and to avoid duplicated tests. Our healthcare institutions have introduced measures such as electronic medical records to reduce duplication of tests.  As test results can be accessed online by healthcare professionals involved in the care of the patient, blood tests are often not repeated unless it is clinically required such as monitoring of platelet levels in dengue patients, and monitoring of white blood cell counts in a cancer patient undergoing chemotherapy.

3     Another example of initiatives by our hospitals to reduce duplication of tests is the iSMART blood orders tracking system at TTSH’s Specialist Outpatient Clinics. This system allows nurses to track the blood tests that have been ordered by different clinical departments to enable the samples to be obtained at one sitting and the results shared by the departments.  

4     Going forward, the National Electronic Health Record system that is being rolled out nationally will enable doctors from different institutions, who are managing the patient, to see the patient’s results from blood investigations that have been performed before deciding when a repeat test is indicated. 

5     Despite such efforts, there are still occasions where tests are duplicated unnecessarily. We will continue to improve on processes to minimise inconvenience to patients and reduce wastage.

6     On blood cultures, the decision to discharge a patient is made based on patient’s clinical condition. A patient requiring admission and blood cultures tend to be generally ill and hence would usually stay in the hospital until results are obtained to inform treatment decisions and the patient has improved. However if the patient’s condition improves or the illness turns out to be non- infectious in nature, the medical team can discharge the patient earlier before the culture results are finalised and the patient is given a follow-up appointment as an outpatient for a review of his condition as well as the culture results.