Pathology Department

Transcription

1 Pathology Department Page 1 of 46 North Devon District Hospital Pathology Department Report of the NDHT User Satisfaction ((Conductted iin February 2013))

2 Pathology Department Page 2 of 46 CONTENTS 0 INTRODUCTION AIM AND OBJECTIVES STANDARDS METHOD RESPONSES TO SURVEY QUESTIONS CONSIDERING HOW WE COMMUNICATE WITH YOU: HOW SATISFIED ARE YOU WITH THE WAY IN WHICH YOU CURRENTLY REQUEST PATHOLOGY INVESTIGATIONS? DOES THE CURRENT RANGE OF AVAILABLE PATHOLOGY TESTS & INVESTIGATIONS MEET YOUR NEEDS AND REQUIREMENTS? HOW SATISFIED ARE YOU WITH THE WAY WE REPORT PATHOLOGY RESULTS? WHERE PATHOLOGY RESULTS AND REPORTS INCLUDE ADDITIONAL ADVICE AND INTERPRETIVE COMMENTS, HOW CLEAR, HELPFUL AND RELIABLE DO YOU CONSIDER THESE TO BE? HOW SATISFIED ARE YOU WITH PATHOLOGY RESULT TURNAROUND TIMES? IN YOUR OPINION, SHOULD LABORATORY STAFF PROCEED TO FURTHER RELEVANT INVESTIGATIONS ON THE SAMPLE(S) PROVIDED IF PRELIMINARY TEST RESULTS ARE ABNORMAL OR UNEXPECTED? IN YOUR OPINION, SHOULD LABORATORY STAFF NOT ANALYSE SOME REQUESTED TESTS IF THEY ARE THOUGHT TO BE CLINICALLY INAPPROPRIATE? HOW SATISFIED ARE YOU WITH THE OUT OF HOURS (ON-CALL) SERVICE? HOW SATISFIED ARE YOU WITH THE SUPPORT FROM THE POINT OF CARE TESTING TEAM? HOW SATISFIED ARE YOU WITH THE ANDROLOGY (SEMEN POST VASECTOMY & INFERTILITY) SERVICE? WHAT WOULD YOU CONSIDER TO BE THE BEST & WORST ELEMENTS OF THE PATHOLOGY SERVICE AND WHY? HOW SATISFIED ARE YOU OVERALL WITH THE NORTH DEVON PATHOLOGY SERVICE? PLEASE MAKE ANY FURTHER SUGGESTIONS AS TO HOW WE COULD IMPROVE THE PATHOLOGY SERVICE:- (LABORATORY RESPONSES ARE SHOWN IN BLUE ITALICS) Acknowledgements The Pathology Management Team is grateful for the help and support of John Jarvis and the NDHT Clinical Audit Department. Thanks also go to Ruth Teague and the Specimen Reception Team of the Pathology Department for help with distributing the questionnaires.

3 Pathology Department Page 3 of 46 0 INTRODUCTION The Pathology Department complies with the Standards for the Medical Laboratory issued by Clinical Pathology Accreditation Ltd. The standards A2 and H2 set requirements that the laboratory management shall determine the needs and requirements of its users and assess their level of user satisfaction on a regular basis. This survey has been performed to comply with these standards, and in doing so, will bring to the attention of laboratory management areas where we could improve the Pathology service. 1.0 AIM AND OBJECTIVES The purpose of the survey was to assess the level of satisfaction of NDHT staff, (from the northern locality only), with the overall Pathology Service by responding to specific questions. The information gained through this exercise will enable the laboratory management team to look at the service we provide and decide how to improve it to meet the needs and requirements of our users, as part of our commitment to continually improve quality. 2.0 STANDARDS Clinical pathology Accreditation Standards for the Medical Laboratory v2.02, A2 and H METHOD A four page questionnaire was designed to elicit NDHT users views about the Pathology Service at North Devon District Hospital. The questionnaire is available in Q-Pulse (Q- SURVEY-7). Approximately 247 individually addressed surveys were sent out to a variety of grades of staff (consultants, nurses, trainee doctors healthcare assistants etc.), based at the North Devon District Hospital and community hospitals in the northern locality. A further 40 copies of the survey were also placed (i) on the counter in the NDHT library and (ii) in the communal area of the Medical Education Centre. In total, 317 paper surveys were distributed.

