CUH submits compliance plan amid HIQA concerns over radiological referrals

Cork University Hospital had to submit an urgent compliance plan to the Health Information and Quality Authority (HIQA) after an inspection discovered that medical radiological procedures took place without an appropriate referral.

Overall, CUH was found compliant in four areas, substantially compliant in seven and not compliant in three in a recent Hiqa assessment of compliance with medical exposure to ionising radiation regulations.

A key issue raised by inspectors was around referrals for radiology procedures, with medical radiological procedures having been carried out in the absence of a referral from a recognised referrer.

In the radiotherapy department, referrals were only accepted from appropriately registered medical practitioners, and from radiation therapists for image guided radiation therapy (IGRT) exposures.

However, in a sub-set speciality area, inspectors saw evidence of non-compliance with this regulation. A blanket system for referring patients for medical radiological procedures in the orthopaedic out-patient department was applied in which inspectors viewed significant numbers of pre-signed blank referral cards.

In addition, inspectors saw evidence where these pre-signed cards were completed by individuals not recognised as referrers within the hospital.

In discussions with staff working in this department, it was clear that this issue was ongoing for several years and attempts to change legacy referral practices in this service had been unsuccessful.

Inspectors also discovered that in some cases, practitioners entered the procedures on the system for radiology procedures retrospectively, after the procedures had been done, meaning no appropriate referral had been made prior to the procedures.

Under this regulation, the hospital was required to submit an urgent compliance plan, and Hiqa said that their response “provided assurance that the risk was adequately addressed”.

The hospital told Hiqa after the inspection that all referrals were now provided by a recognised referrer, and that the practice of retrospective referrals had ceased and was “no longer accepted”.