Pathology User Survey - dchft.nhs.uk€¦ · Practice Managers and also from the Nursing Staff. What you say can really make a difference to how we develop our service to meet your

Document Title: Pathology User Survey 2017 Page: 1 of 26 Document No: PAN PATH- REP 0003 Author: Sharon Wood Version: QP 4.0 Authorised by: Paul Davies

Pathology User Survey

Results 2017

Thank you for participating in our Pathology Survey Surveys were distributed to both hospital and community service users, electronically in the hospital

team brief, using survey monkey and hard copies left in communal rest room

Question 1:

It was fantastic to have such a good response, 52 in total, especially from the community GP’s and Practice Managers and also from the Nursing Staff.

What you say can really make a difference to how we develop our service to meet your needs.

Don’t feel you need to wait for the next user survey to voice a suggestion; we are keen to receive quality improvement suggestions all year round.

Please contact myself, the Pathology Quality Manager at [email protected]

Tel: 01305 254326 or any member of the Pathology Management Team, see website for details http://www.dchft.nhs.uk/gps/pathology-services/Pages/default.aspx



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Question 2:

It is good that so many of our users find the ICE system user friendly.

You said:

4 responders were dissatisfied with the lack of speed and complexity in accessing and using the system. One user expressed particular issues ordering 24 hour urine tests, whilst another would have liked some profile test groups.

We clarified:

At certain times of day there is increased traffic on the network and it is difficult to avoid the system slowing down. At these busy times back-ups are kept to a minimal. In the community your IT provider that interfaces to ICE (SystemOne/EMIS) may be able to resolve specific issues.

We will:

An audit of how 24 hour urine tests are setup on ICE will be done to see how the requesting of these tests can be made easier. A review of profile test groups will be conducted to see what profiles already exist and ones that can be added.

If there are specific tests required to be added to ICE, please contact Tracey Chapman, Pathology Systems Manager via email ([email protected]).



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Question 3:

It’s nice to see that the majority of the users of the Histology system find it to their advantage and easy to use.

You said:

2 responders expressed difficulty in finding information and tests requested

We said:

We are hoping that more users will take up using ICE requesting for histology tests and this will be encouraged in the near future. ICE requests are far safer for getting the tests you want and speeds up the laboratory processes leaving less room for human error.

Ideally it should be straight forward for you to request histology, cytology or andrology tests however if you are experiencing problems then please contact the Pathology System Manager, Tracey Chapman ([email protected] ) who will be happy to help.



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Question 4:

The majority of those that use the service were either very satisfied or satisfied, with a few who were on the fence, were neither satisfied or dissatisfied:

You said:

1 responder had a patient who wanted to do an out of hours viewing in the mortuary and questioned the process of getting permission from the site manager.

We explained:

It is hospital policy that all mortuary call outs are referred to the site manager to avoid unnecessary call-outs to staff who are off site. Evening views are only arranged in really exceptional circumstances as most can be arranged for the next working day.



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You Said:

1 responder expressed concerns that patients receive unnecessary treatment or extended isolation precaution, due to restriction of service over the weekend.

We explained:

As much as we would like to provide a full service 24/7 in Microbiology, where most of the infection prevention screening is processed, we have neither the resource, demand or staffing to do this. The service offered out of hours is there to provide support for those most in need and tests deemed urgent are agreed with the Pathology clinical staff and in line with national guidelines. The microbiology department works closely with the Infection Prevention and Control Team, to ensure appropriate screening of patients, to safeguard the patient and others, however these are screening tests and do not affect the direct management of patients and therefore not considered urgent.

There is a full 24/7 service for Blood Sciences and Hospital Transfusion.

Currently there is no demand for weekend service in Histopathology.

You said:

That it would be helpful if all samples could be processed in hours, as practices close at 18:30 and on-call doctors have limited access to patient records.

We explained:

The utmost is done to complete routine work within the normal working day and however processing does extend into the evening, depending on urgency & integrity of the sample, late running / evening clinics, and transport delivery times. All tests have defined turnaround times published on the Trust website: http://www.dchft.nhs.uk/gps/pathology-services/Pages/default.aspx .

Therefore the time that results can be made available is dependent on the time that the samples are delivered to the laboratory. Although the Trust provides the transport of samples from the surgeries to the laboratory, the service is commissioned by the CCG’s, and not within our control (See question 6 responses).

