31 Oct 2022

Staff shortages, aging equipment flagged in summary of problems facing radiology departments

8:41 am on 31 October 2022
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Five of the country's public hospital radiology departments are rated high risk, two are medium risk and a further three are not even trying to comply with the international radiology standards, according to an inspection body summary released to RNZ. Photo: 123RF

This is the seventh story in an RNZ series about the growing pressures and profits in radiology, the jammed bottleneck that most patients must pass through.

Five of the country's public hospital radiology departments are rated high risk because of problems such as ageing or poor equipment, lack of space and staff.

A further two hospitals' departments are rated medium risk.

The slew of bad risk ratings has come to light in a new one-page summary released to RNZ by the inspection body International Accreditation NZ (IANZ).

A further three hospitals are not even trying to comply with the international radiology standards.

The 10 departments make up around a third of all public radiology.

Scanning at them is carrying on.

The risks include "insufficient personnel" and "radiology information system concerns" - these systems are vital for reading scans to diagnose what's wrong.

In three cases there is "no space - privacy and safety concerns" or "accommodation" shortcomings.

RNZ reported last week on two of the 10 - Palmerston North and Southland - that are "high risk" and suspended from the international standards regime due to lack of staff.

The new IANZ lists reveals another three hospitals are also "high risk".

It is not naming any hospital due to confidentiality provisions.

RNZ has asked Te Whatu Ora - Health NZ (HNZ) to identify all the services.

One of them is a major tertiary hospital, and two are regional hospitals.

The tertiary's vital signs read: "Insufficient personnel - Recruitment initiatives in place but little success - hampered by registration hold ups".

Also, the tertiary has "Radiology Information System (RIS) concerns" and "IT issues".

An earlier report RNZ obtained last month said RIS/IT problems in the central region were common and risked "patient death or life-changing delay to treatment".

RIS is the reporting system that doctors use to interpret scans. If RIS is compromised, diagnosis is compromised.

Does it matter?

IANZ does not have the power to shut down any of the radiology services, and it is not mandatory for them to be accredited.

Its current rating on a further two unnamed regional hospitals is "medium risk".

Both lacked staff and space, its report shows.

The three departments that are named are those that have not attempted to get IANZ accreditation in the first place. These are tertiary hospital Waikato, and regional hospitals Greymouth and Wairarapa.

Tertiary hospitals are where most of the really difficult clinical care is undertaken.

RNZ has asked HNZ why these three hospitals are not trying to get accredited.

Accreditation is not mandatory for public hospitals, but it is mandatory for all elective high-tech scanning (MRI, CT, nuclear) that is paid for by ACC.

"Moreover, accreditation is a third-party assessment and recognition of service competence, which means hospital management can have confidence that an accredited service is functioning appropriately and that they (the management) will have oversight of any issues that could compromise service delivery," IANZ, a Crown entity, told RNZ.

ACC told RNZ it "recognises the value of an IANZ accreditation because it provides assurance that high-tech imaging services meet appropriate quality and competence standards".

ACC-funded MRI and CT volumes are undergoing huge growth.

Private health insurers also require IANZ accreditation for high-tech scanning (low-tech is the likes of standard x-rays).

"If the provider loses accreditation, they are required to advise the insurer as soon as possible - this is standard practice," said the health insurers' body, the Financial Services Council.

Acute hospital care that requires ACC-funded scanning comes under HNZ standards.

'Complex risk mitigation'

HNZ did not mention the high or medium risk ratings at its seven public hospitals over the course of numerous inquiries for weeks by RNZ.

It also did not mention the three that have opted out of accreditation entirely.

IANZ said it only suspended services where it identified "high risk" issues that failed to be mitigated within a set deadline, usually three months.

All but Southland and Palmerston North have risk mitigations in place, its new summary shows.

However, in three out of those five cases, it adds, "but being monitored".

At a fourth, the high-risk tertiary hospital, the report says, "complex risk mitigation in place for RIS and IT issues".

"Where these challenges exist there are robust risk mitigation processes in place to ensure diagnostic imaging can be delivered safely," IANZ chief executive Dr Brian Young said in a statement.

If mitigation did not work, a service could be suspended.

"However, if effective risk mitigation is in place, the service will continue to be accredited."

Major outage

RNZ is aware that Wellington, a tertiary hospital, and the central region around it, suffered a major RIS outage in mid-October.

Last week, the region's radiologists were given yet another new work-around to use to try to beat the IT bugs.

There have been so many "extremely laborious" workarounds across the region that includes Hawke's Bay and Palmerston North hospitals, that staff were "jaded" and baulking at new attempts to improve things, the September report to HNZ said.

Last week, HNZ told RNZ it did not have enough radiology workers but services were safe and being delivered "as they have always done".

It did not outline what checks it was making, but said it had confidence in staff's dedication and skill, and was trying to recruit more.

The September report by radiologists to HNZ repeatedly emphasised the extra load being put on staff by the region's faulty radiology information system.

Wellington Hospital raised its RIS risk rating to 24 - deep in the red zone - in August last year to match Hutt Hospital's, a risk register shows.

The register said any significant, irrecoverable system failure would have a major impact on patient safety and lead to "irretrievable loss of historic information".

Since then, an upgrade project has begun but it stalled after the September report.

HNZ told RNZ in September the problems were "largely uncovered" by the upgrade.

But the alarm was raised more than eight years ago in central region hospitals, where there is evidence of angry doctors warning their DHB superiors the information system was dysfunctional, unmanageable and subject to abject failings.

One doctor told RNZ in recent days: "We haven't had a functional system from day one.

"It has never ever worked to our satisfaction."

Government regulations had forced hospitals into choosing a flawed system, they said.

The problems around reporting back accurately on scans were reducing how much scanning Wellington Hospital could outsource to private providers to cut queues, doctors said.

Wellington Hospital has budgeted up to $9 million for radiology outsourcing in the coming year, up from just over $1m.

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