This Review was instigated as a result of the commencement of a major review of x-ray reporting at two hospitals in Ireland involving a long term locum consultant radiologist at the hospital in Oban and the coincidental expression of concerns by a GP practice regarding the accuracy of a number of x-ray reports by the same radiologist.
The review took the form of a ‘Look Back’ of all chest x-rays, barium examinations and x-rays of children under 12 performed within the review period. It was undertaken by an independent external consultant radiologist and consisted of the re-reporting of a total of 1697 images. The aim of the review was to identify if there had been any missed pathology within the radiological reporting process and to ensure that patients had received appropriate care.
Of the 1697 images reported by the external radiologist, 45 (2.6%) were judged to be Category 3, i.e. possible significant missed pathology. All of these reports were clinically reviewed by the Locality Acute Clinical Director (a consultant physician), the Community Health Partnership (CHP) Clinical Director (a GP) and the relevant referring clinician. It is important to highlight that the level of missed pathology at 2.6% falls within the limits of professional acceptability previously laid down by the Royal College of Radiologists and other professional bodies.
The referring clinicians of all ultrasounds undertaken within the review period (totalling 435) were also requested to clinically review the cases and to consider whether these should be repeated. 92 patients were referred for repeat scans, 63 of whom accepted the offer. All of these scans were undertaken between July and October 2008 by Raigmore Hospital Radiologists or by the Oban Ultrasonographer.
The main observations from the Review highlight the following:
There were two cases where the diagnosis of lung cancer was delayed. However, in the opinion of the authors of this report, this did not impact significantly on their clinical care or outcome.
In the remaining 43 Category 3 cases, the reported radiological discrepancies did not impact on patient management, care or outcome.
The Look Back confirmed that two ultrasound scans identified ongoing morbidity which was likely to have been present at the initial investigation where there had been an effect on clinical management and outcome. In both cases this led to prolonged discomfort of the patients but did not affect their eventual recovery.
Dr Ian Bashford, NHS Highland Board Medical Director, said :
"A review of x-ray and ultrasound investigations reported by two consultant radiologists at Lorn & Islands Hospital in Oban was recently undertaken by NHS Highland. This review was prompted by concerns among a GP Practice regarding the accuracy of a number of x-rays and also because a hospital in Ireland had reviewed x-rays carried out by a radiologist who subsequently worked as a locum radiologist in Oban.
"The Review re-assessed all chest x-rays, barium examinations, all x-rays performed on children aged under 12 years and all ultrasound investigations reported by consultant radiologists at the hospital from 16 October 2007 to 15 May 2008.
“The main aim was to establish whether there were any patient safety concerns, to provide reassurance that radiographs and scans had been read correctly, to ensure that patients had been managed appropriately and that no harm had occurred to any patient. It involved reviewing 1,697 x-rays and 435 ultrasound scans.
"All patients affected directly by the review were contacted by NHS Highland and a helpline was set up via NHS24 for any members of the public who had any general concerns about the incident.
“The Review has now been completed and we are today publishing the findings in full to allow patients, members of the public and other interested parties an opportunity to read it for themselves.
“The main observations from the report highlight that there were 45 Category 3 cases where a discrepancy in reporting may have had a clinical significance with possible implications for patient outcome. Further investigation of these cases highlighted that in 43 of them the reported radiological discrepancies did not impact on patient management care or outcome. In the remaining two cases it was found that a diagnosis of lung cancer was delayed but according to the findings of the Report this did not significantly impact on the clinical care or outcome of the patient. At this stage it is also important to highlight that the overall incidence of potential missed pathology falls within the limits of professional acceptability previously laid down by the Royal College of Radiologists and other professional bodies.
“In addition to the above there were also two ultrasounds which identified ongoing morbidity that was likely to have been present at the initial investigation which led to prolonged discomfort for the patients concerned but did not affect their eventual recovery.
“The report also highlights a number of other more general observations and associated recommendations and actions which we will be looking at implementing as soon as possible.
“In conclusion, I would like to reassure patients and members of the public that we take seriously issues such as those that led to this Review being carried out in the first place and we have published the report in full to allow everyone an opportunity to look at the findings in more detail. However if anyone has any more questions or requires additional information then we would ask them to get in touch and we will do our utmost to deal with them.”
Argyll & Bute Community Health Partnership has also concluded its wide ranging review of the provision of its radiology services in conjunction with a range of users and clinicians and in collaboration with colleagues from NHS Greater Glasgow & Clyde and Raigmore Hospital. This has resulted in plans to establish a sustainable, quality assured and cost effective outreach service provided from the team of Consultant Radiologists at Raigmore Hospital, with improved technology facilitating remote and timeous electronic reporting of images.
For a copy of the Report please Click Here
