Southern DHB report into endoscopy wait times released

Southern DHB has aligned its processes for accessing colonoscopies at Dunedin and Southland Hospitals since commissioning an external report into the Assessment of Diagnostic and Treatment Times for Endoscopic Cases.

It will also be undertaking a further review and investing in building stronger internal relationships to better handle cases where endoscopies are being requested, but standard criteria are not being met.

Chief Medical Officer Dr Nigel Millar says that the final version of report that was commissioned into the service raised important issues that need to be better understood.

The report, released today, looked at 20 cases, spanning several years, that had been selected for review due to concerns about their management. It found delays in diagnoses in 10 of these cases.

Dr Millar acknowledged these occurred in a context of many thousands of colonoscopies having been performed over this time period. 

Southern DHB has long met wait time targets for colonoscopies, for patients whose referrals are accepted in line with national criteria. However concerns were raised relating to some patients whose referrals did not meet national criteria, but where specialists believed a colonoscopy was necessary.

Since receiving the report in its draft form, the process for specialists to review cases where patients who did not meet the general criteria for colonoscopy, but believed such an exploration was warranted, has now been implemented at Southland Hospital, as it is in Dunedin.

A further review will look at 102 cases where questions have been raised around patients’ care pathways. These pathways will be examined against a control group of patients whose pathways were as expected.

“Any case of delayed care needs to be taken seriously. However, it is recognised that bowel symptoms, such as pain and bloating, are non-specific and in many people are not the result of gastrointestinal tumours.

Clearly, it is impractical to investigate everyone who presents with these symptoms, so additional risk factors are applied such as examination findings, the duration of symptoms, unexplained bleeding and results of blood or stool tests.”

“Unfortunately, there is always a possibility this misses some cases in people who are referred, but not accepted, for publicly funded colonoscopy.”

However widening access to colonoscopy, to investigate symptoms that have been shown to be less likely to be due to gastrointestinal tumours, has the unintended consequence of developing longer waiting lists, and delaying access to those patients with symptoms shown to be more likely to be associated with a cancer diagnosis, Dr Millar says.

“This is a challenging balance to strike, and we appreciate the sincere concern all clinicians experience, and have shared with us, in managing this.”

Dr Millar says this challenge is why it is so important that Southern DHB has joined the national bowel screening programme, and notes the participation rates in the South are among the highest in the country, particularly for Māori.

The programme has so far detected 80 cancers that would not otherwise have been detected, and polyps (precancerous lesions) in over 700 patients.

“This a critical step to reducing late-presentation cancers and gives us an important foundation to move forward from.”