- Number of patients recalled has continued to climb
- Ten serious issues declared
- Biochemistry accreditation suspended over multiple issues
The Royal College of Pathologists has been called in to review a merged pathology service which has had to recall thousands of patients for repeat blood tests.
The North Kent Pathology Service, which carries out work for both Dartford and Gravesham Trust and Medway Foundation Trust, has recalled 3,292 patients since June 2018 when non-urgent blood services were centralised.
Of those recalled, 2,420 patients have been retested, and a harm review covering all recalled patients is underway.
Approval for an external review by the Royal College of Pathologists was given in September, although its terms of reference are still under discussion. NKPS said the terms needed to take account of the changes in governance which had already taken place to ensure it gave “maximum value”.
In September, HSJ reported that nearly 2,500 patients had been recalled due to samples being kept for too long or being rejected.
But documents released under the Freedom of Information Act reveal the problems have continued and the number of patients recalled has continued to climb. In particular, the documents show:
- The Darent Valley laboratory site – which processes routine samples from Medway and Swale as well as the Dartford area – had its biochemistry accreditation with the UK Accreditation Service suspended in October when 23 issues were found. The service has continued to be delivered from the laboratory and a follow-up assessment is expected;
- In January, 99 blood and urine samples requiring a specialist test which potentially reveals serious diseases were not processed and the samples had not been saved, meaning patients had to be recalled for repeat tests;
- Immunology tests were not sent directly to GP IT systems, although they could be seen on a different system. Over a period of six months last year, 6,792 test results had not been reported through the GP system, and it is now been proposed to send lists of these results to GPs;
- In the first week of February, 178 samples were not unpacked on the day they arrived and nine had to be rejected. Four others were abnormal, possibly due to the delay, and were also rejected;
- 304 patients had to be retested for B12 deficiency after the laboratory ran out of B12 reagent in October and failed to make safe the samples so they could be tested when supplies were received. This followed an earlier problem with B12/folate testing, where 1,663 patients had to be recalled; and
- 17 test results which could indicate acute kidney injury were not reported to GPs speedily because automated telephone systems were not set up correctly.
In total, there have been 10 serious incidents declared with nine closed after corrective action was put in place.
In a statement, NKPS said: “The review process, which was signed off by an assurance board, is focused on those groups considered to be at higher risk based on the requested test and patients are at different points in the process, at this stage it is not possible to give detailed figures on the completed reviews and their outcome.”
The news comes as the wider Kent and Medway area considers reorganising its pathology services.
Information obtained by HSJ