Serious concerns around delayed X-ray results at Kettering General Hospital prompted a national-scale review into radiology reporting.
The Care Quality Commission (CQC) launched the review after inspections identified issues at the Rothwell Road hospital, as well as hospitals in Worcester and Portsmouth.
At these trusts, inspectors found serious problems with delays in reporting on radiology examinations, leading to a backlog in reporting, and images that had only been reported on by non-radiology clinicians who were not adequately trained to do so, putting patients at risk.
Kettering General Hospital’s chief executive, Simon Weldon, said: “Kettering General Hospital has been working very hard over the last two years to improve its radiology reporting systems to ensure patients have their images reviewed in a timely way.
“Our biggest backlog issue arose when we migrated imaging data onto a new regional radiology reporting system in 2016.
“This led to a large number of images being shown on our system as unreported – when in fact we believed that most of these related to clinical circumstances where a report was not needed but had not been closed on the system.
“Because it was possible that some of these were images had not been reported on in a timely way, we have invested £2m since 2016 in a programme to comprehensively review them.
“The review has ensured that unreported episodes can be appropriately closed and where needed any outstanding actions have been undertaken for individual patients.”
The national review is due to be complete by September and in a report out today (Thursday) the quality regulator has raised concerns about the lack of agreed best practice.
They are calling for the development of national standards for reporting turnaround times and improved guidance to support trusts in monitoring their own performance in order to protect patients from the potential risk of delayed or missed diagnoses.
Mr Weldon added that they have improved their reporting and monitoring arrangements and almost cleared their historic backlog.
He said: “Where any delays have been found which could have impacted on patient outcomes we have undertaken a ‘harm review’ process which has established that so far there have been no cases of patient harm as a result of longer waiting.
“We have also been focusing on improving radiology reporting times for patients who are currently undergoing treatment and care.
“We have appropriate reporting times for MRI and CT scans and are working to keep our plain film X-ray backlog to levels that are clinically appropriate and we are investing in external capacity to achieve that.
“We have also improved our reporting and monitoring arrangements and have been working very closely with our local health partners and regulators to do this.
“Current patients should be reassured that our historic backlog has almost been dealt with and are strengthening existing reporting arrangements to reduce remaining work to manageable and appropriate levels in the near future.
“We have also changed the way we report inpatient radiology plain film X-ray images so that now all inpatient images are reported on by consultant radiologists which is line with best practice.”
Analysis of the data submitted by a sample group of 30 trusts as part of the national review revealed that the trusts’ own timescales set for reporting radiological examinations referred from emergency departments vary widely – from an hour at one trust, to two working days at another.
For outpatient referrals, the expected timescales ranged from five days to 21 days – showing the lack of agreement among trusts on how quickly an examination should be reported on.
Trusts who were effectively monitoring their own performance had triggers in place to alert them to the fact that a backlog in reporting was starting to develop.
The CQC’s review found some examples of good practice where routine monitoring triggered prompt action to minimise delays in reporting.
However, it also identified some trusts who had a backlog of images and lengthy waiting times for patients awaiting their results.
Professor Ted Baker, CQC’s chief inspector of hospitals, said: “While our review found some examples of good practice it also revealed a major disparity in timescales for interpreting and reporting on examinations, meaning that some patients are waiting far longer than others for their results.
“We are calling for agreed national standards to ensure consistent, timely reporting of radiological examinations.
“This will allow trusts to monitor and benchmark their own performance – and ensure that, for example patients are not put at risk by delays in their X-ray results being reported to the clinician responsible for their care.
“With demand for radiology services increasing, trusts face real challenges in managing reporting workload.
“Many rely on outsourcing to external providers or delegating reporting to non-radiology clinical staff within the hospital.
“Where this is happening, those tasked with interpreting and reporting images must be appropriately trained and competent to do so.
“In the future, new technology has the potential to significantly improve how images can be read and reported.
“However, we need to act now to address the challenges and help minimise the potential risks so that patient examinations always receive a timely report by an appropriately trained healthcare professional.”