4 Pathology Department Page 4 of 46 There were 63 returns (20%), and the categories of staff were as follows: The largest group, nursing, comprised the following:

5 Pathology Department Page 5 of 46 All questions with a score were scored in the range 1 = very dissatisfied to 10 = very satsified. The charts below represent the results (actual totals of each score) for the total sample and then a comparison between the two largest categories; medical staff (Consultants, Trainee Doctors and GPs) and nursing staff. These two categories accounted for 56 (89%) of the. As the scoring sample varied in size for these groups, comparisons between the two groups are expressed as a percentage. All comments are reported verbatim apart from the anonymisation of names.

6 Pathology Department Page 6 of Responses to Questions 1. Considering how we communicate with you:- By telephone (for clinical and technical advice) Face to face (visiting the lab, teaching sessions etc) (general queries) Non-urgent clinical advice service ndht.pathologynddh@nhs.net How satisfied are you overall with these communication systems? scoring 61 No data 1 Not used 1

7 Pathology Department Page 7 of 46 Comments: (Laboratory are shown in blue italics) Positive Neutral I mostly deal with histo/cytol Service- very good Ever since I started in 2006, your team has always responded excellently in every all times Have not used it Some of the staff can be reluctant to help at times. I do not think you advertise "advice" time to staff. See laboratory response below. Negative Terrible on the phone. Rude. Will not help at all ever. Very unhelpful. We have received many positive comments relating to communication. However we would encourage you to report any incidence of bad telephone manner to a laboratory manager. Contact numbers can be found here: Numbers Some cultures/swabs take longer than 48 hours. Most of the turn around time for microbiological specimens is fixed by how long bacteria take to grow. We are looking at how we can reduce the time taken to begin processing specimens after they have been taken from the patient - and have already seen some significant improvements in blood culture results. Usually communication is OK. But have had incidence where they have been very curt & almost rude. Even when I explained I was not the person they needed to consult. See laboratory response below INR results. Phone through is better than fax as these can be missed or very late. The pathology department is no longer responsible for issuing Warfarin doses associated with INR results this is now managed by the NDDH Pharmacy. The NDDH Medicines policy states that any drug prescriptions must be in hardcopy format, this is why we used to FAX these results to community hospitals. I did the Head of Department + Transfusion re. our opening on Easter Mon- unfortunately none of the on-call staff were informed. We apologise for the times when the quality of service you receive is not good enough in relation to telephone enquiries. We would encourage you to report instances of poor telephone manner to any of the laboratory managers. This way we can investigate the incident close to when it occurred. We are also considering the creation of a single Pathology Helpdesk telephone number with a dedicated member of staff to initially take all calls to the department during the day, Monday to Friday. This could release pathology staff from answering the phone leaving them to continue processing specimens and improve telephone manner.

8 Pathology Department Page 8 of Considering the information we provide for you, e.g. Pathology Newsletters (Testing Times) and the Pathology Handbook (found on the Trust s website at ) How satisfied are you overall with this information? scoring 59 No data 2 Not used 1 Not able to comment 1

9 Pathology Department Page 9 of 46 Comments: (Laboratory are shown in blue italics) Positive Neutral Negative Testing Times is a useful innovation. I have never made use of the handbook It s OK. But don t use very often at all. I will go & have a look at now Have never used these items Honestly I never look at it Terrible, not useful. 10 top points bit long to read. We would prefer to have a hand book, for tests not on BOB!! We agree that the format of the handbook is not very user friendly. We will improve the layout of the front page of the Pathology Handbook (available from BOB at ) so that it includes links to all blood and non-blood specimen collection guides (tests), turnaround times and reference ranges. This is the information you say you use the most but that it is currently difficult to find. We are reluctant to provide paper copies of the handbook as they go out of date very quickly.

10 s Northern Devon Healthcare NHS Trust Pathology Department Page 10 of How satisfied are you with the way in which you currently request Pathology investigations? a. Design of request forms: se n o p R e scoring 63

11 Pathology Department Page 11 of 46 b. Requesting urgent tests:- scoring Not applicable 47 16

12 Pathology Department Page 12 of 46 c. Add-on requesting:- scoring 48 No data 2 Not applicable Not sure what this is 12 1

