FOLLOWING THE recent controversy over thousands of general practitioner referral letters being left unprocessed by Tallaght hospital, the Health Information and Quality Authority (Hiqa) decision to undertake a national survey of how patient referrals are processed by hospitals and GP surgeries is welcome.
Although the five-year backlog of about 58,000 unreported X-rays is an indication of severe management deficiencies at one of our major teaching hospitals, in many ways questions over the integrity and consistency of the method used to transfer a person’s care to hospital represents a greater threat to patients throughout the Republic.
Although most people who seek medical advice can be looked after in primary care, a minority require referral for a consultant opinion on diagnosis and treatment. Central to this referral process is the status of the request: is it urgent, routine or indeed an emergency?
An effective referral system has more to do with basic management structures than medical expertise. The referring physician must choose a reliable method of transferring the request to the hospital; the hospital must ensure the letter reaches the consultant directly; and the consultant must read the referral within 48 hours of its arrival. Having assessed its urgency, a suitably timed appointment must be dispatched to both the patient and the referring GP as quickly as possible, and certainly no later than 14 days after the letter arrives in the hospital.
It is also essential that no matter where in the State a person lives, and irrespective of whether they are a public or private patient, the process is consistent. Hiqa has indicated that it will closely examine “the performance and integrity of the referral process”. Working with the Irish College of General Practitioners, it hopes to report back on its findings within three months.
Governance failures have been consistently identified as problems in our public health system. Hiqa’s emphasis on processes that minimise risk to patient safety is important. Its directive to Tallaght hospital to develop, within a two-week timeframe, a detailed governance and quality improvement plan is a clear signal of its intent and a welcome warning to other healthcare institutions that basic governance failures will not be tolerated. It must also pressurise the Health Service Executive to identify systemic weaknesses before they cause harm to patients and in order to prevent further damage to public confidence in the health service.