Six-month wait for X-ray results at Sydney hospital amid health executive mismanagement
A backlog of more than 50,000 scans, mostly X-rays, at a Sydney hospital was the result of a record of failure by health executives who turned a blind eye.
Patients who had X-rays at a major Sydney hospital waited on average 131 days for the results amid a backlog of more than 50,000 scans, with health executives ignoring doctors’ concerns that patients could suffer as a result of the delays.
A damning report by the NSW Ombudsman has laid bare the Sydney Local Health District’s comprehensive mismanagement of a staffing crisis at Concord Hospital in Sydney’s inner west, with the radiology department critically underresourced.
X-ray scans would normally take just a day to process, but between 2019 and 2023 the backlog in hospital’s imaging department grew to the point that, at its peak, 40 per cent of the total scans were unreported. By 2023, a “significant number” dated back six months and a small number dated back several years.
One 92-year-old patient experienced a delayed cancer diagnosis as a result of the backlog, and one scan of a 13-year-old was not reported until a year after it had been taken, by which time the fractured had healed.
The ombudsman found that the SLHD’s management of the imaging backlog fell within the meaning of section 26(1) of the NSW Ombudsman Act, which triggers a report of the investigation. That section is reserved for conduct of the most serious kind.
“Based on the available evidence, I find that the conduct of the Sydney Local Health District in responding to and managing the increasing backlog of radiology studies at Concord Hospital radiology was unreasonable and wrong,” the ombudsman’s report says.
“The SLHD failed, over a protracted period of several years, to address ongoing and unreasonable delays in reporting radiology studies at Concord Hospital radiology.”
The report was triggered by a public interest disclosure lodged by the chair of Concord’s Medical Staff Council, Winston Cheung. Dr Cheung led an uprising by staff two years ago at the hospital when a vote of no confidence in then chief executive Teresa Anderson was passed, as anger reached boiling point over long-term underresourcing.
Documents obtained by The Australian reveal the concerns about resourcing at the hospital are ongoing, with urgent requests by the staff council for funding and equipment upgrades in several departments not actioned.
Among the most critical items are $8m a year for the commissioning of a second ICU to increase bed capacity and double ICU staffing, and $759,000 a year that was promised for a new ICU outreach service, both of which were outlined as critical priorities by the staff council but have not to date been funded.
The nephrology department is also still waiting for a requested $5m dialysis and renal unit refurbishment.
The radiology crisis at Concord highlights the way in which staff concerns and concerns for patients safety were repeatedly dismissed by health district executives, who failed to increase staffing even as the number of unreported scans reached the tens of thousands.
By mid-2023, patients were waiting on average 131 days for their scans to be reported.
Doctors who were concerned that the most critical scans be prioritised supported a plan by SLHD executives to report these scans first. But this plan was then overturned as executives decided to prioritise the backlogs instead.
The ombudsman found that the SLHD “did not have a process for systematically identifying and addressing the potential patient safety risks associated with the (scan) backlog until 2023”.
The report found that although the SLHD made continuous efforts to recruit radiologists between 2019 and 2023, its recruitment and retention rates during this period were lower than the state average and stronger intervention to manage the backlogs should have been actioned.
“Effective changes only took place after multiple resignations and external intervention,” the report says.
The SLHD said in its submissions to the ombudsman that there were only 14 adverse incidents out of the 50,178 unreported scans, which were all appropriately followed up and managed, and that the number of adverse incidents was within the general radiology error rate.
But the ombudsman said that “while the number of actual adverse incidents due to the backlog was relatively low, and certain actions, such as prioritising more complex imaging over X-rays, were put in place by the radiology department early on from 2020 to manage potential risks arising from delayed reporting, the SLHD only began systematically identifying and addressing potential patient safety risks associated with the backlog in 2023”.
The report said health executives did not take steps to fully understand or monitor the growing backlog of scans, did not develop targets for scan reporting or turnaround times, and no formal tracking of unreported scans was introduced until well into the backlog.
“It appears that radiology staff, at least, perceived this reporting to be less directed toward SLHD management taking responsibility for identifying, monitoring, and developing a strategy to address, the emerging backlog drivers, and more a means of monitoring the efforts of the already overworked radiology staff,” the report said.
By September 2024, the number of unreported scans had been reduced to 217 images older than four weeks after a crisis plan was implemented.
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