An Outdated System – “Running up a down escalator”

M. Kooblall, M. Okon, C. Mcateer, M. Anwar

Department of Medicine, Our Lady’s Hospital Navan



In this era of modern medicine, we accessed the majority of our medical investigations via a computerised system. At Our Lady’s Hospital Navan, tests that are processed externally cannot be accessed through the hospital computer laboratory system. These include histology reports, immunology reports, reports from the national virus reference laboratory among many others.

We audited 100 charts in the outpatients department where external tests had been ordered. The main aim of this audit  was to verify whether the official reports  were filed in the charts 8 weeks after they were ordered. It was shown that   30 (30%)  reports were not filed. Out these 30 unfiled reports, 2(6.6%)  were histology reports,  20 (66.7%) were immunology reports and 8(26.7%) were reports from the national virus reference laboratory.

Once an external report is received at Our Lady’s Hospital Navan, it  first goes to the laboratory department where  the report is authorised before it is  posted by internal post to the consultant that  ordered the test. After the consultant signed  the report, it is sent to the medical record department where it is filed in the chart by the secretarial staff. The main problem we found was that there was a big backlog in the medical record department to file these reports in the charts and this was due mainly  to a lack of secretarial  staff.

From our point of view, not having these reports in the charts can be  frustrating for both the doctors and the patients as it just delayed the  patient’s management plan. Looking back into those 30 unfiled reports, it took the doctor on average 15  extra minutes to try trace those reports. This time could have been used more wisely if all those reports were available on the computer and would not have the domino effect in delaying the clinic timetable and therefore delaying doctors to attend to their more important duties.

If all the external reports could be  uploaded on  the system  when they reach the lab, doctors will be able to save time thereby  dedicating their time to  more patients.

A request has been sent to the hospital management to update our laboratory system so as all the external reports could be accessed on the laboratory computerised system which will enable us to work more efficiently.

Not being able to access a result just because the report got delayed to get filed is unacceptable. Any crucial health information should be available to staff at the touch of a button. In England a report by PwC suggests a potential £4.4bn could be put back into the NHS by using better use of information and technology1.

Reflecting on this audit, we should encourage   to bring our own systems into the digital age where  clinicians can take advantage of the game-changing opportunities on offer to improve outcomes for patients.



Minesh Kooblall
Department of Medicine,
Our Lady’s Hospital,
Email: [email protected]



  1. (accessed 5 May 2018)