13 Pathology Department Page 13 of 46 d. Labelling specimens scoring 55 No data 2 Not applicable No comment 5 1

14 Pathology Department Page 14 of 46 Comments in relation to question 3: (Laboratory are shown in blue italics) Positive: Request forms much better Often when requesting Triglycerides on fasting sample for some reason didn t get done even though patient has fasted. The score is probably not where I would place it, would be higher but wanted to make this comment We would appreciate any such incidence to be brought to our attention so we can investigate. We accept that there may be occasions when some details are missed when entering them into the computer system. By informing us when it has happened we can work to reduce such incidents. We have reminded staff to take extra care when entering fasting information in to the computer system following this comment. It would be easier to stick a label on the specimens from ward level The only labels in general use in the N.D.D.H. and northern community hospitals are PAS labels which are too large for our blood tubes and designed for paper documentation only. When used on blood tubes they cause our analytical equipment to jam and the automatic de-capping machine to fail, creating delays in processing specimens - so we really cannot accept these. Negative: When the Trust s new Electronic Patient Record (EPR) is introduced it is envisaged that correct sized specimen labels and printers will we installed allowing specimen labels to be generated from the EPR that can be attached to blood tubes. The space is quite small to write on Unfortunately we have no influence over the design of the blood tube labels, however, see comment above second paragraph. Very difficult and often time consuming if multiple bottles used. Difficult to write on some bottles. Please see comments above. Bottle spaces too small to write clearly-should be able to use labels. Please see comments above. Not always enough room on micro form under specimens. Please see comments above.out of hours requests are sometimes questioned unnecessarily if a consultant/doctor have decided it is necessary according to clinical condition it should be done (obviously within reason).many of the tests available during the out of hours period have been agreed by Pathology Consultants and the on-call staff have been instructed to follow these protocols. We would encourage you to discuss the range of tests available during the on-call periods with our Pathology Consultants. Contact numbers are available here: Numbers Microforms for virology OK but dates difficult as we keep to send out later. Addon tests, very polite say done but we don t always get results. Labelling- no give even when a valid reason e.g. No NHS no! Unless the specimen is unrepeatable we regret that we are unable to be lenient with specimen labelling errors. We do have a list of certain exclusions for situations where NHS numbers are not available, e.g. Occupational Health requests for staff who have just started employment in the UK. The Quality Manager monitors rejected specimens on a daily basis to ensure that inappropriate rejections are not made.

15 Pathology Department Page 15 of 46 Need sticky labels! Please see comments above. A lot of chasing urgent test, porters hard to locate. Very time consuming to keep checking to see if results available. Our turnaround times have been praised by external assessment bodies but they do not include the time taken for porters to transport specimens from their origin to Pathology. Audit has shown this to be on average an additional 25 minutes this can be longer if porters have other urgent tasks to do as well as getting specimens to the lab. Ideally, an air tube transport system would dramatically increase the overall TAT for most tests; however this idea has not been taken up by the Trust. Specimen bottles too small to write info in. It would be better to have printed labels like GP surgery use. Please see comments above. Miss the reverse of the old form specifying the bottle colours and number of tubes needed. We took the decision to remove the information on the back of request forms as it quickly went out of date and was then misleading. When finished, new front page of the pathology handbook should help you find test information quickly. It would be good if the GP surgeries were contacted not chemo unit. When requesting add-ons it is time-consuming when asked to produce another form for this request. Please see comments below. Poor, not user friendly. Terrible. Add-on requesting is ridiculous. Let us ring you and don't be so rude when we do ring you. Please see comments above and below. Can be difficult to get through+timely Clumsy and archaic in the digital age! Forms do not include bone profile as tick box or urinary biochem. Limited space on the request forms has meant some tests are not included in tick box format, however, when we introduced the current biochemistry & haematology request forms during the winter of 2011/2012 we increased the number of tick boxes from 7 to 19. Would advocate add-ons by telephone only. Please see comments below. Could an be sent rather than another form? Please see comments below. Would be useful to ring up + add tests on Please see comments below. The new forms are more difficult to read- particularly the fasting slot. We have introduced a second version of the Biochemistry & Haematology request form where the Tick if Fasting box is now towards the bottom left instead of the top right of the forms. It is very unclear sometimes which bottles have to be hand written, a clear list would be helpful. Add on by phone please Spaces on bottles could be bigger ADD ON REQUESTS: We receive high numbers of add-on requests for tests on a daily basis. If each one were to be telephoned (or on-call staff bleeped) to add on non-urgent tests this would disrupt the flow of work for lab staff and lead to reduced turn-around times for urgent samples. Currently add-on tests are received by means of a separate request form. 90% of the add-on requests come from A/E and MAU.

