The National Director, Hospital and Specialist Services Fionnagh Dougan recognises that Hawke’s Bay Hospital’s radiology system as implemented has “significant limitations”.
Dougan told BayBuzz the limitations were recognised by Te Whatu Ora and a specialist regional team was established to focus on resolving issues that had been highlighted by staff.
“The work of this team resulted in material improvements to the responsiveness of the system as well as a reduction in the clinical workflow risk, although these remain elevated and the subject of close scrutiny,” Dougan said.
The External Review of Te Whatu Ora Te Matau a Māui Hawke’s Bay Radiology Services review added further impetus to the improvement effort, she said.
She said the review made 18 recommendations broadly related to:
- Stabilising the radiology information system and having it ready to perform as a regional system
- Strengthening process steps related to e-order and sign off of diagnostic results
- Addressing wider considerations related to clinical governance, leadership and culture, as we work towards a longer-term goal of implementing an electronic medical record.
Of the 18 recommendations, 6 have been implemented/completed, 10 are in progress and two have been accepted in principle but are pending, Dougan said.
“An upgrade to stabilise the system has recently been carried out and, the radiology information system is now operating as expected across the Central region.
“The improvement effort is not finished. We are now focussing on other steps to further strengthen the safety and stability of the system.”
BayBuzz has submitted an Official Information Request to get details of the recommendations which have been implemented/completed, recommendations which are in progress and recommendations which have been accepted in principle.
Dougan’s response followed the release of the External Review of Te Whatu Ora Te Matau a Māui Hawke’s Bay Radiology Services report which highlighted a ‘decapitated system’, ‘culture of learned helplessness with a belief amongst staff that clinical issues and risks are known but no resolutions offered,’ ‘a system waiting for actual harm to occur before it does anything’ and clinicians enduring more than a decade of poor performance, frequent workstation crashes and unsafe processes within the radiology department.
The review was completed in April and the 35-page report was released to media in August.
The report highlighted patient safety issues, staff welfare and safety issues and technical issues raised by staff previously.
Some of the examples given around patient safety included: issues with test results, unacknowledged and missing results, delayed reporting of a healed carotid artery dissection and continuation on anticoagulants unnecessarily, work arounds with potential issues including GPs being unable to access results, waiting four hours for the reporting of acute CT and reports coming through once patients had transferred from ED to Wellington for care.
The report mentioned staff welfare and safety issues, saying, “It cannot be overemphasized that there are issues of clinician burnout and significant stress, leading to health and safety and overall wellbeing concerns for individuals. Support is required to these individuals and Te Whatu Ora as an employer has a duty of care to ensure an adequate response is provided.”
Some of the technical issues mentioned included: prior studies not being visible to reporting radiologists, radiology reports not being delivered to referrers, with at least one case where a critical report was not delivered to the referrer leading to a 16-month delay in the diagnosis of malignancy.
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