Audit reveals major failures of colonoscopy service in Otago, Southland

Prolonged delays for patients requiring colonoscopy, interservice state of war and stress for clinicians requiring trauma counseling.

These are among the points addressed in an overwhelming external audit of colonoscopy services and delays in treating bowel cancer at the Southern District Health Board (SDHB). The SDHB ordered the audit after several years of complaints.

Written by Doctors Phil Bagshaw and Steven Ding, Doctors of Christchurch, the audit revealed serious problems in controlling bowel cancer and dysfunctional relationships between clinicians – a problem that is known but impossible to resolve by management.

"The SDHB have lost the war in the fight against bowel cancer and must take responsibility for acting to turn the tide," Bagshaw said Friday. "We have made constructive recommendations on how to solve problems and we expect everyone to do their best to follow them."

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Health data showed that SDHB, covering Otago and Southland, had one of the highest rates of bowel cancer in the country, one of the highest rates of spread beyond the intestine at the time of treatment and one of the highest rates of emergency gut surgery. cancer and one of the lowest colonoscopy rates, said the audit.

The auditors examined 20 patient cases for the report. One patient, a 71-year-old woman, waited three and a half years for a colonoscopy that revealed a rectal tumor. She was removed from the waiting list and received treatment only after being redirected.

Another patient whose symptoms, including unexplained rectal bleeding, met the badessment criteria should have undergone colonoscopy within six weeks, the auditors said. Instead, she waited 10 months to get a diagnosis.

The auditors found that the fight against bowel cancer posed serious problems for the SDHB population and that the lack of available resources seemed to be a major obstacle for the SDHB in terms of capacity to solve these problems.

The report also provides a picture of the deteriorating relationship between clinicians at Southland Hospital and staff at the Dunedin Hospital gastroenterology department.

According to the report, there was a state of inter-service warfare, as well as dysfunctional relationships within the gastroenterology department and with other hospital services. Serious personnel conflicts could affect recruitment, the auditors said.

"Relationships with the surgical and medical departments at Southland Hospital have been particularly tense and there is an urgent need to provide counseling services to some of the staff involved," the report said.

"Most of those surveyed showed signs of distress and some were on the verge of tears."

The report's authors recommended that SDHB create an organizational plan to reverse unwanted performance and, if necessary, advocate for additional resources. If progress was unsatisfactory over the course of a year, the auditors recommended considering a separate endoscopy service for Southland Hospital.

ANOTHER OPINION COMING SOON

A preliminary version of the report, published Things Under the Official Information Act, it had 203 pages and its annexes, but the SDHB decided to delete it when it released the final version on Friday.

In a statement accompanying this publication, the health council said that since the release of the report, it had aligned its colonoscopy access procedures in Dunedin and Southland hospitals. He planned to undertake another examination. This would involve an additional 102 cases where questions had been raised about a patient's treatment.

Melissa Vining, Southland man's wife, Blair Vining, a patient with terminal bowel cancer defending a national cancer agency, has been questioned about the need for a new review when the audit had clearly identified problems.

"I think it's time to stop watching and moving on to action."

Vining said it wanted the SDHB to adopt the recommendations made during the audit. The current guidelines for colonoscopy were too strict and meant that the cancer was detected too late.

"We think that being denied a colonoscopy is catastrophic for the people of the South, because many people suffer."

It was not just a southern issue, she said. "It's an underlying problem made up of 20 DHBs who all do their own work and do not have a single central point of leadership, which creates disparity of care for all New Zealanders. "

Dr. Nigel Millar, SDHB Medical Services Officer, said the audit raised important issues that needed to be better understood. Of the 20 cases selected for audit, delays in diagnosis were noted in 10 cases. Millar said that this had occurred as part of several thousand colonoscopies during the same period.

Since the report was received, the process by which specialists have examined cases in which patients who do not meet the general criteria for colonoscopy, but who believe that such exploration was warranted, was implemented at Southland Hospital. as in Dunedin.

Millar said finding a difficult balance was a challenge, as expanding access to colonoscopy to look for symptoms less likely to be due to tumors had the consequence unexpectedly to develop longer waiting lists.

"Any case of delayed care should be taken seriously, however, it is recognized that intestinal symptoms, such as pain and bloating, are not specific and that, in many people, they do not result from gastrointestinal tumors. -intestinales. "

The SDHB has joined the national gut screening program, said Millar, and participation rates in the south of the country are among the highest in the country, especially for Maori. The program had so far detected 80 cancers that would otherwise have not been detected.

"This is a crucial step in reducing late-onset cancers and provides us with an important foundation for moving forward."

This week was hot for the SDHB, who also participated in a coronial survey on the death of a 2-year-old child. The toddler had been taken to Dunedin Hospital twice in two days but died one day after his release. Millar said during the investigation that the toddler would not have to be sent home.