16 Pathology Department Page 16 of 46 We are looking at three possible actions: (i) Introducing a Non-Urgent Add-on List for MAU and A/E so requesters can write their add-on tests on the list and send this to the lab at set times in the day/night, (ii) Introduction of a Pathology Helpdesk telephone line which could take add on tests by phone and (iii) Meeting with clinicians from A/E and MAU to discuss what is needed to deliver an acute service, coming up with an agreed way of delivering the pathology service in a timely fashion that benefits all sides. 4. Does the current range of available Pathology tests & investigations meet your needs and requirements? scoring Not applicable 60 3 Comments: (Laboratory are shown in blue italics) Negative I would like to see PSA + testosterone as tick boxes please see above

17 Pathology Department Page 17 of How satisfied are you with the way we report pathology results? a. The format of the paper reports:- scoring 60 Not 2 applicable No data 1

18 Pathology Department Page 18 of 46 b. Display of results on the computer system:- scoring Not applicable % Medical (24) 15 Nursing (23)

19 s Northern Devon Healthcare NHS Trust Pathology Department Page 19 of 46 c. Telephoning urgent results:- se n o p s R e scoring Not applicable No data % 20 Medical (24) 15 Nursing (22)

20 Pathology Department Page 20 of 46 d. High/low flags & reference ranges scoring 59 Not applicable 3 No data 1

21 Pathology Department Page 21 of 46 Comments in relation to question 5: (Laboratory are shown in blue italics) It is an onerous task for ward clerks to file results/duplication We agree that paper pathology result sheets are no longer fit for purpose in most cases and we have raised this at the highest level within the Trust, asking to stop printing blood test results. However as the Trust still has a paper based medical records system we have to keep printing paper results until the medical records system changes to electronic format. This should happen as part of the Electronic Health Record system implementation, currently in progress. Sometimes when we expect results to be put on the computer eg. Blood culture results & MRSA swabs it is longer than 48 hours. Some of the ranges are not neonatal. The Microbiology Dept is currently reorganising their working practices which will improve the turnaround times for blood culture & swab specimens, but where organisms are grown, it often takes longer than 48 hours to identify them. "We are unable to give out electronic interim microbiology reports due to limitations of the IT systems. Important interim reports are directly communicated to the clinical teams." Neonatal reference ranges We used to issue a lab comment when reference ranges were adjusted for age and/or sex, but this takes up more space on paper reports, producing multiple sheets of comments in many cases - national work is being done to harmonise reference ranges but very slow process. We are working to improve the information regarding neonatal reference ranges in the Pathology Handbook. Negative: Computer should report normal ranges for all results. RR are not always appropriate e.g. for some therapeutic drugs and this can be explained in result comments. Sometimes takes a phone call to get results verified so that they are displayed We appreciate that it can be frustrating for users to see the Results awaiting validation message, but with 5 million results issued each year, some will take longer than others to be released. An audit undertaken in July 2013 showed that 96% of biochemistry and Haematology results are validated and available to view within 10 minutes of the result becoming available. Virology not on NDDH difficult to get to Exeter results from BHC as they time out There are significant governance issues with transcribing results from other laboratories onto our computer system, and there have been significant harm events in the past from doing this. Part of the remit of the pathology modernisation process will be to ensure that there is an electronic method for pulling external results into the NDDH system. Computer system can be time consuming & sometimes hard to get a computer. Phone calls would be good for all urgent results. Where the lab has been informed in advance (by telephone) that a specimen needs to be processed urgently, these are fast-tracked through the laboratory and the results made available as soon as possible on the pathology computer system. Grossly unexpected abnormal results are always phoned. Because of the relatively high volumes of urgent specimens to process (all specimens from A/E, MAU, ICU, SCBU etc. are classed as urgent, along with approximately 30 adhoc urgent requests received each day from other sources), we have been advised in the past by Clinical Pathology Accreditation Ltd, to avoid phoning results unless absolutely necessary due to the increased risk of transcription errors.

22 Pathology Department Page 22 of 46 Micro/virology results not on computer system. Computer system obsolete and not intuitive. Paper results often not filed in notes. See previous. I hate the current PATH IT system-extremely clunky and non-intuitive - We agree. When the Trust s new Electronic Health Record (EHR) system is introduced, Pathology results will be displayed in a modern, Windows based application. It is not clear whether reference ranges are adult, paeds or neonate (adjusted) Some of them are (as far as I am aware) but not all and it is not clear if they are. Are paper results still necessary? IT presentation is difficult to navigate. See previous. Paper reports result in too much duplication of effort for in-patients. Computer system archaic. See previous. Although result is fast it is difficult to see if results go beyond 1 page, and a lot backwards + forwards searching required. Cumulative results difficult to read See previous. Spaces on bottles could be bigger See previous. As a ward manager and clinical practitioner I find the number of results on the ward requiring filing impractical for signing. They are often left on the ward or reach the ward (if patient has been moved) after the patient has been discharged or moved again See previous. Paper results are useless (understand used for audit trail but surely there should be a check box for the Drs to check as seen on the computer). Unnecessary waste or time + paper by ward clerks + Drs + are never/rarely used for results- computer always used. See previous. Paper reports seem pointless and can never be found once filed in notes. The current computer system is clunky and slow. See previous. Paper reports too many sheets! Not ecologically sound. See previous. Serology for?? micro and some other tests not available on the computer system, with the issues with filing makes it difficult to review results. See previous. Often get copies of the same result See previous.

