12 Sep 2023

Fears, frustrations and critical risks highlighted in report on Hawke's Bay hospital

3:01 pm on 12 September 2023
Male doctor,medical students or surgeon using digital tablet and laptop during the conference,Health Check with digital system support for patient,test results and patient registration,selective focus

Problems and vulnerabilities connected to IT systems at Hastings hospital have been highlighted in a surveillance report. Photo: 123RF

Doctors have been grappling with mistrust around information entered into the IT systems at Hawke's Bay hospital, including what it tells them about patients and critical scan results.

A newly released report has revealed 15 critical risks that assessors found in late June, before suspending the radiology department's international accreditation in July.

It described reporting gaps which critical results about patient health had slipped through.

"The uncertainty of the delivery of [scan] reports was of particular concern for the radiologists, adding to their stress."

"Mistrust" and frustration are mentioned five times in the short report by International Accreditation, or IANZ, released to RNZ.

"There was an inherent mistrust of the system" among senior doctors, it said.

Staff "were overworked, tired and frustrated, and they have become fearful not of 'if', but 'when', a major incident of patient harm will occur", it said - and indeed, there were documented cases of harm, it added.

One failing was that the radiology IT system and the clinical IT were not able to share critical results.

They were "not integrated" and "therefore reports are not automatically sent out".

"Critical results are sent out via a manual process or a phone call if the referrer can be identified."

But the system often failed to show which doctor had made a referral.

"There is no way to easily identify the referrer and unnecessary time is spent doing so."

Referrals by GPs for a scan were having to be typed into the system.

The system was stabilised in May but problems persisted, it said.

Doctors were being forced to work after-hours to get scan reporting done.

Te Whatu Ora: two reviews into patient records

Te Whatu Ora was now randomly going through patient records in Hawke's Bay to find any harm that had gone unreported.

The agency said a review of a risk register "did not find a significant number of harm events logged, and those which had been are all being investigated".

But this was during a period of low reporting, it said, so it had begun a second review, this one of random patient records, to find unreported events of harm, or potential harm

Cases would be managed as they were found.

And once it had looked through a large enough sample, it would be in a better position to assess the rate of harm.

It said the concerns of the local community and radiology staff had been heard.

"Substantial work has been in place for some time to stabilise and enhance the reporting system, and this work will continue under a governance group," it said in a statement.

Latest IANZ report adds to issues raised in earlier review and report

But poor reporting had harmed patients, IANZ said. At least four events were being investigated in August; RNZ has asked Te Whatu Ora for an update.

The IANZ report comes on top of a scathing external review in April of the district's radiology, which Te Whatu Ora had kept under wraps for months.

Once it was forced to release the report in August, the agency then told the public all the risks were being dealt with.

The Minister of Health echoed this, saying the "immediate safety risks" at Hastings hospital (Hawke's Bay hospital) had been addressed. She added the way IT was set up there, "is not present in other hospitals".

However, an internal agency report last September about radiology reporting problems across the whole central region - from Hastings to Wellington to Whanganui - stated:

"The risks are alarming to read considering the serious nature and length of time they have been present.

"... these risks have been present for a long time in many districts in the region ... The risks are present and we must address them."

It listed failings that echoed Hawke's Bay's, including:

A "missing clinical result" from a scan; "delayed or missed communication of clinical result"; "reduced capacity/clinical capability due to lack of integration"; and "unavailability/poor performance of system".

Hastings' radiology system was upgraded in May 2023 and had been "stabilised" - and new rooms were being built for it - but the problems remained "unresolved" as of late June.

Similarly, Hutt Hospital's radiology IT had just been upgraded, but was rated as "high risk" just last month by IANZ. Counties Manukau's system was, too.

The mid-2023 IANZ assessment at Hastings said problems with its clinical IT portal "were common across other hospital services including Medical Laboratory and Cardiology".

"Discussion with key staff indicated they were frustrated by the system and the lack of perceived engagement from IT to resolve the issues."

On top of that, Hawke's Bay was short of doctors and medical technicians, with vacancies worst for radiologists, the assessment said.

Cyclone Gabrielle's impacts had made trying to recruit harder, the hospital told IANZ, when it pleaded in May 2023 for the assessment to be postponed. "We ... cannot stress enough the impact that Cyclone Gabrielle has had," it said.

IANZ went ahead anyway, finding that the staff shortages and IT woes had combined to present "several recognised and documented critical risk of patient harm issues ... which remain critical even after controls were applied".

The problems have added to the long wait lists for scans.

Routine scans have a six-week target to get done, but at Hastings this had blown out by midyear to:

  • 2-6 months to get a CT scan
  • MR 2 months
  • Nuclear medicine 3-4 months
  • Community-referred ultrasound 3-4 months
  • Steroid injections up to a year
  • Fine-needle aspirations up to 5 months

The hospital continues to deliver radiology services.

Te Whatu Ora has repeatedly told the public that the "tireless work of our clinical staff" ensured the services were safe.

But the assessors in June reported back that "discussion with key staff identified low morale, staff were overworked and frustrated with inefficient workflow".

The health agency did not mention frustration or mistrust in its media release about Hawke's Bay's suspension in July, though these featured in IANZ's findings.

Te Whatu Ora was due to report back to IANZ last week on what safeguards it had put in place. RNZ asked for an update.

If it does not fix things properly within a year, Hastings will have its accreditation formally withdrawn, as happened recently to Palmerston North Hospital.

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