THE MANAGER of Letterkenny University Hospital has apologised to the women impacted by serious failings in the hospital’s gynaecology services following the publication of a damning report.
The review found women who suffered delayed cancer diagnosis were wrongly triaged and not booked in for follow up appointments in some cases. It identified that 38 women waited longer than 100 days for their diagnosis or treatment.
“It is clear that the experience for these women, and the service provided to them, was unsatisfactory. All cases, in one form or another, are typified by delay –delay from an urgent GP referral to a gynaecology outpatient appointment; from gynaecology outpatient appointment to urgent diagnostics, such as ultrasound or hysteroscopy; and/or from diagnostics to intervention,” the report stated.
“In some cases, there is evidence of incorrect triaging; evidence of not being correctly placed on the patient management system; and evidence of not being booked in for follow up outpatient appointments, diagnostics and/or interventions.
“Failure to communicate effectively was a common theme which underlined a number of incidents. In a case that illustrates the point, LUH attempted to contact a vulnerable patient, who did not attend outpatient appointments and a planned procedure, by phone multiple times and failed. LUH did not contact the referring GP”. This should have been done under national guidelines which led to a delayed diagnosis.
“LUH is beset with large and worsening waiting lists for both inpatient, day case and outpatient services, and there is evidence that insufficient effort is being made to improve the situation.”
The whistleblower who campaigned for the investigation, Letterkenny-born Dr Margaret MacMahon, said the review shows “shocking failings”.
“The review addresses clinical management and patient safety processes in the gynaecology service at LUH. It hasn’t provided us with information regarding any injury or harm to patients including death,” said Dr MacMahon.
“The investigator has discovered the shocking failings within the gynaecology service. It remains to be seen if the Irish Health Service is going to be able to comply with the recommendations as soon as possible.”
In a statement from Saolta this morning LUH Manager, Seán Murphy, said: “On behalf of LUH, I would like to apologise to women where the care provided to them fell short of the standards that they should expect. Over the last two weeks, we have contacted each of the patients or families where women with a diagnosis of endometrial cancer waited longer than 100 days for their diagnosis and treatment. We have offered to meet each of these women or their families and to date we have met many of them and provided them with a copy of the clinical review relevant to their own care. We have also provided them with a copy of Dr Price’s wider clinical review and we have committed to updating them on the improvements that we are continuing to put in place in the gynaecology service.
“The gynaecology team is fully committed to implementing the recommendations in this independent review and work has already begun on many of these recommendations. We will continue to work hard to make sure that we provide the safest possible gynaecological service to the women of Donegal.”
Tony Canavan, CEO of the Saolta University Health Care Group said, “I want to assure the community in Donegal that the team in the gynaecology department in LUH, with the full support of the hospital and Saolta Group management team are working very hard to improve the service provided at the hospital. The delays in accessing the gynaecology service experienced by some women with post-menopausal bleeding in LUH in the past are unacceptable and on behalf of both the Saolta Group and the hospital, I want to apologise to any woman or family impacted in any way by these delays.”
Dr Pat Nash, Saolta Group Chief Clinical Director said, “I commissioned this independent review of the service to determine the quality and safety of the gynaecological service at Letterkenny University Hospital and make recommendations to us so we can improve the service for the women attending the hospital. I want to assure the community in Donegal that we are committed to providing a safe and sustainable gynaecological cancer service and we have already begun implementing the recommendations in Dr Price’s review report. A Special Measures Team, comprising an external Consultant Obstetrician / Gynaecologist and Senior Manager from the Saolta Group have been on site in LUH since early July to support and oversee the implementation plan to address the recommendations in this report. This will ensure that clear pathways and processes are in place in LUH to ensure that all women presenting with possible endometrial cancer are seen, investigated and managed in a timely way to ensure the best outcome for them. In addition, we will be ensuring that a robust process is in place involving continuous audit and review of performance data which will provide assurance that all women are being managed safely within the appropriate timeframes.
“The hospital has restructured its processes for triaging patients and assigning appointments, additional staff have been approved and the recruitment process has commenced, an additional gynaecology clinic is taking place weekly, and work has begun on commissioning an additional dedicated maternity theatre.”
Professor John Morrison, Consultant Obstetrician and Gynaecologist and Clinical Director for Women’s and Children’s services across the Saolta Group added, “We are committed to putting the necessary measures in place in the gynaecology service in Letterkenny University Hospital to enable women in Donegal access necessary treatment within the appropriate timeframes. While many women have had very positive experiences and have been successfully treated by the team at the hospital who are highly trained and committed healthcare professionals – some women experienced unacceptable delays. Over the last year, we have been working very closely with our colleagues in the gynaecology service in LUH to support them to put the necessary measures in place to improve this service. We have now formally established an Implementation Team to drive the implementation of all of the recommendations and we hope that we can have input from some of the women whose care we reviewed into the implementation process.”
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