Pathology User Survey Report 2013-14 - WhatDoTheyKnow · Pathology User Survey Report 2013-14 ... There have been instances of ... Service failure mainly surrounds communication with

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Pathology User Survey Report 2013-14

Introduction

Pathology at Barts Health NHS Trust is accredited by Clinical Pathology Accreditation (CPA), soon to be replaced by ISO15189:2012. A number of CPA and ISO standards (4.14.3) require evidence that the service has consulted with users to determine their perception of the service, whether the service has meet their needs and requirements and to use their input when assessing future service development needs and the Quality Management System.

As part of a Pathology wide commitment to the requirements of the CPA and ISO15189 standards, the Pathology Quality Committee commissioned a GP user survey. The committee has subscribed to a popular web-based survey facilitator known as Surveymonkey. This provides for the on-line design of each survey ultimately generating a link that can be circulated to the users by e-mail directing them to the website. The user is then able to complete the survey quickly and easily and not have the inconvenience of having to post a paper copy of their response back to the committee.

Scope

It was decided to send this survey to all the GP we serve within Tower Hamlets, Newham, Redbridge, Barking and Dagenham, and Waltham Forest.

Lessons learnt from this survey will be applied to subsequent surveys both to GP and users within the Trust. In this manner there should be a year on year improvement in the efficiency and relevance of the process.

Survey Distribution Strategy

Every effort was taken to obtain the GP email addresses to populate Surveymonkey but without success. Eventually we obtained an email list of 265 Practice managers from NHS Shared Business Services Ltd (FHS) to which we distributed a standard e-mail message which included the link to the survey website (see Appendix 1). We requested that this be distributed to GP in their practice. This was reinforced by each CCG agreeing to add an item in their respective news letters that where distributed to each GP (Appendix 2).

The questionnaire was activated on Monday 3th February 2014, but due to a poor response a reminder was sent after two weeks and the open date extended until the 28th February.

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Survey Design

Once the user clicks on the link in the e-mail message they are directed, through their web browser, to the survey site. They are then guided through a series of requests for information.

The survey comprises 17 questions in total, not all of which require an answer. The user will be directed to the next relevant question depending on the initial answers provided.

Questions are grouped in related subject areas covering issues such as:

• Information about the respondent • Pathology services used • Requisition ordering • Service information and clarity • Access to electronic links • Specimen collection and transport • Test repertoire • Turnaround times • Result interpretation and clarity • Access to advice • Response to enquiries • Training topics • Other feedback

Most questions provided the respondent with the opportunity to provide comments.

The questions and the analysis of the responses received are listed in Appendix 3.

Analysis

The survey was distributed to the 265 GP practice managers across the CCG that we serve, which generated 60 responses. NHS Open Exeter shows that we have 874 GP in this cohort which gives a response rate of 6.9%.

Nearly half of respondents were from GP in Tower Hamlets (27), followed by Redbridge (14) and Waltham Forest (10). We had relatively few replies from Newham (5) and Barking and Dagenham (3).

Nearly all GP used our Haematology, Biochemistry and Microbiology services, with 60% using Cytology, Immunology and Virology services. Interestingly 40% of GPs that replied have sent samples to Histology. As expected no samples were sent from primary care to Stem Cell, although 3 GP in Tower Hamlets claim to have sent samples to either Clinical Transplantation and/or Cytogenetics.

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Although most GP were satisfied in receiving their Pathology supplies, a sizable minority, one-third, thought that it was difficult or very difficult to obtain supplies; this might be a more acute problem in Waltham Forest where 5/9 GP were unhappy in receiving their supplies. The most common problem expressed was practices receiving less stock then they ordered resulting in practices having insufficient stock, Other issues included difficulty in ordering, stock items not being available, delay in receiving supplies and supplies being sent to the wrong practice.

Levels of satisfaction with availability and clarity of service information were generally good with only five respondents thinking that the information was unclear. Comments made included that there was too much information on the Hba1c result with the result being at the bottom of the result which could be missed. Another thought Southend Hospital provided more clinical advice from Biochemists. Suggestions included providing more information about tests especially grouped tests e.g. Hepatitis, an online system to see results and improved communications with the lab.

