Difficulty finding patient information and inconsistencies in Dunedin Hospital's records were noted by the Southern Cancer Network team auditing 33 referrals to the hospital's colonoscopy service.
Notes were held electronically and in paper form, and information was not always in chronological order or clearly filed.
"The referral letter and documented decision in relation to the colonoscopy review panel (CRP) referral was not always found within the patient notes."
One patient referred three times for colonoscopy was recorded on the panel's spreadsheet only on the third referral, but there were three letters on the patient file declining colonoscopy on all three occasions.
Nine of the patients audited were not found on the CRP's summary list, but further investigation showed that seven of them had not been reviewed by the CRP.
These patients also had the longest waits for treatment of any of the 23 patients who were found to have cancer.
Four of them had colon cancer which had spread.
No explanation for why these referrals did not go before the CRP is given in the audit report.
Referrals audit
The 33 Dunedin Hospital colonoscopy patients referred between February 9, 2004, and June 20, 2009. -23 had cancer.
15 with colon cancer.
6 with rectal cancer.
1 with colon and rectal cancer.
1 with private diagnosis; tumour site not included in Dunedin Hospital files.
5 of the colon cancer patients' disease had spread.
11 of the 14 patients who received colonoscopies at Dunedin Hospital were found to have cancer.
No information is given to indicate whether any of the patients have since died.
Addressing the issues
The Otago District Health Board set up the Gastroenterology Project Board, which has been meeting weekly since the middle of January. Its work includes:
- Considering how 200 extra colonoscopies might be done.
- Streamlining the referral process.
- Evaluating existing processes and learning from the way other services work.
- Investigating how the department could be redesigned to better manage the flow of patients, allow for extra procedures and improve privacy.
- Helping to work out the number of colonoscopies that can be done next financial year.
- Helping to develop a staff strategy which sets out the level and skill mix of staff with an agreed recruitment plan designed to ensure the agreed number of colonoscopies can be delivered.
Colonoscopy referrals: What happened to them?
- 25 of the 33 were reviewed by the hospital's colonoscopy review panel (made up of three gastroenterologists and one colorectal surgeon).
- 11 were declined colonoscopies.
- 14 had colonoscopies at Dunedin Hospital (11 found to have cancer).
- 3 patients had private colonoscopies.
- 1 had a public colonoscopy in Auckland.
- 1 was admitted to surgery.
- 1 was admitted to hospital with an acute condition (previously denied surveillance colonoscopy).
- 2 requests accepted but deferred (one of these underwent cancer surgery following private colonoscopy).
Note: The audit team found that 7 patients' referrals did not appear to have been reviewed by the audit team. Although access to surveillance colonoscopy has been severely limited since 2007, seven of eight people in the audit were successful in gaining these. No details about their condition at the time of referral are given. Another observation of the team is that although 12 of the 33 referrals specifically requested colonoscopy, only five of these were successful, while almost half of 19 referrals which did not specifically ask for colonoscopies were granted the procedure.
