Community Anatomic Pathology in Auckland recently lost its histology accreditation. Photo: 123RF
Te Whatu Ora is moving to check the safety of hospital labs nationwide after staff at one in Auckland were exposed to toxic fumes, at others two caught typhoid and delays jeopardised patients' care.
An internal document shows the agency expects it will need a "comprehensive" fix to deal with "significant" risks.
Community Anatomic Pathology in Auckland lost its histology accreditation recently, partly over lab workers exposed to toxic chemical levels and patients waiting weeks for results.
"The overall state of the laboratories and the practises they have in place pose an inherited risk from the former DHB's [district health boards], and will likely need a comprehensive approach to addressing significant and/or ongoing risks," the central health agency said in an internal document.
"There is growing demand on our laboratories in terms of the volume of the work, which can put pressure on processes, and work is often undertaken in facilities that, over time, may have become not fit for purpose."
Two lab workers were hospitalised this year after having caught typhoid from samples, one at a private lab in Auckland, and a second at Canterbury Health Laboratories, CHL.
Seventy percent of hospital patients depend on labs delivering accurate test results; delays hold up treatment and can threaten accuracy.
Labs are also grappling with strikes, the now-omnipresent health staff shortages and IT problems.
The tech problems have pushed some lab upgrades back more than a year, creating a "nationally important risk", and an "extreme risk" for one, Crown-owned CHL, according to its latest risk register, for July, released under the OIA.
One landmark project is the Clinical Data Repository, due next June, to enable all labs to share test results for the first time, making it easier, safer and quicker for patients.
Te Whatu Ora did not respond to a question on if the repository would be ready by next June as scheduled.
The agency's Auckland lab woes included turnaround times of results that posed a "significant clinical risk to patient diagnosis and care"; formaldehyde levels in excess of recommended limits - it was also penalised for this in 2017; and a "significant risk" in how hazardous substances were handled.
Some of its workload has now been put onto other hard-pressed labs in the northern region and Waikato.
Following this, Te Whatu Ora has ordered health and safety checks at multiple labs in 18 health districts from Northland to Southern.
"The Board and Executive ... need a more detailed picture of the occupational health and health and safety risks present in our laboratories," said the assessment, aimed at any lab the agency owns or operates, but excluding third-party labs.
The checks will focus in part on ventilation and hazardous substance management - of the likes of formaldehyde - as well as training.
Staff shortages and growing demand loom large in the risk register.
Medical scientist and Apex union lab workers president Bryan Raill said staff shortages that created "duress" must be assessed alongside lab conditions, but Te Whatu Ora's approach "astonishingly" was not doing this.
"They're stepping out of the inertia they've been bound, so this is a good thing, but it needs to be a wider thing," Raill said.
"It's not only your physical environment, being safe there, but you have to be safe in terms of what you do."
The two typhoid infections were a red flag, Raill said.
One occurred in March at a lab run by leading private operator Awanui in Auckland, and one in May at CHL. RNZ approached Awanui for comment.
"They occurred in the context of an unusually high number of typhoid cases being imported into the country, meaning more samples were being processed by labs," Te Whatu Ora said.
Both were investigated and changes were made. "The investigations will be shared with all of our laboratory teams."
All laboratories either run or contracted by Te Whatu Ora must be accredited by IANZ. It is that accreditation, for histology, that has been suspended at Anatomic in Auckland.
In a statement late on Monday, Te Whatu Ora said risks were "complex and need to be tracked for extended periods while mitigations are identified and put in place".
At Community Anatomic Pathology, it had extra interim measures in place "to keep everyone safe", including breathing PPE.
"Te Whatu Ora is committed to identifying, tracking and mitigating all potential risks and issues within our service until they are fully resolved and no longer identifiable as an issue/risk," said the director for service strategy, planning and purchasing, Rachel Haggerty.
The Canterbury risk register showed a lack of pathologists, and growing demand, had both been "extreme" risks for two to three years.
The pressures were "reducing the time available for quality management and safety processes", increasing overtime, staff stress and sick leave.
Adding to the squeeze was Te Whatu Ora's financial practices: It did not let districts bill each other, so work that would have gone to private labs in one area, was now going to public labs elsewhere, and CHL found this was adding to workloads.
"This work is having to be performed within the existing budget," the risk register said.
It was important "to raise and track locally" the financial problems, Haggerty told RNZ.
"The impacts of new test, surgeries and medicines/treatments on pathology services have also historically not been understood well nor accounted for and we are considering a number of options as outlined in the risk register to manage this."
The Institute of Medical Laboratory Science warned the government months ago technicians were under "unsustainable pressure".
At the tech end, a lot of labs relied on health IT company, Sysmex, but there was a "major risk", Canterbury said.
"There is concern that Sysmex ... does not have sufficient resources to deliver the items currently requested by their customers in a timely manner," the register said.
"This impacts many laboratories in NZ."
Projects scheduled for early 2023 were being pushed into the second and third quarter of 2024. This required "national oversight".
A Sysmex platform underpins the national Clinical Data Repository.
Sysmex New Zealand said its services to Te Whatu Ora were confidential and commercially sensitive, and referred all questions to the agency.
The agency said there were delays to an IT platform at Canterbury used nationally as a laboratory information system, so the risk had been escalated.
"It would not be appropriate for us to comment on the mitigation of this for an external provider. This work is separate to work on a clinical results repository," Haggerty said.
The national repository work was ongoing, to expand the Sysmex éclair database that currently held Covid-19 test results.
At the Auckland lab, it had already improved turn-around times so the mean time was six days; in 98 percent of cases, results were sent out within 15 days and 90 percent in 10 days, Haggerty said.
They were addressing environmental conditions, meeting increased demand and making the service more sustainable, while coming up with a business case to move into a new fit-for-purpose site which was going through governance sign-off, she added.