Report reveals QA failed to get specially-trained staff to review 23,000 chest x-rays
QUEEN Alexandra Hospital has been heavily criticised after thousands of patients did not have chest X-rays reviewed by an expertly-trained clinician.
A report by the Care Quality Commission (CQC) today reveals 28,000 chest and abdomen X-rays between April 2016 and March this year, from patients coming through A&E, were reviewed only by medical staff not trained to see subtle signs of what could be serious illnesses or conditions.
At the time of the inspection in July, there was a backlog of 23,000 X-rays waiting for a review by a radiologist.
In three circumstances, staff at the Cosham hospital missed signs of lung cancer which were later picked up by radiologists after patients asked for a second X-ray, revealing the diseases.
Investigations into the three patients, two of which have now died, showed symptoms of lung cancer were noticeable on the initial X-ray.
The chief inspector of hospitals at the CQC Professor Ted Baker is now launching a review into all acute NHS hospitals in England surrounding their X-ray procedures.
In response to the inspection, Portsmouth Hospitals NHS Trust chief executive Mark Cubbon apologised to patients.
He told The News: ‘It is totally unacceptable that any patient has suffered harm as a result of delays in our clinicians reaching the appropriate diagnosis.
‘We want to offer a very sincere apology to patients and their families, in particular the three patients specifically mentioned in the report.’
The CQC inspector said during their visit they were informed that in 2007, due to the escalating problem with the lack of capacity within radiology, reviews of standard chest X-rays by radiologists was stopped for certain referral pathways.
Mr Cubbon has now launched an independent investigation into the issue.
He added: ‘I don’t know the reasons behind that decision in 2007 but I have launched an investigation into this.
‘I want to know the rationale behind that decision and the reason behind this backlog growing in the first place.
‘This investigation will flush out and allow us to address the circumstances that led to this build up of backlog cases.
‘It is completely unacceptable that any of our patients would have a delay in their diagnosis because of this.
‘That is something I take very seriously. My commitment is that we clear this backlog, address the issues and look at what caused the historic issues.
‘I want to know exactly where things went wrong.
‘For patients to be subject to harm from a policy we had or a policy adhered to is something that will not happen again.’
The CQC has put four warning notices on QA Hospital. They are:
n The trust must take steps to prioritise and deal with the backlog of unreported images (including those taken before January 2017), assess the impact on patients, and notify any patient who is adversely affected.
n There must be robust processes put in place to ensure that any images are reported on and risk-assessed.
n Details of how the backlog will be addressed must be submitted to CQC.
n The trust must send CQC weekly reports on the size of the backlog, and times taken for reports to be produced.
Since September, the hospital has worked to half the number of backlog cases with around 13,000 X-rays reviewed by a radiologist.
Mr Cubbon said they have got external support to help with the backlog as well as radiology staff working additional hours and employees with correct training helping.
He said long-term they are aiming to recruit more radiologists, of which there is a national shortage, and train more staff at the hospital to have the necessary requirements to do the work.
But Mr Cubbon said this extra workload will not affect new patients needing X-rays, CT or MRI scans as they will be reviewed by a radiologist.
The hospital is hoping to see the remaining 13,000 backlog cases cleared by February.
In the meantime, patients who have had a chest or abdomen X-ray in the emergency department within the last two years can access a helpline if they have concerns.
Mr Cubbon said: ‘We want to be able to reassure patients and offer them support.
‘I know if anyone has had an X-ray after coming into A&E they will be concerned upon seeing this report.
‘I want to make sure any member of the public if they have on-going symptoms or if they are worried to call the helpline.’
The free helpline number is 0800 7837 118. It will be staffed today between 7am and 8pm; tomorrow between 8am and 8pm; Sunday between 8am and 8pm and Monday between 8am and 8pm.