23 Pathology Department Page 23 of Where pathology results and reports include additional advice and interpretive comments, how clear, helpful and reliable do you consider these to be? scoring 60 No data 3 Comments: (Laboratory are shown in blue italics) Negative Software awful See previous. Alert screen not always helpful The Laboratory Comments can contain various types of information some of which is clinical advice based on the results shown.

24 Pathology Department Page 24 of 46 Neutral These comments rarely add value to me How do you link to the websites Due to the old fashioned nature of the current laboratory computer system, it is not possible to add working hyperlinks to the results and laboratory comments. Where web addresses are given you have to manually transcribe this into a web browser address bar. 7. How satisfied are you with pathology result turnaround times? a. Routine test result turnaround times scoring 62 No data 1

25 Pathology Department Page 25 of 46 b. Urgent test result turnaround times scoring 51 No data 7 Not applicable 5

26 Pathology Department Page 26 of 46 c. On-call test turnaround times scoring 43 No data 8 Not applicable 12

27 Pathology Department Page 27 of 46 Comments in relation to question 7: (Laboratory are shown in blue italics) Positive Much improved since porters come around to collect samples Excellent Neutral Sometimes can wait for 2 hours (urgent test). See below. Urgent tests sometimes take days. Transport issues if test not in N Devon See below. Paed urgent/on-call results take too long. See below. Too slow during the day. See below. Two hours is a long time to wait to get an SBR back when we would get an immediate result if we had a ward bilirubinometer. For July 2013 the average TAT for Bilirubin tests from paediatric sources were:- Bassett Ward: 40 mins from receipt of specimen in lab C. Thorpe: 49 mins from receipt of specimen in lab SCBU: 58 mins from receipt of specimen in lab Previous audits have shown that transport to the lab adds, on average, 25 minutes. We are keen to explore with users ways of ensuring that the time taken to produce an important clinical result is as short as possible. Negative Also, sometimes we are waiting longer than 48 hours for blood cultures to come back if it is over the weekend so babies have an extra dose of IVAB + have to wait to go home. See response on page 21. Sometimes a delay in verifying (its often been done when we ring but not updated on computer). See previous response. Clotting can take a while + some micro tests seem to take forever + histology also seems to take a very long time. Micro result time is dependent on how long it takes to grow and identify a particular organism which can vary considerably. Histology specimens need to be fixed in formalin which will vary from a few hours for small biopsies to a couple of days for large resection specimens, before any microscopic interpretation can begin. Turnaround times (TATs) for any specimen are available on request and average TATs for all specimens are published in the pathology handbook: Pts frequently wait for routine results before discharge (+ TTA being written) therefore delaying discharges regularly. There have been no other reports of delayed patient discharges due to delayed in Pathology result reporting. Without specific examples we are unable to investigate this further. Urgent results should be phoned through when done rather than having to keep checking computer. See previous.

28 Pathology Department Page 28 of 46 Questions 8 and 9 relate to the following statement:- Referral of a patient s specimen to Pathology is a clinical consultation. With this in mind:- 8. In your opinion, should laboratory staff proceed to further relevant investigations on the sample(s) provided if preliminary test results are abnormal or unexpected? scoring 58 No data 3 Not applicable 1 Not sure 1

29 Pathology Department Page 29 of In your opinion, should laboratory staff not analyse some requested tests if they are thought to be clinically inappropriate? scoring 58 No data 3 Not applicable 1 Not sure 1

30 Pathology Department Page 30 of 46 Comments in relation to questions 8 and 9: (Laboratory are shown in blue italics) Not applicable to grade/band/workgroup Some may be appropriate to do straight away- needs specifications Neutral Depends if consensus reached is by clinician If not analysing this could be discussed/alternative tests offered if needed Should discuss both with doctor (not call the ward for the nurses to discuss with Dr + ring pathology back. Direct contact of requesting Dr. The difficulty we have is that: Doctors are frequently moving around Many request forms do not have the name or bleep number of the requester or consultant included (left blank). It is not always a medical doctor who requests pathology tests. We contact staff at the location of where the patient is so that repeat specimens can easily be taken if required. Wording still a bit ambiguous The pathology staff do not see the patient & their clinical condition As a member of nursing staff might be pertinent to speak directly to doctors first! As most likely this is what nurses will do. See response above. Negative Would rather additional tests be done on sample already submitted this will save time & discomfort for patient. Additional tests can often been done on samples that have already been submitted, (dependant on time elapsed since the specimen was collected and the required additional test.) Some tests can only be performed on fresh samples, e.g. lactate. The Pathology Handbook has this information available to users:- Biochemistry:- Investigations-Biochemistry.pdf Haematology:- Microbiology:- Some tests have not been run (mainly micro) leading to a delay in. Dr Tom Lewis, Consultant Medical Microbiologist responds: It is not possible to report the result of urine culture in a meaningful way without clinical details. This allows results to be tailored to clinical need and reduces the risk of inappropriate antibiotic prescribing. All urines with clinical details are now cultured, regardless of pyuria, with sensitivities to an extended panel of antibiotics.

