STAFFING PROBLEMS:A HIGH proportion of the consultant staff at Ennis General Hospital are either in locum or temporary posts, the investigation by the Health Information and Quality Authority (Hiqa) found.
In addition it found the only full-time consultant radiologist post at the hospital had been filled by locums since the last permanent radiologist left in 2001. The locums that filled this post since then were generally on “short six- month contracts”.
The use of locums is known to pose increased risks to patients as they restrict continuity of care and in the past there were a lack of robust procedures employed in the recruitment of locums.
The head of the Health Service Executive, Prof Brendan Drumm, last year referred to “the risks” associated with locum posts in internal correspondence with the HSE human resources department and sought assurances that strict procedures would be followed in their recruitment.
And an internal HSE report into the misdiagnosis of Ann Moriarty (53) – which partly led to the establishment of the inquiry published yesterday – noted that a locum consultant radiologist had misread as normal a chest X-ray carried out on her in June 2007.
Her cancer was missed at Ennis hospital and she died last year.
The Hiqa report said it came across examples of poor interdisciplinary communication within Ennis hospital.
It said there was a need for a much more structured and managed approach to internal communication within the hospital.
Meanwhile, the husband of Ms Moriarty had expressed concern before the investigation that not only were her X-rays misread on more than one occasion at Ennis but her abnormal blood tests were also filed away without being acted on at the hospital.
The Hiqa report found there was “limited evidence” of a robust system for the timely dissemination of blood tests results to a patients’ clinical team in Ennis after they came back from the laboratory at the Mid-Western Regional Hospital in Limerick. The Hiqa investigation also found the lack of a CT scanner at Ennis could delay diagnosis, management and discharge of patients.
It said funding to purchase a new CT scanner was collected by voluntary fundraising.
While the HSE said the service would be in place this year the investigation team were told during interviews that there was “a lack of clarity around resources for this new service”.
Hiqa also found limited integration between the different information systems being used within Ennis hospital which meant that important patient information may not be shared efficiently between the different services which “could result in ineffective and unsafe decisionmaking about patient care”.
The investigation team also found problems with reporting lines within the HSE hospital network system which left no single person at hospital level fully accountable for the quality and safety of services.
“The various reporting lines and absence of clear local authority and devolved decisionmaking meant no single person at hospital level was fully accountable for the quality and safety of services and this system is unacceptable,” the report said.
Furthermore, they found that some of the issues highlighted in a report last year into an outbreak of Clostridium difficile at Ennis hospital, which contributed to the deaths of a number of patients, have still not been addressed.
These include issues around high occupancy and lack of isolation facilities.