A review into how 13 cases of bowel cancer were missed following routine screening at Wexford General Hospital has found there were a number of missed opportunities in responding to the concerns of a staff member.
A report into the issue finds shortcomings in the performance of a clinician which were not identified in 2014.
Following the review, a new early warning system has now been implemented by the bowel screen programme.
The review was ordered after 615 patients had to be recalled which led to more than 400 patients being called for a repeat colonoscopy.
Thirteen cancers were detected as part of the process, including the case of one man who died before the review began.
A number of recommendations made by a Safety Incident Management Team are also being implemented.