All but two practices from Redbridge that responded to the questionnaire receive their results through electronic links. In contrasts only three-fifths (30/51) confirmed that they are able to request tests electronically, primarily from Tower Hamlets (22) and Barking & Dagenham (3). No practices that replied from Newham could request tests electronically.

Nearly one fifth of users were at least dissatisfied with specimen collection and transport, being reflected across all CCG. This largely involved practices having samples collected in the morning or early afternoon; they would all prefer a late afternoon or early evening collection rather than storing samples in the fridge overnight. There have been instances of collection failures and a rude courier. Greater flexibility in collecting samples and two collections per day were suggested. Two practices praised the service “Our courier does a good job under difficult circumstances” and “Specimen collection and transport systems are extremely efficient and productive always on time and better for practice”

In general the majority of users were satisfied with the repertoire of investigations offered. One in ten of users however expressed some level of dissatisfaction with all specialties with the exception of Histology. Three users requested BNP as an additional test, followed by Vitamin D and LFT - individually, not in a panel.

All respondents in Tower Hamlets and Newham at least usually receive their results in a timely manner. Respondents from Redbridge, Barking & Dagenham and Waltham Forest either rarely or never receive one in three of their reports. The main cause appears to be due to registration errors or incorrect sender codes. They express frustration in delay in being able to contact the labs. One respondent stated that stool samples took too long to report and another that “at present 10% of samples are useless because the Phlebotomists have either not taken enough sample, the sample has become useless in transit, or the bottles have smashed or leaked”

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All respondents from Tower Hamlets and nearly all others from other CAG thought that the reports were clear to understand. Most comments involve report formatting complaining that the result was buried beneath explanatory text and disclaimers, e.g. Hba1c, Vit d2 and TV in HVS – “Sometimes the amount to free text associated with results has an impact on how easy they are to read when rendered on the INPS vision screen” and “Also found that comments from electronic results stopped the results from being filed into patient’s notes. Other responders requested additional information e.g. Feedback on resistance/sensitivity to the drug given to their patient by the GP, complete sensitivities of microbs if patient is allergic or multiple resistance so they do not have to phone lab for advice, immunology results to have more advice on slightly abnormal immunology and for blood films results to suggest possible further action. One respondent requested that for Microcystic anaemia, it would be helpful if a thalassemia or Ferritin tests could be automatically organised to avoid patients having to return to Phlebotomy. They also requested a single report for patients with multiple tests e.g. Hep B and Hep C.

All respondents in Tower Hamlets and Barking & Dagenham showed a level of satisfaction in receiving urgent results in a timely manner. Around one in four of respondents in other CAG however showed a level of dissatisfaction. Service failure mainly surrounds communication with one commenting that “communication was a shambles”. Issues involve labs not phoning through tests marked “urgent please phone” and very out of range sodiums not always being phoned through. One respondent found it difficult to organise urgent tests, delaying patient referral, while another stated “You frankly don’t do urgents anymore”

Communication with the labs proved the biggest problem for the respondents with approximately two in five showing a level of dissatisfaction for all specialties and across all CAG. Most comments state how difficult it is to contact the labs “phone sometimes just rings and rings”. “Emails take a day to respond – faxes are even worse”. Two respondents requested a list of telephone numbers to contact labs for their results and for clinical advice, “phoning the Trust switchboard is a frustrating experience”

There is general satisfaction with the responses received to enquiries from specialties, although this varied between CAG. Respondents in Tower Hamlets and Barking and Dagenham showed a one in ten level of dissatisfaction, while for other CAG this increased to one in four. Problems involved faxes not being received and IT problems not being resolved. Particular issues revolve around out of hour’s services “Microbiology very difficult to get a response” and “Biochemistry does not seem very helpful in giving patient details” although they praised the Biochemistry in hours service. Other compliments included “Microbiologists are particularly helpful” and “clinical advice is usually very helpful and responsive”

Only 40% of all respondents felt they had an adequate opportunity to discuss their requirements with representatives of the Pathology service. The picture improves slightly

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for Tower Hamlets and Barking and Dagenham up to nearly 60%, but worsens for the remaining CAG down to around 30%.

