CT discrepancies found, patients being informed

As of Friday, St. Joseph's General Hospital and the Vancouver Island Health Authority have found 24 "significant discrepancies" in the 1,313 CT scans reviewed so far.

 

As of Friday, St. Joseph’s General Hospital and the Vancouver Island Health Authority have found 24 “significant discrepancies” in the 1,313 CT scans reviewed so far.

In conjunction with a provincewide review of the quality of medical scans in B.C., St. Joseph’s, in partnership with VIHA, is in the process of re-reading up to 2,723 CT scans analyzed by Dr. Jose Zanbilowicz between April 2009 and January 2011.

Of the 1,313 scans categorized so far, they have found 24 significant discrepancies and will follow up with each of these patients and their physicians, according to a news release from the Ministry of Health Services.

“While there is no indication of a pattern of concern for X-rays, mammography or ultrasounds, a quality-assurance review will be done to ensure they were read correctly,” it stated.

Patients who do not receive a letter or telephone call can be reassured they are not affected by this review, according to the ministry.

Zanbilowicz had also worked on a temporary basis at the Dawson Creek Hospital in June 2010.

The Northern Health Authority has reviewed 100 CT scans read by Zanbilowicz. The health authority found six significant discrepancies and is following up with each of these patients and their physicians.

The update into the investigation came at the same time as the Ministry of Health Services announced that Dr. Doug Cochrane has completed the first phase of his review into the quality of medical scans in B.C.

The first phase concludes that all physicians currently providing medical scan interpretation in the province are appropriately qualified and licensed.

However, the report recommends that a new peer review approach will help better support individual radiologists, improve quality and strengthen public confidence, according to the ministry.

Last month, Health Services Minister Colin Hansen appointed Cochrane, the chair of the BC Patient Safety and Quality Council, to lead an independent two-part investigation, focusing first on a review of the credentials of all radiologists working in B.C.

“Based on my initial work, I am confident the 287 physicians currently providing diagnostic imaging services are appropriately licensed,” said Cochrane. “However, to ensure the quality of their work, medical staff need opportunities to upgrade their skills as diagnostic technology evolves, and they need the support of colleagues through a structured, rigorous review of their work on an ongoing basis to ensure high-quality patient care.”

Specifically, Cochrane recommends that:

• The Ministry of Health Services implement a provincewide peer review system for diagnostic imaging on a phased-in basis — where a proportion of medical scans initially read by each radiologist in a health authority would be re-read by another radiologist, with any discrepancies reported to both the health authority and their board.

• The College of Physicians and Surgeons of BC immediately implement retrospective peer reviews, focusing on hospitals identified by health authorities where radiologists may have been operating without peer support and review.

• The College’s Diagnostic Accreditation Program initiate medical reviews to assess the quality of physicians reporting in any facility that houses a CT scanner or MRI in B.C. if this has not taken place as part of the accreditation process.

• Health authority boards instruct their medical advisory committees to include regular in-depth performance reviews as part of their appointment processes for medical staff.

Cochrane said that since his review was launched Feb. 11, health authorities identified concerns with the quality of medial scans performed by two additional licensed and credentialed radiologists — Zanbilowicz and a locum radiologist temporarily practising in the Fraser Valley in 2009 and 2010 — bringing the total number of physicians involved to four.

Reviews of their work continue.

The second part of the review will include a comprehensive fact framework of the known incidents, analysis of the response by health authorities when they learned of the issue, a review of the health authority physician credentialing and privileges — including the role played by the College of Physicians and Surgeons of BC  — and any further issues identified during the course of the review, according to the release.

Cochrane’s full report is available at:

www.health.gov.bc.ca/library/publications/year/2011/cochrane-phase1-report.pdf.