- Patients not offered follow-ups within six months dropped off waiting list
- Validation exercise has revealed no harm but some patients recalled
- Similar IT system feature may be present elsewhere
- Trust also reviewing its elective care data systems and training
A trust has had to re-examine the cases of more than 31,000 patients after they were automatically and wrongly discharged from its care because they did not have another appointment within the next six months.
Dartford and Gravesham Trust in Kent has revealed that soaring waiting times post-covid meant patients who needed follow-up appointments were not offered them within six months, which before covid was a very unusual occurrence.
When they passed six months, they were dropped off waiting lists altogether, due to a feature in the trust’s patient administration system designed to ensure outdated pathways are closed. It is a common feature in many such systems, HSJ was told.
The problem was discovered when the medical director was alerted to two haematology patients who had not received follow-up appointments when they expected one.
The trust has now “validated” more than 31,000 patients who have been in contact with it since 1 September 2021. So far, it said, it had not found evidence of harm, although some people have been recalled for clinical review or investigation, and a small number are still to be seen.
Many of the 31,000 had originally been told they would be offered a follow-up appointment, but this was never booked and they were automatically discharged.
In haematology, where the issue was first spotted, 1,211 patients were identified as “lost to follow-up” and 116 needed either a full clinical review or further investigations. Just 26 remain to be seen with no harm identified in the others. However, a separate review is looking at three cases — including two where patients with abnormal protein went onto develop myeloma, a cancer of blood cells.
In other specialties, small numbers of patients have required further appointments – for example, 44 in trauma and orthopaedics and 12 from paediatrics — but no harm has been found.
A paper to this month’s board said the trust’s policy on when to start and stop the “clock” on elective referral to treatment patients had not matched “best practice”, and had been changed to adopted a Kent and Medway-wide policy, with a new follow-up waiting list being rolled out across its divisions by October.
But it has also commissioned a review by the South Central and West Commissioning Support Unit of demands on its business intelligence unit, and is taking other steps to improve data quality, with additional training on referral-to-treatment time recording and improvements to data assurance and governance.
The board was originally alerted to the problem last year when a paper to a closed meeting – which has now been shared with HSJ – highlighted a “lack of consistent processes and functions across the trust in managing patients’ 18 week pathways and follow up appointments”.
It added that the trust had not established a consistent way of tracking follow-up patients, which should have been put in place in 2008 when the 18-week target was first introduced.
Source
Board papers, information from trust
Source Date
Augist 2023 and April 2022
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