31 Pathology Department Page 31 of How satisfied are you with the out of hours (on-call) service? scoring 32 No data 1 Not 30 applicable Comments: (Laboratory are shown in blue italics) Positive Negative V. good It is ridiculous to have to bleep biochem + haem + porter to get some basic blood tests done. There is no need to telephone or bleep the oncall scientists for biochemistry or haematology tests up until midnight. On-call staff check for newly arrived specimens every 30 minutes. This issue is also under review by pathology managers.

32 Pathology Department Page 32 of 46 Varies-see 7 (Paed urgent/on-call results take too long). See previous Occasional off-handed attitude of on-call staff but prompt service. See previous. 11. How satisfied are you with the support from the Point of Care Testing Team? scoring 26 No data 2 Not 34 applicable Not sure who these 1 are

33 Pathology Department Page 33 of How satisfied are you with the Andrology (semen post vasectomy & infertility) service? With only 5 returns there were too few data to compare but the results are recorded below: Score % No data 2 Not applicable 56 Comments in relation to questions 11 and 12: (Laboratory are shown in blue italics) Negative Not very clear how semen samples should be done (ie. If produced on site, if so where?). There is no on site (NDDH) facility for patients to produce semen specimens. Full information and guidance for users and patients is available on the Pathology Handbook:- Would be useful to have more than one ABG machine doing lactate? MAU/FAU This comment does not relate to the Andrology service. 13. What would you consider to be the BEST & WORST elements of the Pathology Service and why? There were a variety of positive and negative comments. The largest groupings of positive comments related to staff being helpful and friendly and the service being efficient. It was more difficult to group the negative comments but the majority were directed towards the computer system and its output. All comments are listed below, in alphabetical order. Where have already been made, See previous response is shown.

34 Pathology Department Page 34 of 46 BEST (40 ) 36 hr cultures Accessible, prompt results Accuracy + turnaround time Advice Advice- helpful and knowledgeable. Computer access - past results and latest results All the histopathologists are very helpful + nice Always available to discuss results and give advice Always happy to help with any queries (name supplied) old sideburns Available to discuss if needed Communication Displaying on computer system Do good job Efficiency Efficient Efficient, friendly and helpful Excellent communication + accuracy of reporting Fast + efficient Fast efficient Fast service, especially when urgent Friendly, efficient. Very helpful Good computer system although old + needs updating Good histol/cyto service Helpful speed Helpful staff (in the main) Helpful staff on telephone I've always find the staff helpful and efficient LabCentre (retro but functional and always works) New request forms are quick and easy to fill out Overall very efficient service Phoning when an abnormal result Polite and try to be helpful Rapid turnaround Request Forms Routine tests- very good service Speed - approachable (illegible word) The pathology report- the only contact really They phone through abnormal results Very helpful, knowledgable senior staff on hand to aid clinicians in interpretation of tests or advice or choice of investigations Very helpful lab staff, useful clinical