One third of respondents suggested educational topics for future podcasts. One thought this sounded an “excellent idea”, others thought that we should first be concentrating on providing a faster more efficient service. Topics suggested were:

• Supplies to GP surgeries

• Test requesting - OGTT 24hr urine cats

• Interpreting results – Immunology, Biochemistry (Triglycerides, high ferritin, GGT management, raised liver enzymes, endocrine), Haematology (Low red cell indices, abnormal WBC racial variants), Microbiology (Colour swab usage and collection of mycology and threadworm samples

On asking how satisfied they were overall with the pathology service, 64% (35) were at least satisfied, 16% (9) were neither satisfied nor dissatisfied and 20% (11) were at least dissatisfied. The most satisfied CAG was Tower Hamlets with only 8% (2/25) dissatisfied. Satisfaction fell further East with Newham 25% (1/4), Redbridge 25% (3/13), Barking & Dagenham 100% (3/3) and Waltham Forest 50% (5/10).

Fifteen practices expressed an interest in meeting a pathology representative to discuss their requirements - see question 16.

Finally fourteen respondents provided general comments regarding service provision, some thought that the service was “shambolic” and “had deteriorated since the merger”, while others recognised that the service had “recently got better” and that the “Pathology result service was much better”. Many suggestions requested contact details and others requested T-Quest, especially speeding up the process of adding on new locums.

Conclusion

It is tempting to assume that the general lack of response to an invitation to feedback the user’s experience of the Pathology service indicates satisfaction. Equally however, it could reflect a belief that responding is futile or reflect the time constraints in primary care. Despite so few GP responded to the questionnaire general themes can be identified that require additional investigation and possible action.

It is recommended that this survey is endorsed by the Pathology Quality and Governance Committee who will undertake a more detailed analysis and initiate the following actions.

• Publish a schedule of further surveys.

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• Circulate the survey report amongst the Quality Managers to address discipline specific issues.

• Review how GP surgeries are ordering and receiving their supplies across all CCG

• Specialties to review clarity of reports

• Continue roll out of T-Quest to both request and receive results

• Review urgent services

• Review communication with GP surgeries. Consider centralised Pathology helpdesk or disseminate contact numbers to practices. Also consider out of hours availability.

• Respond to the fifteen individuals who requested a meeting with a Pathology representative and minute the outcome of this meeting along with any actions that emerge as a result.

• Contact the CCG and obtain GP lists with email addresses for future surveys, so GP can be contacted directly through SurveyMonkey.com.

• Consider the utilisation of CCG Newsletters to keep GP abreast of changes within Pathology

11 August 2014

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Appendix 1

E-mail Message Wording (First release)

Re – Survey of the Pathology Service at the Barts Health NHS Trust

Dear Colleague

Barts Health NHS Trust was formed on 1 April 2012 following the merger of Barts and the London NHS Trust, Newham University Hospital NHS Trust and Whipps Cross University Hospital NHS Trust.

Since this time Pathology has been going through a period of restructuring and consolidation and we now wish to carry out a survey to assess the levels of GP satisfaction with our service and to ensure that we fully understand your present and future requirements with a view towards adapting services to meet them.

The Pathology Service provides a number of services including Biochemistry, Haematology and Microbiology; therefore we are interested in receiving your views to any of the individual services relevant to you and your practice.

Your feedback would be greatly appreciated. The more questionnaires that are returned, the more we can be sure that all your views are taken into account.

All participants will remain anonymous and any information given will be treated as strictly confidential.

We understand that your time is valuable, so we have kept this questionnaire as short as possible.

Please use the link below if you wish to complete our survey which will be active for four weeks from Monday 13th January 2014. If you have any colleagues who might also want the opportunity to provide feedback, please forward this message to them.

https://www.surveymonkey.com/s/THYKMM5

If you would like to discuss any issues regarding the survey, then please contact us as below.

Thank you for your valuable time.