We have alert limits for abnormal results; these have been agreed with the laboratory clinical staff and are in line with recommendations from the Royal College of Pathologists. When we have results that meet or exceed this agreed criteria, we have a duty of care to convey these as soon as possible to the requestor or someone delegated by such person to act appropriately in the interests of the patients wellbeing. This regularly includes results that become available outside normal



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working hours, these results are communicated to the designated out of hours service. Occasionally the patient information is restricted to what is available on the original request form if the patient is not known by the Trust Patient Administration System.

Question 5:

The responses showed the majority of users are very satisfied or satisfied with the core service. However as always there is room for improvement and when asked what we could do to improve your experience:

You said:

That electronic Histology results would be more efficient than paper reports

We explained:

Histology requests can be made via ICE and we would gladly see in an increase in users requesting histology testing via ICE. Our reporting system automatically links to ICE so patients’ results are available through that system. If you are still receiving paper copies of reports and would like them to stop, please contact the lab manager via email,( [email protected].).



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Question 6:

Although 88% of responders were either very satisfied or satisfied, with compliments from 2 users, this was the first question to generate a significant expression of dissatisfaction.

When asked what we could do to improve your experience, we received 13 responses which fell into one of two categories and related to in-house and community access.

You said:

Internally you expressed dissatisfaction with the POD system; reporting a high breakdown rate, delays with the PODS returned, porters being too busy to transport samples and lab staff being disinterested in getting the POD system back up and running / returning PODS to site of origin.

We explained:

The POD system is a hospital wide system and as such the estates department has ownership of it. We assist in the management of the system. During night shifts the one member of staff on duty is unable to extensively investigate breakdowns, their priority is to process the urgent work arriving. Full investigations of the system would require a staff member to leave the department which is not possible.



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Each area has an allocation of PODs and each of these PODs has an electronic ID which dictates where its home station is. When the POD is placed in the system in the pathology lab the POD is automatically routed to its home station. The laboratory does not reroute the PODs unless we have been requested to by an area that has not had any PODs returned to it. We do need all areas of the hospital to assist by ensuring that they do not hold on to PODs that do not belong to them.

If any areas have any questions regarding the use of the system please contact the blood sciences department.

We have:

Increased the number of staff who are capable of doing troubleshooting, however we do need to get assistance from the estates department on occasions and there are instances where we have to wait for the company to intervene.

You said:

In the community, your issues related to transport collection times, especially the later collections, as you are expected to deliver a full service until 20:00, with the current system, limiting the choice of services you can offer. It also put burdens on your service for ensuring the integrity of the sample you send and qualities of results subsequently received; for example with Potassium levels.

We explained:

As explained earlier, transport collection is complicated by the level service from the Trust being commission by the CCG, and therefore somewhat out of the control of the laboratory and Trust. It’s important that transport is considered when service changes are in the planning stage and addition resources and funding considered.

We will:

The laboratory is planning to work with the transport department, to understand the current system and agreement, to see what can be done to improve the services, this will require support from the CCG.



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Question 7:

The majority were either very satisfied or satisfied, with no dissatisfaction expressed, however there were a few department specific suggestions:

Blood Sciences; you said:

You would like faster TAT on certain tests particularly NT pro-BNP and additional questions relating to this test could be dispensed with.

We will:

Train more people to perform this test to ensure more reliable, frequent processing.

We will review the additional questions relating to this test with Dr Olufadi (Consultant Chemical Pathologist) and aim to simplify the additional information we require to interpret the results and provide clinical advice.



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Blood Sciences; You said:

You would like faster TAT for outsourced tests.

We explained :

The process for processing outsourced tests is currently very labour intensive as we do not have electronic links to our referral laboratories. The result entry requires manual transcription and a second check. We receive anywhere between 500 and 800 reports a week with varying complexity.

We are:

Looking to work more closely with our near neighbours via the One Dorset Pathology project. One of the objectives is to consolidate the referral work. Once a common laboratory information system is in place then the TAT for the more frequently requested outsourced tests should be dramatically cut.

Microbiology; you said:

More information on resistance patterns as often don’t get full details and therefore can’t use the information without phoning for more detail.

We explained:

Antibiotic susceptibility results are released using a matrix agreed with the consultant Microbiologists in line with the antibiotic stewardship guidance, to ensure clinicians are guided towards the appropriate treatment and to prevent emergence of resistance.

