Radiology backlog a 'potential key risk' for trusts: CQC chief

CQC chief inspector Ted Baker told HSJ, the variety in hospitals’ performance on reviewing X-rays and scans was a “risk that has not been adequately managed in the past” and called for national standards to safeguard patients’ safety.

His comments came as the CQC today published a report which found wide variation in the speed with which trusts examine and report on radiology images.

Their review followed patients dying at Queen Alexandra Hospital in Portsmouth following missed cancers, and backlogs of thousands of unreported images at Worcester Royal Hospital and Kettering General Hospital.

Among the CQC’s findings were:

• Trusts’ own timescales for reporting radiological examinations from emergency departments varied from one hour at one trust to two days at another;
• In one area, a chest X-ray for a GP patient would be reported within two days at a trust, but it would take 10 days for its neighbour trusts to do the same;
• Reporting targets of routine referrals varied across trusts from seven days to three weeks; and
• The highest vacancy rate for radiologists at a trust was 65.2 per cent.

The review exposed serious backlogs at four trusts. These were:

• 33,400 unreported images at King’s College Hospital Foundation Trust; 
• 15,000 unreported images at Chelsea and Westminster Hospital FT;
• 8,700 unreported examinations at East Kent University Hospitals FT; and
• 8,300 unreported examinations Lewisham and Greenwich Trust.

Following the CQC’s review, these trusts have cleared or significantly reduced their backlogs.

All trusts with backlogs have been asked to carry out harm reviews, but no other incidents of harm to patients have been reported yet.

In the last five years, radiology use has grown by an estimated 16 per cent.

Professor Baker said the lack of national standards meant it was “very hard” for trusts to benchmark themselves and that there is a “lack of capacity” to report images.

“This risk has not been adequately managed in the past and this is an opportunity to move forward,” he said.

“Trust boards need to recognise this as a potentially key risk for them and make sure they’re taking the most effective (steps) to manage the risks in terms of delays in reporting.

“Each trust’s board needs to assess the situation in its own organisation, and asking questions about how the risk is prioritised, if its KPIs are out of line, and talk to clinicians to explore all approaches.”

He said the review team, which visited some of the trusts with high backlogs, got a “real sense” that “often it was left to radiology departments to manage the problem”, rather than the trust board.

Professor Baker said he was keen new standards were developed “as soon as they reasonably can be”.

More focus on trusts’ radiology reporting will also be applied by the regulator when it inspects trusts in the future.

Professor Baker acknowledged that staff shortages were a major cause of the “difficult problem”, which cannot be “solved overnight”.

The CQC’s review reported an average vacancy rate for radiologists of 14 per cent.

The Royal College of Radiologists said the report’s primary finding “is nothing new”, and warned backlogs would continue unless radiologist staffing was improved.

Its president, Dr Nicola Strickland, said the premise of national standards for the turnaround of imaging reports was “laudable”, but added maintaining high quality national standards “is another question”.

She called for trusts to publish their reporting workloads and backlogs on a weekly basis to ensure large backlogs are avoided.