35 Pathology Department Page 35 of 46 WORST (36 reponses) Computer system Laboratory Response: See previous response. Cultures taking longer than forty-eight hours See previous response. Difficulties in obtaining/processing very small samples We will be arranging a discussion meeting between in SCBU Pathology clinicians and paediatric staff to address this. It is unusual for tests to not be done if there are appropriate clinical details included on the request form. We see many requests for specialised tests that would Disagreeing with completing tests when they are be inappropriate in many clinical circumstances and clinically indicated clinical details on the request form help to substantiate the request for these tests. We keep specimens for a while after receipt, and some tests can be retrospectively analysed upon receipt of clinical information. DO not process tests if discrepancy with form + tube We have to be strict on the requirements for labelling to even if same patient (ie. two different forms of identity- ensure patient safety is maintained. This is to ensure the name and number) correct patient is treated, based on the result we issue. Electronic Report See previous response. Urgent pathology requests from NDDH can be phoned to the lab and we will arrange a porter to collect the Fixed midday transport times specimen. Routine collection times can be discussed with Sodexo (natalie.clark@sodexo.com). Sodexo manage the portering service and can be Having to wait for porter from main unit to come over contacted on ext It smells? I've had a very rude phonecall regarding labelling If you experience such behaviour we would encourage bottles + forms. Also unpleasant staff when asking for you to make a note of the person you were talking to and add ons to bloods informing the Pathology Quality Manager on ext Keep checking on the computer for INR results- time See previous response. wasting Log on procedure to PATH See previous response. We would encourage you to discuss this issue with Dr Microbiology advice Tom Lewis on ext We occasionally make mistakes and endeavour to Mixing up patients + their specimens correct these and inform users as soon as possible. We also investigate the root cause of such errors. Negative conversations. Staff not wanting to wait whilst I get reports book and pen to write results down No lactate on ABG Not being allowed to add on results by phone AND awaiting validation - get on with it!! Occasionally maybe results need flagging (eg. Low Hb on one blood sample- abnormal for patient) one member of staff can be rude at times Paper based ordering- reliance on portering to deliver samples If you experience such behaviour we would encourage you to make a note of the person you were talking to and informing the Pathology Quality Manager on ext Blood gas analysers have recently been replaced and all will now analyse specimens for lactate levels. See previous response. Quoted reference ranges are based on the prediction interval between which 95% of values of a normal adult population fall into. As a result of this, 2.5% of the time a normal value will be less than the lower limit of this interval, and 2.5% of the time it will be larger than the upper limit of this interval. It is not possible to assign bespoke patient reference ranges to the laboratory computer configuration as reference ranges are configured for each test and not by individual patients. If you experience such behaviour we would encourage you to make a note of the person you were talking to and informing the Pathology Quality Manager on ext The Trust s Electronic Healthcare Record system procurement project includes electronic ordering of diagnostic tests. Porters will still be the only method of transporting specimens to the laboratory.

36 Pathology Department Page 36 of 46 Paper copies? Still needed Paper path slips- not moving with technology + massively wasteful Paper reports Paper system for results. Quality of new blood bottles Reports not always clear- sometimes not quick enough Results that are only on paper copies Software for results Sometimes it can take a while to get results Too many paper results. Too many paper results. Having to write on blood bottles Very occasional loss of specimen results When they assume a test is from OH + its GU or GP See previous response. See previous response. See previous response. See previous response. We always try to issue clear, succinct and unambiguous reports. We would encourage you to contact the Pathology Quality Manager on ext with examples of where this is not the case. See previous response. See previous response. See previous response. See previous response. See previous response. Missing specimens are notoriously difficult to investigate. Causes could be specimens labelled with another person s ID, specimens falling out of the specimen bag on transit to the lab, loss or mix up within the lab or placing the specimen in the wrong container on the ward prior to porter collection, e.g. we have previously found specimens placed in paper shredding bags and sent to Sodexo. We always investigate such occurrences in the lab. It is often difficult to decipher some of the handwriting on request forms in future electronic ordering will resolve this. We generally only assume where to send results when there is no information on the request form. If you have examples of this issue please contact the Pathology Quality Manager on ext who will investigate.

37 Pathology Department Page 37 of How satisfied are you overall with the North Devon Pathology Service? a. Biochemistry scoring 60 No data 1 Not 2 applicable

38 Pathology Department Page 38 of 46 b. Haematology scoring 59 No data 1 Not 3 applicable

39 Pathology Department Page 39 of 46 c. Microbiology:- scoring 58 No data 2 Not 3 applicable

40 Pathology Department Page 40 of 46 d. Histology/Non-Gynae Cytology scoring 27 No data 2 Not 34 applicable

41 Pathology Department Page 41 of 46 e. Blood Transfusion:- scoring 40 No data 1 Not 22 applicable

42 Pathology Department Page 42 of 46 f. Mortuary/Bereavement Dept:- scoring 20 No data 2 Not 41 applicable

43 Pathology Department Page 43 of 46 g. Pathology Supplies:- scoring 42 No data 1 Not applicable 20

44 Pathology Department Page 44 of 46 h. Pathology I.T Dept scoring 42 No data 1 Not applicable 20 % Medical (20) Nursing (20)

