Audit office reports 11-hour waits at A&E unit, new CT scanner not operating

The Audit Office on Thursday reported “prolonged” waiting times of up to 11 hours for patients at accident and emergency units, following an undercover inspection of the Nicosia and Limassol general hospitals.

It reported that the situation at the Nicosia general hospital was much slower than in Limassol, with average wait times reaching five hours and 15 minutes in the capital, compared to two hours and 49 minutes in Limassol.

The longest wait time, it said, was 11 hours and 28 minutes, recorded at the Nicosia general hospital.

It said that one exacerbating factor for wait times is that between 3am and 6am, “the specialist doctors on duty are informed about and provide services only for cases which are deemed to require immediate handling”.

For the remainder of cases, it said, specialist doctors are informed at 6am, with this state of affairs said to “leave patients in suspense and leave their relatives suffering”, with relatives “usually waiting outside the units until they are informed of how the patient will be managed”.

“Some cases are delayed simply because there is a disagreement between the clinical doctors regarding the question of to which speciality a case belongs,” the report said.

“Rightly, in our opinion, a mechanism for resolving disputes is being implemented, but this mechanism must be direct and not cause any delay. Disagreements between the responsible units should in no case cause a delay in the management of cases,” it said.

In addition to prolonged wait times, the audit office reported that in some cases, patients were being referred to wards and clinics from accident and emergency units by resident doctors rather than by specialist doctors, and with no communication with any specialist doctors reported before those decisions are made.

This practice, it said, “carries the risk of incorrect or incompletely documented clinical decisions”, and thus entails “a potential impact on the quality of services provided to patients”.

It pointed out that additionally, “in the event of legal proceedings”, a specialist doctor not being consulted for a referral “may expose” both the state health services organisation (Okypy) and the doctors involved to legal liability.

In a similar vein, the report stated that in one instance at the Limassol general hospital, the opinion of a neurosurgical specialist was required. The request was made  via fax from the Nicosia general hospital.

However, it said, this opinion was received “with a delay”, by which time the patient in question had “already been admitted for treatment to an Okypy hospital in the Nicosia district”.

It said it had raised the matter with Okypy, which had said that “neurosurgery is not a core speciality” – in short, that it would not be feasible for there to be a neurosurgeon present and available at all times at all hospitals.

This position was not directly disputed by the Audit Office, but it did state that “Okypy, in its response, did not provide the necessary evidence to substantiate” it, and that as such, “our service considers that the issue requires further examination from the health ministry”.

The report also stated that on the day workers from the Audit Office visited the Nicosia general hospital, it found that the accident and emergency unit’s CT scanner had broken.

As such, it said, patients requiring CT scans were transferred to a private hospital, but the agreement struck with that hospital “provides exclusively for the performance of examinations only, without the provision of a medical opinion”.

For this reason, the medical opinions were thus sought from Greece, as, even though there was a radiologist on duty at the Nicosia general hospital at the time, they “refused to provide services citing practical and medical reasons”.

It also pointed out that the CT scanner at the Nicosia general hospital had suffered “two consecutive failures in a short period of time”, which, it said, “raises questions regarding its maintenance”.

Additionally, it pointed out that a new CT scanner had been acquired by the hospital in June last year at a cost of €1.5 million plus value added tax, but was “not operational to date”.

It said the issue of the CT scanner also raised questions regarding the legislative framework regarding the matter of “telediagnosis”, given that the CT scans on the day were being examined by specialists in Greece, and that it found that there is no legislative framework at all regulating the matter.

On this front, it did note that the national e-health authority is currently in the process of preparing draft legislation.

The report also pointed out that medical opinions regarding x-rays were offered days after the scans had been taken at the Nicosia general hospital, “despite the fact that a radiologist was on call at the hospital at the time the x-rays were performed”, with patients often already having been discharged by the time opinions were offered.

“The delay in drawing up the opinions increases the risk of failure to promptly identify findings, with clear implications for patient safety and the traceability of clinical decisions,” it said.

It said Okypy had, following the Audit Office’s visit, “given instructions to terminate” this practice.