INVESTIGATION:A SHORTAGE of consultant radiologists at Tallaght hospital as well as management weaknesses at the facility were among the main factors which led to nearly 58,000 X-rays going unreported at the hospital between 2006 and 2009, an independent investigation has found.
The report of the investigation, chaired by Dr Maurice Hayes and published yesterday, found backlogs in the hospital’s radiology department had been a problem for years due to work overload. Consultants had been writing to management about the problem since 2003.
The report says consultant radiologists expressed their concerns to hospital management on more than 30 occasions between 2005 and 2009. One consultant’s letter in July 2008 said the backlog was “growing like a mountain”. Other letters pointed to the risk to patients as a result.
The backlog of 57,921 X-rays came to light last March after the hospital disclosed two patients, one of whom had died, had a delayed diagnosis. All the X-rays have now been reviewed and “no untoward event, no missed diagnosis and no undetected condition” was found. “This is a strong indicator that the X-rays had been competently reviewed at the time, even if not reported on,” the report says in its executive summary. Later it says the inquiry team had been assured there “were no significant abnormalities detected” during the review.
The report refers to the fact working group within the hospital was asked to look at the issue in 2006 but there was no evidence its report was implemented. Some efforts were made to deal with it through the employment of locums but efforts were not sustained.
The fact that various figures for the extent of the backlog were being quoted in correspondence within the hospital in 2008 and 2009 is also highlighted in the report. In the early part of 2009 the backlog was estimated at 40,000 but in mid-2009 the hospital told the Health Information and Quality Authority it was 4,000. Dr Hayes said there was confusion over the numbers but no evidence of a “cover up”.
Apart from a shortage of consultant radiologists, there was also a shortage of clerical back-up staff to type radiology reports. In 2006, the report says, there were boxes of tapes waiting to be typed. Persistent problems with the typing of X-ray reports “contributed significantly to the backlog”.
The report says there was also an absence of written policies and protocols at the hospital setting out categories of X-rays which did not require to be read by a consultant radiologist and there were difficulties too with the hospital’s radiology IT systems.
“There was a shortage of consultant radiologists. The existing workload when compared to an internationally validated model demonstrates the workload is high when compared to two other Dublin teaching hospitals or to Australian norms. Responsibility for this must be shared by the hospital for not adequately prioritising or vigorously pursuing additional consultant appointments, and by the HSE (and its predecessor bodies) for not approving posts in a reasonable and timely manner,” it says. Some posts took years to be approved.
Another Dublin hospital, unnamed in the report, had practically twice as many radiologists for a similar workload.
New guidelines were recently introduced by the HSE making it clear not all X-rays have to be reported on by radiologists. But even if these guidelines had been in place in Tallaght, some 26,275 of the unreported X-rays would still have had to have been reported on, the report states.
The inquiry found no evidence that a patient’s public or private status impacted on whether or not their X-rays were reported or left in the backlog, though the radiology IT systems made identification of a patient’s status in this regard difficult, the report says.
MAIN POINTS-
RADIOLOGY REVIEW
There was a problem almost from the opening of the hospital, and in the face of rapidly growing demand, of significant overload in the hospital’s radiology department. Problems included:
* A shortage of consultant radiologists, and this was made known to the management.
* An absence of formal written policies and protocols for dealing with X-rays and GP referral letters.
* Difficulties with the radiology IT systems as well as difficulties with the IT system for scheduling outpatient appointments.
* Persistent problems with the typing of radiology reports which contributed significantly to the backlog of unreported X-rays.
* Inadequate response on the part of the hospital to the clearly flagged problems of system overload.
* No significant abnormalities were detected when the backlog of 57,921 X-rays were reviewed.
* No GP referral letters were left unopened, but 3,498 GP letters seeking appointments to see orthopaedic specialists were not processed properly. No patient appears to have been endangered by the failure to process GP referral letters on time.
* A dispute between hospital management and orthopaedic consultants over a lack of ringfenced beds for orthopaedic patients led consultants to stop accepting outpatient referrals and so the letters were not processed.
* There were weaknesses in management and governance systems at Tallaght hospital.
* Neither the hospital nor the HSE seemed to have learned from other similar cases.