Report: Late diagnoses cost lives

Lives are being cut short because public hospitals are not diagnosing and treating people in time, a new health report shows.

The worrying trend emerged in the latest serious and sentinel events report published by the Health Quality and Safety Commission yesterday.

In Wellington, six patients faced delays in cancer diagnoses and treatment, with one waiting four years to start lung cancer treatment after a follow-up appointment was not booked.

The delay in the diagnosis of 17 New Zealanders in the past year prompted the commission to instruct all DHBs to review patient management systems and inter- departmental communication "in light of what appears to be a growing problem".

Capital & Coast District Health Board chief medical officer Geoff Robinson said the latest results had sparked an audit of all departments' processes when dealing with X-ray, biopsies and bloodtest results.

"With 700 doctors and 2800 nurses, all of whom order tests from time to time, it's a really major exercise to get this done."

The country's 20 district health boards reported 360 events for the year ending June 30. Almost 3 million people are treated in public hospitals each year.

The report covers all preventable incidents in which a patient was harmed or there was the potential for harm.

Public hospitals were forced to begin releasing details of such incidents in 2008, after a series of Official Information Act requests from The Dominion Post. They are now made public annually.

This year, the 20 DHBs were charged with making details of the events available on their websites.

The results show the number of falls in hospitals had dropped, but clinical management events, delayed treatment and suspected in-patient suicides had increased.

Not all events were preventable, but "many involved errors that should not have happened", commission chairman Professor Alan Merry said.

"In a modern healthcare system these events quite should not happen, yet DHB reporting suggests they are becoming more frequent." Suspected in-patient suicides had leapt from three in the previous year to 17, but did not appear to be an emerging trend. Most cases involved mental health patients, although two patients were in general wards.

Three mental health patients under the care of Capital & Coast killed themselves - the first since 2004.

Nationally, the number of falls, which accounted for almost half of all events, had declined for the first time since reporting began six years ago.

While this was a positive step, Prof Merry said too many people were still being harmed while receiving healthcare.

Capital & Coast chief executive Mary Bonner apologised for the 19 serious and sentinel events that happened in the past financial year.

" . . . each year in our district we undertake more than 425,000 patient appointments, procedures and operations - including more than 115,000 radiology procedures - almost all without adverse incident".

Contact Bronwyn Torrie
Health reporter
Twitter: @brontorrie

The Dominion Post