Risk as staff worked past their scope: report

Photo: ODT files
Dunedin hospital. Photo: ODT files
Radiology staff at Dunedin hospital were left to make clinical decisions beyond their scope earlier this year, resulting in "severe or catastrophic" risk.

No nuclear medicine-trained radiologist at the hospital meant medical imaging technology staff were under high stress, making decisions they were not trained or comfortable doing, a report by the International Accreditation of New Zealand (IANZ) said.

Te Whatu Ora Health New Zealand (HNZ) Southern said this week it had still not recruited a nuclear medicine radiologist, but the private sector was filling the gap.

The IANZ report from June was provided by HNZ under the Official Information Act earlier this week, following the revelation in August of the department’s high-risk ranking in IANZ’s national review table.

It provided deeper insight into the struggles of the department at the time.

The lack of a nuclear medicine radiologist was the issue the report found most concerning out of the four major nonconformances detailed.

It was given the highest possible risk score of 25 points — meaning consequences were severe and prevalence widespread or certain.

Following the resignation of the nuclear medicine radiologist in the first half of 2022, the service had been unable to secure another radiologist to provide advice and reporting.

"This had resulted in MIT staff being relied upon to make clinical decisions for which they were not trained, or comfortable doing, creating a high level of stress.

"The lack of availability of technical advice had meant that the patient was often over-scanned to ensure nothing was missed, and on occasion, rescanned."

Examinations had been reported by telehealth provider I-Telerad in the interim, but the radiologist was not easily contacted for advice, the report said.

Management indicated a contract was under way to secure the services of a private sector radiologist, who would be available for consultation and reporting.

HNZ Southern group operations director Hamish Brown said nuclear medicine technologists were supported by senior staff.

"We have also appointed a New Zealand-based provider of nuclear medicine reporting to provide clinical oversight and reporting of examinations."

"We have not been able to recruit to this position as there are a very small number of nuclear medicine-trained radiologists in New Zealand, as well as globally.

HNZ Southern continued to use I-Telerad for outsourced reporting, he said, but did not comment on contact issues.

Further staff shortages were the subject of the second non-conformance in the IANZ report, with a risk score of 20.

There was a shortage of 4.7 fulltime equivalent (FTE) radiologists, a shortage of 40.1%.

Medical imaging technologists were also lacking, with 15.5 FTE vacancies, a shortage of 26%.

Various waiting list issues and partial scanner closures were a consequence of the shortages, the report said.

The number of radiologists lacking at the hospital had not changed in the months since the report was written, Mr Brown said.

"Southern continues to actively recruit for radiologists."

Private sector radiologists were also used for locum support as well as consultation and reporting.

The report flagged the need for some electrical recertification and relabeling as the third major non-conformance, with a risk score of 20, although HNZ said in August overdue testing had been carried out.

The final major non-conformance was the poor condition of the digital subtraction angiography (DSA) equipment — a combination of X-ray equipment and high-speed image-processing equipment — with a risk score of 15.

The DSA unit in use had an increasing number of faults and failures, and there were warnings of reduced image quality.

A replacement had been planned for November 2022, but work had stalled due to ceiling mounting issues.

Mr Brown said the DSA equipment was regularly serviced in line with manufacturer’s recommendations.

Replacement was set to take place in the first quarter of next year.