Staff in Cork University Hospital were using ‘pre-signed blank referral cards’ to refer patients for medical radiological procedures despite not being designated to do so as part of their jobs, a HIQA inspection has found.
The report into ionising radiation facilities found that ‘significant numbers’ of these pre-signed referrals were used as part of a ‘blanket system’ for referring patients for imaging services in the orthopaedic out-patient department at the hospital.
“Inspectors saw evidence where these pre-signed cards were completed by individuals not recognised as referrers within the hospital,” the report said.
“In discussions with staff working in this department, it was clear that this issue was ongoing for several years and attempts to change legacy referral practices in this service were unsuccessful to date.”
The issue led to calls for management at CUH to submit an urgent compliance plan – to ensure the clear allocation of responsibility and effective communication for radiation protection, and to strengthen the involvement of medical physics experts in the facility.
The inspectors said that CUH management’s response ‘provided an assurance that the risk was adequately addressed’.
The inspection of radiation services at the hospital took place in July 2025. This included a review of compliance plans from previous inspections in 2020 and 2023. However, inspectors found that overall compliance with regulations around the use of ionising radiation had reduced since 2023.
“The report said: While measures had been implemented to address the findings of these previous inspections, not all achieved improvement in compliance.”
While the hospital had a radiation safety committee which was informed of any safety concerns and had responsibility for the protection of patients using radiation services, inspectors found that reporting pathways from the RSC to hospital management ‘needs to be strengthened’.
The report was one of 14 inspections of ionising radiation facilities across the country published by HIQA yesterday.
Among them was Tallaght University Hospital, where inspectors said that radiation safety governance and oversight needed to be strengthened.
“While there were governance and oversight structures in place, they were not sufficiently effective to identify issues with the allocation of responsibility detailed in radiation safety practice documentation,” the report said.
“The inconsistencies noted in the documentation viewed and the lack of evidence regarding the monitoring of compliance with the regulations indicated that governance, management and leadership structures in the area of radiation safety must be strengthened.”
A spokesperson for TUH said the hospital acknowledged HIQA’s findings. “A targeted improvement plan was put in place immediately after the inspection, with all actions due for completion by the end of Q1 2026. Over 75 per cent of the actions are complete, and we continue to prioritise the remaining work to ensure the highest standards of patient safety.”
As in previous inspection reports for some medical facilities, inspectors identified incident reporting as an area requiring further attention. Medical facilities are required to ensure that all potential incidents and near misses are identified, recorded, reviewed, analysed for patterns and reported in line with HIQA guidance.
Overall, however, high levels of compliance with regulations were found across several sites. Staff and management in several facilities, including the BreastCheck Group – Eccles Unit in Dublin 7, the Osteoporosis Scanning Centre in Castlebar, and Vhi Swiftcare Clinic Cork, demonstrated a strong commitment to radiation protection practices.
Affidea Waterford and Blackrock Health Blackrock Clinic used clinical audits effectively to support safe care, while Global Diagnostics Ireland and UPMC Aut Even Hospital Ltd. used radiation dose monitoring systems to help ensure patients receive the lowest dose necessary for accurate diagnosis.
University Hospital Galway also used dose monitoring systems and established diagnostic reference levels for radiotherapy planning scans, demonstrating a proactive approach to patient dose optimisation.
Where inspectors identified failings, facilities were required to submit a compliance plan outlining how they will come into compliance with regulations. In a statement HIQA said it ‘continues to engage with facilities where non-compliances are found’.
Original source: ie