Failings at Tallaght hospital

Mon, Nov 8, 2010, 00:00

A THOROUGH report from Dr Maurice Hayes and his fellow investigators has answered most of the questions raised by the discovery of unreported x-rays and unprocessed GP referral letters at Tallaght hospital. But it has also provided interesting insights into the inefficiencies in our public health system.

The Hayes investigation concluded a shortage of consultant radiologists combined with management weaknesses at the hospital were among the main factors why some 58,000 x-rays were left unreported between 2006 and 2009. However an overload problem was flagged to management at the hospital as early as 2003; consultants expressed their concerns about the matter on at least 30 occasions, including warnings about the risk the backlog posed to patients. But it wasn’t until a local GP brought his concerns to the attention of the Health Information and Quality Authority that the true magnitude of the problem was identified.

A fundamental concern is whether any patients were harmed as a result. Last March Tallaght hospital said two patients had suffered a delayed diagnosis. Last week’s report concludes “no significant abnormalities, as well as no unrecognised malignancies” were identified. However, given the number and range of tests in the backlog, a small number of incidental or even suspicious findings must have been identified by an initial review. It would have been better if the report had spelled out in detail the process by which x-rays were reviewed and how potential abnormalities were further investigated. It is significant, however, that had new health service guidelines been in place, which allow some x-rays to bypass consultant radiologists and be assessed by clinical teams instead, some 26,275 x-rays from the backlog would still have required formal reporting by a radiologist.

On the separate matter of the inadequate processing of letters from GPs referring patients to Tallaght, the Hayes report reaches a most significant conclusion. Because the hospital’s electronic diary system could not offer outpatient appointments beyond a 12-month timeframe, an ad-hoc process, labelled by Hayes as “queuing to queue”, developed. Some referral letters ended up stored in boxes in administration. But Hayes may have been somewhat benign in his description: because these letters were not included in the formal electronic process, it is difficult to see how they could have been part of an orderly queue.

A sign that all is not yet well at the teaching hospital is the finding that this informal queuing process, affecting over 2,700 people, is still in place across many specialities. This failure must be addressed as a priority.

The report also reveals there are some 17,000 patients with appointments already on outpatient waiting lists at Tallaght. These figures provide an insight into the wider system’s inefficiencies. But because of a continuing failure to record waiting times from the point a patient is referred by their GP until they are seen by a consultant, a true measure of public hospital waiting times still eludes us.