Procedures for Extracting and Testing Blood Samples at Hospitals

Miss Penny Low asked the Minister for Health whether the Ministry could review (i) the blood-taking procedure in hospitals whereby patients are subjected to repeated blood takings within a span of one to two 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.

The Minister for Health (Mr Gan Kim Yong): Sir, blood investigations are conducted for various purposes, ranging from routine health assessments, 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 the assessment of the patient's conditions.

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.

Another example of initiatives by our hospitals to reduce duplication of tests is the iSMART blood orders tracking system at the Tan Tock Seng Hospital'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.

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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 whether a repeat test is indicated.

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

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

Miss Penny Low: Sir, I thank the Minister for his comprehensive answer. I have been told that it is possible these days to use diagnostic kits with just a very small sample of blood for a number of tests, instead of taking specific blood samples for specific tests. Is that something that is also being practised in our hospitals? If so, then it could really reduce the number of times that a patient would be asked to give blood for tests.

Mr Gan Kim Yong: Sir, I agree with the Member's general intention that we should minimise the number of tests that are done on the patient unless they are necessary. However, blood tests are such that they are usually for specific objectives and purposes. When we take blood samples, they are to be tested for specific results that we are looking for. Therefore, it is unlikely for us to be able to draw blood from a patient for a comprehensive test in anticipation of tests that would be needed in future. Usually, the doctors or nurses in attendance will decide the relevant tests that need to be done on the blood sample. So we will draw the blood and it will be subject to the tests that are prescribed by the doctors or nurses for the specific purpose of treating the patient's diseases. If the patient is admitted subsequently for a different episode, tests may have to be done again because the illnesses or the problems that the patient has may be quite different from the conditions before and, therefore, repeat tests may be necessary so that we can determine the conditions of the patient and are able to prescribe treatment more precisely. These are clinical decisions that will be decided by the doctors and the nurses on the ground based on the conditions of the patient. But I do agree with the Member that we should continue to see how we can minimise unnecessary tests or duplication of tests because tests are inconvenient and sometimes can be painful to patients. So, our objectives are in alignment.

Miss Penny Low: I would like to once again thank the Minister for his very comprehensive answer. My question was really about using more advanced diagnostic kits where we could draw one blood sample for multiple tests that are required by the clinics. Obviously, if they have to go for repeated tests because they are admitted for different conditions, that has to be done.

Mr Speaker: Miss Low, please keep your questions short.

Miss Penny Low: Yes.

Mr Gan Kim Yong: Sir, I agree. The hospitals and the doctors will look at whatever technology that is available to minimise the necessity to draw additional quantities of blood. We will minimise the amount that we need for the tests. But, again, these tests would have to be prescribed by the doctors and the nurses.

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12.30 pm

Mr Speaker: Order. End of Question Time.