Histopathology; you said :

The TAT is a bit slow sometimes.

We explained:

If you have an urgent test and require the results in order to start patient treatment we will always endeavour to do our best to a result to you as quickly as possible. Unfortunately we have experienced a period of short staffing both in the lab and also with the consultants which will always have an impact on TAT despite our best efforts to mitigate any impact.

We will:

Continue to monitor our TAT with an aim to improve. We strive to meet the RCPath recommended TAT as published on the website however there will always times when we fall short of this.



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Question 8:

There is general satisfaction with the TAT

You said:

Results are not always brought to your attention especially abnormal results or results effecting treatment, such as for patients on heparin infusion.

We explained in general:

We have alert limits for abnormal results which take into account the previous test results; these have been agreed with the laboratory clinical staff and are in line with recommendations from the Royal College of Pathologists. When we have results that meet or exceed this agreed criteria, we have a duty of care to convey these as soon as possible to the requestor or someone delegated by such person to act appropriately in the interests of the patients wellbeing. This includes results that become available outside normal working hours. With >8000 tests coming through our doors every day, it’s impossible to phone everything and tests which are abnormal but not critical are alerted on the report and not verbally.



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Relating to patients on specifically on heparin; we said

We have specific criteria for patients that are on heparin infusions. Our criteria is to phone all IV heparin APTTR results of >2.5 as directed by the consultant haematologists. We are concerned that you have found this to be a specific issue. Could we ask you to contact the blood sciences department directly to discuss individual cases so that we can check our procedures are being followed.

You said:

It would be helpful if you were informed of all the outsourced tests

We explained:

The turnaround time and any specific requirements of the more commonly referred tests are detailed on the website for each department. This information also gives the referral laboratories:

http://www.dchft.nhs.uk/gps/pathology-services/Pages/default.aspx

Select the department or go direct via the links below:

http://www.dchft.nhs.uk/gps/pathology-services/Pages/Histopathology-.aspx

The tests and the referral laboratories are tabulated at the bottom of the webpage above

http://www.dchft.nhs.uk/gps/pathology-services/Pages/Blood-Science.aspx :

There is a link on the webpage, and the outsourced tests and services used is detailed in the link document:

For test repertoire and specific test information including turn-around-times, click here

http://www.dchft.nhs.uk/gps/pathology-services/Pages/Microbiology.aspx

There is a link on the webpage, and the outsourced tests and services used is detailed in the link document:

Test Repertoire

For test repertoire and information on specific microbiology tests including turn-around-times and urgent request procedures - click here



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We also carefully select these laboratories on service quality and audit them against their published TAT’s, to ensure ourselves we are reporting quality results, on an annual basis.

Blood Sciences will endeavour to expand the number of referral tests detailed on the website. There are a vast number of infrequently required tests. Please contact the laboratory if guidance is required for a test that is not listed.

Question 9:

Again the majority were either very satisfied or satisfied

You said:

You would like to be contacted within 1 hour if there are problems with processing specimens, as you have targets to meet.

We explained:

We recognise that delays to the service that we provide may potentially have an adverse effect on the running of your department. It is not always immediately obvious to the laboratory how problems with analysers or individual tests will escalate. However we do contact the site manager as soon as it is apparent that any difficulties within the department will cause a delay to service. The



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site manager decides how the issue is escalated and communicated. This enables us to focus on restoring the service as quickly as possible.

You said:

Please phone haemolysed samples

We will:

Explore the possibilities of implementing this request.

Question 10:

Again generally you were very satisfied or satisfied

You said:

Haematology improved with introduction of email service (Eagle House).



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We say:

Thank you for the positive feedback, it’s good to know changes have helped improve the service.

You said:

Biochemistry and Microbiology excellent.

We say thank you:

Thank you for the positive feedback, it’s good to know what’s going well as well as what is causing issues.

You said:

New advice and guidance will hopefully help with contacting Haematology, I am aware they are very busy with clinics.

Another said they would like the Haematologists to be available to discuss results and another it is a bit ‘hit and miss from a GP perspective.

We explained:

Issues with Haematology consultants availability for laboratory support has been flagged as a serious concern and the Trust Executive Team are aware. Pathology is working with the Clinic Management, to find a solution which is safe for all patients at whatever point in their care pathway they need care or diagnostic support from the Haematologist .