45 Pathology Department Page 45 of Please make any further suggestions as to how we could improve the Pathology service:- (Laboratory are shown in blue italics) Maybe pathology staff could remember all depts are busy & maybe stressed and vice versa See previous response. Don't send us results we haven't requested please it takes a long time to check they are not ours. We do audit this and acknowledge that we occasionally send result to the incorrect location. However it causes us difficulty when we receive requests that have no requester or location to send the results. In some of these cases we make an educated guess where to send the results, which sometimes may be wrong. Electronic ordering of diagnostic tests (coming in the future) will help this situation. Mortuary staff can be abrupt and unhelpful See previous response. To call all urgent surgical INRs, so as that the ward is informed as soon as result available as not to keep checking (very time-consuming when busy) The results pages do not automatically refresh themselves; this is how the system has been designed and we cannot change that configuration. We agree that it is not user friendly. We are also unable to telephone large numbers of results out to wards and clinics, as it would take staff away from analysing urgent specimens with an increased risk of transcription errors. When the Trust s new Electronic Health Record (EHR) is introduced, we hope it will improve the display of results with a real time, auto refreshing results screen. To save wasting time checking the computer for INR results. The pathology team could ring ward with results. See response above. At times- Warfarin results are hard to get-? Telephone them through to community hospitals or we ring you. The NDDH Pharmacy department now handles Warfarin dosages and can be reached on ext On ward pathology IT teaching would be more useful + supplies via top-up rather than separate. We agree. We are currently looking at implementing a (NDDH only), pathology supplies top-up service. On occasion if a specimen is labelled incorrectly it tends to be the nurses that receive the phonecall for the lab and at times get an earful of abuse. I would suggest the person who has taken the sample be contacted as it was their mistake. Just a suggestion See previous. Dump the computer system. Is it cost or nostalgia that means we still use something that was obsolete when I started here 12 years ago? See previous. Sometimes very good and helpful: organising urgent/complicated transfusion specific advice on children's testing. Thank you. You need a new computer system (like we all need an upgrade.) See previous response. Computer system is helpful but a little quaint.

46 Pathology Department Page 46 of 46 Have fully integrated IT with alerts and flags-? Will come with new EHR. Yes, the forthcoming electronic heath record (EHR) will include an integrated pathology results section. Very good department. Turnaround time best in district Allow us to add on path results on the phone please please please. See previous response. Make a better system of telling you you have urgent blood results. The EHR will flag up urgent and abnormal results and notify individual requesters when results are waiting for them to view. Order comms. This is included as part of the EHR project. Microbiology- consultant advice can be very patronising. We would encourage you to discuss this issue with Dr Tom Lewis on ext Histology- consultants always prepared to bend over backwards to help. Seem to work beyond their allocated sessions. Nothing is too much trouble. Dr (name supplied) is especially accommodating When we send a urine sample for processing do you automatically do the sensitivities? When you have a patient with severe confusion due to a urine infection it is a long time to wait for results prior to treatment. All urines with clinical details are now cultured, regardless of pyuria, with sensitivities to an extended panel of antibiotics. We are currently reviewing how we process urine specimens with a view to improving their turnaround times. Personally I think the team should seek to maintain its current level of excellencenaturally technologies will change etc., but developments will succeed with this team's high standards. When requesting microscopy, culture and sensitivities tend not to get sensitivities unless we specifically ask for them in the text box- would be helpful always to get them! All urines with clinical details in the text box are now cultured, regardless of pyuria, with sensitivities to an extended panel of antibiotics. It is not possible to report the result of urine culture in a meaningful way without clinical details. This allows results to be tailored to clinical need and reduces the risk of inappropriate antibiotic prescribing. Sometimes ill babies in SCBU need to have blood tests reported for a variety of reasons-too small sample, sample is haemolysed/clotted or is otherwise unusable. These patients are very small and sometimes very sick. Maybe a discussion on the areas of difficultly + ways to improve them, plus some sharing of experience between those taking the blood + those processing the tests, and some additional training, might be useful. We will be arranging a discussion meeting between Pathology clinicians and paediatric staff to address this. If successful, such meetings could be arranged for other NDDH departments and wards in the future. A top up service to the wards Pathology supplies would be beneficial rather than having to order when ward is busy or short staffed supplies often neglected. We are keen to reinstate this service to wards and other areas where pathology supplies are frequently used. Currently we are assessing how many supplies we send to each NDDH location and based on this analysis, we will calculate the frequency and route of the new top-up service. Re qs 9 syphilis testing was not performed without consulting me re. memory impairment. Patient had +ve syphilis- by the time I found out it had not been performed he had left the country for the next 6 months or so. How about a contact no. for the requesting dr eg. Mobile no. on the form to make it easier to discuss these cases. We would encourage you to discuss this specific issue with Dr Tom Lewis on ext