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Management of referrals for specialist urological services (09HDC01040)

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(09HDC01040, 23 April 2010)

Provincial hospital ~ District health board ~ Urology services ~ Referral triaging ~ Arranging tests and appointments ~ Sharing information ~ Standard of care ~ Complaint handling ~ Rights 4(1), 4(5), 10(3)

The friend of a 79-year-old woman complained about delays in arranging specialist urological services in a provincial hospital. The woman attended the hospital's emergency department (ED) with urinary retention, and the following day she was referred to the urology service. She returned to ED seven times the following month with retention or catheter problems. Further referrals were made to the urology service. The next month the woman was seen by a visiting urologist from the DHB's contracted provider of non-acute urology services. The urologist did not have two of the three referrals, ED records, or the results of tests that should have been carried out prior to the appointment. Arrangements were made for a review in five months' time. The woman continued to have problems and arrangements were eventually made to bring forward the follow-up appointment. Tests following this appointment confirmed that the woman had aggressive and advanced bladder cancer. She died three and a half months later.

It was held that the DHB's systems for ensuring timely access to specialist urology care were not adequate. There were deficiencies in relation to referral triaging, arranging appointments and necessary tests, and ensuring providers had access to relevant information when needed. The delay in diagnosis and treatment is unlikely to have changed the outcome for the patient, but earlier intervention may have reduced her suffering. The patient's friend had also complained to the DHB about the delay. The DHB took four and a half months to respond to the complaint, and its response did not reflect a fair investigation of his concerns. The DHB was found in breach of Rights 4(1), 4(5) and 10(3).