Colonoscopy report delayed to December 11

The Southern Cancer Network's audit report on up to 32 referrals to Dunedin Hospital's colonoscopy service will not be completed until December 11.

It had been hoped the audit would be completed by today, but acting lead chief executive of the network David Meates said in an statement yesterday the time required to audit patient notes was considerably longer than first expected.

This was because of the complexity of obtaining the information required and then aligning it with the audit criteria.

"The auditors are being very thorough."

The audit will compare data from patient notes with the criteria for assessing referrals used by the district health board and the national Clinical Priority Assessment Criteria (CPAC) for both diagnostic and surveillance colonoscopy.

Benchmarking data from around New Zealand, supplied by the Ministry of Health, will also be used.

The audit follows concerns raised by 26 Otago general practitioners earlier this year about access to colonoscopy services, which prompted Health Minister Tony Ryall to call for an urgent report on the matter last month.

The GPs said some patients with accepted signs of possible bowel cancer were being refused colonoscopies and could have an increased risk of early death from bowel cancer.

Although the doctors expressed concerns regarding about 50 patients, not all of them formed part of the audit.

Access to full patient records was required and this was denied in some cases.

The doctors' worries about their patients were listed in an informal survey conducted by South Link Health executive director Prof Murray Tilyard to see if increasing concerns he was hearing expressed were isolated incidents or more widespread.

The matter became public in mid-October after a letter outlining the survey results which was sent to the board and 175 Otago GPs was leaked to the Otago Daily Times.

Some of the concerns raised by doctors were about the hospital's decision in 2007 not to follow the national guidelines for routine surveillance colonoscopies for those considered at increased risk of the disease.

That decision was made because of the pressure on the service from patients with symptoms of bowel cancer.

The report on the audit will go to the Otago District Health Board and Mr Ryall, but it is not clear at this stage when it will be made public.

Health and Disability Commissioner Ron Paterson is also expected to be interested in the audit report.

After the GPs' concerns became public he revealed he had been concerned about the pressure the colonoscopy service was under last year, and had raised concerns over a case referred to him with both the board and the Ministry of Health.

National secretary of the Gastroenterology Society Dr Susan Parry, who was involved with a study several years ago which showed the difficulties services were having in meeting ideal waiting times for colonoscopy, said the capacity had improved, but there were still substantial waiting lists.

The society would be contributing to various reviews being carried out around the country through the four cancer networks.

There was evidence delivering services at the recommended times was a struggle, particularly in the main centres, In a recent interview she said she hoped the attention being focused on the issue would result in more consideration being given by district health boards of the need to ensure colonoscopy waiting lists were managed so the procedures could be delivered in a "timely manner".

If any group of medical professionals went public about their concerns, it should not be dismissed lightly, she said.

The review process was a constructive way of looking at the issues raised and the hope was that it would be of benefit to both the hospital and patientsThe review could also indicate whether there were circumstances specific to Otago which "may be out of keeping with other areas in the country".

The October report of the gastroenterology service to the Otago board's hospital advisory committee stated the public scrutiny of the colonoscopy service had had a "significant impact on staff".

It had increased the workload of all staff as the number of complaints and queries for information had increased.

elspeth.mclean@odt.co.nzf

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