The HSE today published its independent report into the unreported x-rays and management of GP referral letters at Tallaght Hospital. The HSE says it accepts the findings of the report and has been working with Tallaght Hospital on an implementation plan, which is now well underway, to ensure that all of the recommendations are acted on. Tallaght Hospital has accepted Dr Hayes’ findings and has undertaken to implement in full the recommendations to ensure that the issues arising for the hospital are addressed in a timely manner.
The Hayes Report identifies significant failings in how a backlog in the hospital’s radiology department developed and in how some GP referral letters were dealt with in the hospital.
The HSE recognises the considerable work that has already been completed by the hospital to address the unreported x-rays. In this regard, all unreported films have now been appropriately reported on by the hospital.
A concerted effort has also been made to address the unprocessed GP referral letters. 97% of patients affected have now been seen by a Consultant at the hospital and the remaining 157 have all been offered an appointment at the hospital, scheduled to take place before the end of this month.
The Hayes report also makes a number of findings concerning management systems and governance at Tallaght Hospital. It is the HSE’s expectation that all management and governance issues will be addressed by the hospital as a matter of urgency. Tallaght Hospital has assured the HSE that significant progress is underway in relation to these and other recommendations arising.
Radiology
All 57,921 unreported x-ray films in the hospital have now been reported on and no further clinical incidents (e.g. delayed or incorrect diagnosis) were discovered. The HSE is satisfied that the hospital is now compliant with the guidelines produced by the HSE National Clinical Programme for Radiology and endorsed by the Faculty of Radiologists. The HSE has approved funding for two additional Consultant Radiologists posts in the hospital and together with the x-ray reporting guidelines now in place the HSE is satisfied that the backlog of unreported films will not recur.
The report recommends that a review be carried out into Consultant Radiologist staffing levels in hospitals. The HSE is committed to carrying out this review and will do so with the benefit of insight from the Faculty of Radiologist’s Workload and Consultant Staffing Survey when it becomes available later this year.
In line with another recommendation in the report, the HSE has committed to strengthening workforce planning across all radiology departments countrywide. Guidelines to deal with appropriate workforce planning are being developed by the HSE’s National Clinical Programme for Radiology. In addition, National Guidelines on Radiology Reporting have been issued to all hospitals. Hospitals have now assured the HSE that they are compliant with the new guidelines to ensure films are appropriately reported.
The HSE is putting in place a national framework for equipment maintenance and replacement, and will continue to progress the work on RIS and PACS as recommended in the report. As part of the HSE’s ongoing National Integrated Medical Imaging System (NIMIS) project the HSE will validate the existing RIS/PACS in Tallaght hospital against the NIMIS standard and will integrate the Tallaght system into the national NIMIS solution which will improve the efficiency of x-ray reporting.
GP Referral Letters
The hospital’s management of GP referral letters is also dealt with in the report. While the report finds that there were no unopened letters, it identifies clear failings in how letters were dealt with. Of the 3,498 patients affected, 97% have been seen at the hospital and the remainder have all been offered an appointment with a Consultant at the hospital scheduled to take place before the end of this month. The hospital has assured the HSE that it now has in place appropriate systems and protocols for dealing with referral letters to ensure that this issue does not occur again.
Other recommendations regarding the processing of referrals and monitoring access to Out Patient Department (OPD) services in all hospitals is now underway. The HSE has been assured that all hospitals are applying the Code of Practice for Healthcare Record Management. The HSE has established an out-patient performance improvement project which is looking at standardising waiting list information across all hospitals to improve the performance of out-patient departments nationally. The HSE is also participating in a project with HIQA on improving the quality of referral information and systems from GPs to out-patient clinics.
The report supports the development of Clinical Directorates which are now well advanced in all hospitals. Clinical Directors are now in place in hospitals around the country to provide clinical leadership to ensure that there is effective working and cooperation between management at the hospital and clinicians in responding to issues that arise.
The report also notes that orthopaedic services would benefit from a national strategy for orthopaedic services and trauma. The HSE agrees that a national orthopaedic and trauma strategy is needed and is progressing this through the recently established Clinical Programme for Orthopaedics within the HSE’s Quality and Clinical Care Directorate.
The HSE will continue to work with voluntary organisations to embody best practice in Service Level Agreements to ensure that patient safety is paramount. HIQA has consulted with the HSE on the new National Standards for Better, Safer Healthcare and the HSE will be assisting all our services to embed quality and safety improvements, which will in turn prepare facilities for licensing in the future.
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