Hospitals fined for breaching colonoscopy targets

From the beginning of this month, the HSE is “fining” all hospitals which fail to carry out urgent adult colonoscopies within 28 days. Maureen Browne reports.

Maureen Browne
Maureen Browne

A fixed charge of €750 per patient is being levied on all hospitals which fail to meet these targets.

“The hospital is still required to treat this patient urgently, or refer them to another public hospital,” Liam Woods, HSE Interim National Director Acute Hospital Services, said in a letter to all Hospital Group CEOs and Clinical Directors.

Mr. Woods said that given the clinical context, the new measures would not apply for paediatric services.

He said that there continued to be breaches of targets for urgent colonoscopy and there was a need to ensure a high level of responsiveness within Hospital Groups to reported retrospective and prospective breaches.

“We have also seen in many cases that urgent breach patients are not receiving To Come In (TCI) appointments for an additional 20 – 30 days after the target time, which is not an acceptable additional delay.

It is not adequate for the outcome of this discussion just to report a future TCI date for the breach patients(s)

“It is imperative that all Hospital Groups have a designated person that each week reviews the BIU report and immediately follows up with the hospital where there are actual or prospective breaches. It is not adequate for the outcome of this discussion just to report a future TCI date for the breach patients(s). Where a TCI date is greater than three days following the 28 day target Hospital Groups/Hospitals should be actively seeking to reschedule a routine appointment, identifying potential DNAs/cancellations so that the breach patient can be offered the free slot or assessing the potential of a referral to another public hospital.

“Prospective breaches should also be treated with the same degree or seriousness and urgency to ensure that within target time appointments are found.”

Mr. Woods sad that on further investigation with hospitals the HSE had found a range of issues associated with hospitals not adhering to waiting list management policies (e.g. DNAs X2, CNAs X2 and urgent bowel screen patients being included in reports). Some patients were being reported as breach when in some cases they were not. Hospital Groups should be reviewing with breach reporting hospitals, applications of the appropriate waiting list procedures.

He said that similarly the HSE had previously asked all hospitals to ensure that the threshold of patients identified as urgent was compliant with HIQA thresholds. It was important that Hospital Groups investigated if hospitals were applying the relevant urgent colonoscopy symptom profile to patients.

Said Mr. Woods: “It is absolutely critical that all breach events are reviewed to assess any potential patient harm that the delay may have caused. Where there is evidence that the delay may have contributed to patient harm this needs to be reported to the HSE in line with normal incident reporting.”

“I appreciate that there continues to be a rising referral demand for endoscopy and that there are other scoping demands on current capacity. We hope that the work of the National Endoscopy Working Group and the new Endoscopy Clinical Lead can assist in the near and medium term on such issues. However, it is important that Hospital Groups are highly involved and managing (potential) breaches as a day to day operational function.”