You said:

You sent an INR to the laboratory as the POCT machine stated >8 and received a verbal report that we could only tell you it was >8. However since then this issue hasn’t reoccurred.

We explained:

The laboratory instrumentation has a limitation for values above 8.0. For results just above 8.0 the analyser can sometimes produce a numeric value, but for other high results the limitation of the technology requires a result of >8.0 to be reported. In the scenario quoted the laboratory is providing a confirmatory result. For treatment an actual exact figure above 8.0 is not necessary.



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Question 11:

Whilst there was a good very satisfied and satisfied, we noted this question attracted the highest ‘neither’ response nor highest very dissatisfied responses, especially for Histopathology; unfortunately there were no suggestions on how we can improve your experience with 33% very dissatisfied.



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Question 12:

Majority very satisfied or satisfied.

You said:

You suggested customer service training as ‘some people are so rude’.

We apologise:

We apologise for the unacceptable way you have been treated by our staff, it’s not the level of service we wish to deliver. Please contact the departmental manager to complain at the time the incident occurred, so we can take immediate action, contact details are on the website:

http://www.dchft.nhs.uk/gps/pathology-services/Pages/default.aspx

We have:

We apologise for the behaviour of our staff and have passed your dissatisfaction on to all staff. We are looking into available training courses .Customer care is highlighted for new staff at induction, however your comment has highlighted this needs reinforcement.



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Question 13:

Majority of the responses were in the very satisfied and satisfied categories. With one compliment saying ‘excellent support at all levels, keep up the good work’.

When asked what we could do to improve your experience

You said:

Is there any way Anti –D can be delivered to the community midwives at WCH.

We clarified:

We do supply Anti D direct to Weymouth Community Hospital, please contact Maraneka Greenslade, [email protected] , to discuss further, so we can understand your requirements.

Again you said:

Please increase the frequency of sample collections to enable blood tests to be provided in the afternoon/evening.

We explained the situation and what we plan to do in response to Question 6.



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Question 14:

Again the system appears to be working and the majority satisfied.

For those who were unsure about what was meant by this question, it is the supply of blood tubes, specimen containers, collection kits etc.

You said:

You would like an on-line request system

We explained:

We will explore the use of a generic email address for receiving order forms.



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Question 15:

The majority are satisfied or at least content, however a small number are dissatisfied and it would have been useful to know why.

You said:

You had asked re ‘expired tests’ not being done on e.g. monthly FBCs.

We explained:

Firstly we apologise if we haven’t addressed your issue, to your satisfaction. The expired tests message means that the electronic order was never actioned in the Lab as no sample was received, or an order was requested manually in the Lab system as there was an issue with the electronic order.

We will:

We will review the message that goes out with ‘expired’ electronic orders or we will stop this message going out in the first instance.



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Question 16:

Again it appears we are getting it right for the majority, with 2 compliments which we very much appreciate:

You said:

‘Especially biochemistry and microbiology’ and ‘consultants are always very helpful once we GPs find them!’

We say:

Thank you and please note our responses to Question 10 &11 relating to the availability and quality of clinical advice respectively.



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Question 17:

You said:

You have a website?

I do not think we can access it?

We don’t access it – unsure how? (you gave us your name, so we contacted you direct and talked/guided you around the site).

We say:

We are amazed 62 % of you said the website is N/A to you.

Within the Trust we are listed as a clinical service; pathology service on the hospital intranet which takes you to the trust website.

For GP’s if you go to the DCHFT website; pathology services is on the blue GP tab.

Both routes take you to the link: http://www.dchft.nhs.uk/gps/pathology-services/Pages/default.aspx



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We have information on repertoire of tests, referral laboratories and turnaround times for both. Collection and specimen container information, some patient information leaflets and out of hours service, contact details for key members of staff etc.

Please contact me [email protected] if there is other information you feel we should include, we need to ensure it contains the information you need.



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Question 18:

We asked for improvement suggestions

Your Service Improvement Suggestions We clarified

Please could you improve the search facility on ICE. It is not easy to use and often does not pick up the search word even though it is in the test name (Eagle House Surgery).

We will look into this issue on ICE to see, if any, improvements can be made.

I am based in the Chesil community midwives team (5MID) which receives a lot of results for each pregnant woman in the area. We are wasting a lot of time once the results come back, looking up what surgery the woman is registered at in order to determine which team she is in and who is to file/action the result. The path codes we originally set up don't seem to be always printed on the results - this makes much more work for us. I am planning to look further into this.

