United Christian Hospital announces an incident of deviated reference range for bone densitometry reports
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The spokesperson for United Christian Hospital (UCH) made the following announcement today (September 12) regarding an incident of deviated reference range for bone densitometry reports:
The Radiology & Organ Imaging Department of United Christian Hospital (UCH) discovered the deviated reference range in the bone densitometry machine during an audit on September 8 this year. The department followed up and rectified the reference range immediately.
Investigation conducted by the department revealed that from July 15 to September 2, bone densitometry was performed on 41 patients using alternate mineral density reference range settings, causing minor deviation in the conclusion of the bone mineral density reports. The Radiology & Organ Imaging Department immediately updated the system and used the appropriate reference range to reanalyse the bone mineral density of the patients, updated the bone mineral density reports and reported to the Hospital.
Among the 41 patients who received bone densitometry during the said period, 24 have not yet returned for follow up consultation and their reports have been updated, hence they are not affected. Furthermore, the hospital immediately reviewed the case of the remaining 17 patients who have attended follow up consultations in UCH or Tseung Kwan O Hospital respectively, and noted that 11 patients have the same bone mineral density report conclusion after adopting the appropriate reference range.
For the six patients whose reports arrived at different conclusions due to differentiated values, specialists have reviewed the reports and related clinical records again, confirming that the treatment plans have not been affected.
UCH carefully examined the incident and believed that the clinical impact to patients is minimal. The Hospital reminded Radiology and Organ Imaging Department colleagues to carefully verify and adopt appropriate reference range while performing bone densitometry for patients to avoid recurrence of similar incidents.
The hospital is very concerned about the incident and apologises to the affected patients. The clinical departments and Patient Relations Team have contacted all affected patients for follow up. The case has been reported to the Hospital Authority Head Office via the Advance Incident Reporting System. A Root Cause Analysis Panel will be set up to look into the incident and propose recommendations.
Ends/Saturday, September 12, 2020
Issued at HKT 21:45
Issued at HKT 21:45
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