We will conduct an audit of the requests from the community midwives to see where the problem lies. We will work with you to improve and resolve this issue.

Visits to practices with education would be great, we enjoyed meeting Dr Olufadi , put name to face and learnt a lot. Many thanks

We plan to have open evenings where you can visit the laboratories, see what we do and speak to staff.

Labelling bloods - would like new system for outpatient clinics as soon as possible. - Writing labels can cause mistakes and loss of blood samples.

We are investigating how to solve this issue with our IT supplier.

Please could you have buttons on front page that automatically complete form for various screens: (1) Osteoporosis screen (2) Abnormal LFT screen (3) Macrocytosis screen etc

Collection of tests can be setup on ICE for different screening of tests. We will review the setup on ICE and identify the work required to enable these collection of tests.

We often get 2 copies of haematology reports if there is an abnormality (Presumably the 2nd

We are still investigating how to resolve this issue with the IT supplier.



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is after it has been assessed by the haematologist). There is no need for the 2nd one if there is no additional information. Vitamin D results are not flagged red even if very abnormal

We will investigate this issue and resolve as soon as possible.

On occasion can be too rigid about rejecting samples for trivial reasons. Does not take into account considerable difficulty in sometimes obtainability. eg: I have had issues with sample rejection. In one case as no NHS number printed on label and in another because community nurse labelled bottle 'Bridges' instead of 'Bridge' (all other identifiers correct) - Some dialogue and flexibility around these rare occasions would help reduce patient frustration and ensure best of clinical time - thanks Child Okeford Surgery

As an ISO15189 accredited laboratory we are required to ensure that samples are unequivocally traceable by request and labelling to an identified patient. We do this by ensuring that the sample has 3 points of identification which match the request and any information we hold on the hospital system. In extremely exceptional cases we can accept a minor discrepancy on the understanding that the requesting clinician takes full responsibility for the correct identification of the patient. This is normally only permitted for unrepeatable samples and the requesting doctor is asked to come to the laboratory to personally make the changes and sign the change . This is NOT the case for any samples taken for the hospital blood transfusion department, no deviation from the full and correct data set can be accepted.

Relating to Specimen Collection From GP’s : 1.Increase sample collection frequency 2.. Just to have later collections from practices. This would enable us to improve services to patients by offering blood test appointments all day. Even if we had to take our afternoon samples to one point in the locality to save your driver coming to each practice that would be such a great help

We explained the situation and what we plan to do in response to Question 6.

Additional information for ECHOs and NCS for example would be good if could be extracted from EMIS Web or System One without need to have to duplicate entry into ICE

We will investigate this issue and see how this can be resolved.



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?available consultant phone in time (1 hour?) or email address for clinical advice for GPs

As GP’s you will understand it is not always possible to be available all the of the time, however we will explore the suggestions made.

Sometimes we get the same results sent 5 times like FBC results or we get a report form a GP at Xroad Weymouth to one of our GP that states result courtesy of one of the other GP's we think it may generate automatically by ICE or lab but leads to duplication - regards GP X roads surgery

We will investigate this issue and see how this can be resolved.

On line ordering. Online notification of Issues/non urgent problems. Real time access to make suggestions online, rather than through periodic surveys

We will explore the use of a generic email address for receiving order forms. We will also explore the use of a Generic pathology email address for real time comments to be monitored by the Quality Manager to address any issues/ comments/ complaints/ compliments – please tell us the good things and the bad!

Compliments Our Response

N/A Very Good, no comments Thank you

Keep the service going in Dorchester

Do not let it be privatised

Do not let it go to Taunton to bail out their remote and costly private service

We can reassure our users that there is no intention to privatise Pathology services, or to send the work to Taunton. A number of years ago these options were explored but the Trust took the decision to retain the in-house Pathology service.

There is a project, under the Vanguard umbrella, to merge the Pathology services from Bournemouth, Poole and Dorchester, to create a OneDorset Pathology service. The drivers for this project include developing the quality of the service, as well as ensuring it is robust for any future challenges. The aim is from a user perspective you should only see service improvements

Documents

Pathology User Survey - dchft.nhs.uk€¦ · Practice Managers and also from the Nursing Staff. What you say can really make a difference to how we develop our service to meet your