Yours Sincerely

Pathology Quality Manager Barts Health NHS Trust

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Appendix 2

Tower Hamlets CCG “in Brief Newsletter containing survey link

Headline News 17/01/2014Issue Number: 16

Dr Shah Ali - meet your new Governing Body representaive for LAP 8 Dr Shah Ali is a GP at Barkantine practice and he will be replacing Dr Stuart Bingham as the representative for LAP 8. View this video to learn more about Dr Shah Ali. CQC reports on Barts Health The CQC has published its findings into the inspection of Barts Health Services that were undertaken in November 2013. Read the recently published briefing note on the CQC report on Barts Health here. A factsheet summarising areas of good practice, areas for improvement and compliance actions as highlighted by the CQC in each of the sites can be read here.

Have your say - Barts Health Pathology Service survey

Barts Health are keen to assess the levels of GP satisfaction with the service they provide and to ensure a better understanding of your requirements. Find out more and complete the short survey.

Events and Trainings

Call to Action Tower Hamlets - Public Pharmacy Partnership engagement event 31 January

North East London Public Pharmacy Partnership invite you to an important discussion on how local pharmacies in Tower Hamlets can improve healthcare. General practice staff are encouraged to share this with your patients.

View the flyer here

NHS Medical Leaders Conference 2014 - 11 February Manchester hosted by NHS England

Keynote speakers include Sir David Nicholson

Find out more and book a place

Crucial Conference - The Power of Collaboration and Innovation - 12 February

Londonwide LMCs is hosting this one day conference to deliver the knowledge you will

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need to meet the challenges

Appendix 3

Questions and requests for information with the analysis of responses

Question 1

Please indicate the location of your practice

Answer Options Response Percent

Response Count

Tower Hamlets 45.8% 27 Newham 8.5% 5 Redbridge 23.7% 14 Barking and Dagenham 5.1% 3 Waltham Forest 16.9% 10

answered question 59skipped question 1

Please indicate the location of your practice

Tower Hamlets

Newham

Redbridge

Barking and Dagenham

Waltham Forest

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Question 2

Please indicate the Pathology services you use


Response Count

Biochemistry 100.0% 58 Clinical Transplantation 3.4% 2 Cytogenetics 3.4% 2 Cytology 67.2% 39 Haematolgy 96.6% 56 Histology 44.8% 26 Immunology 69.0% 40 Microbiology 94.8% 55 Stem Cell 0.0% 0 Virology 56.9% 33

answered question 58 skipped question 2

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Question 3

How easy do you find it to obtain your Pathology supplies


Response Count

Very difficult 9.4% 5 Difficult 20.8% 11 Neither 35.8% 19 Easy 26.4% 14 Very easy 7.5% 4 What problems have you experienced? 26


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Numbe r W ha t p ro b le ms ha ve yo u e xp erie nce d ? Cate go rie s1 We have to wait for some time for delivery, sometimes it goes astray Delay/Lost2 1.on occasion results dont always come into GP links�

2 accesing cyberlab to view results is also difficult as site has IT issues and sometimes crashes�3.Results sent to old GPs inbox who users whoi have left- who is IT lead at pathology for communication �4. unable to directly file results from cyberlab on clinical system in practice

N/A

3 Opening times for the pathology department are restricted up untill 1pm and this can be inefficient when chasing up results after this time. N/A4 lab won't supply enough plastic bags for our spoecimens - keep running out Insufficient5 Never get the amount we order which affects our ability to do our job i.e. not having enough cytology pots and brushes. Insufficient6 cytology no longer provides bag within the kit. Not supplied7 MSU results sometimes taking almost 1week. N/A8 no path forms Not supplied9 items ordered don't always arrive�

they may then arrive several orders together leading to storage issuesDelay

10 lost of fax request�saying fax not recd, when confirmed received previously�slow turn around time from order to delivery

Ordering and delivery

11 Usually easy but sometimes things run out. Insufficient12 We would like electronic results N/A13 blood results get sometimes allocated to a different doctor of the practice rather to the one who requested them N/A14 not personally involved in obtaining supplies- have not noticed obvious shortages recently OK15 Delayed results, takes more than a week to get results N/A16 No red top urine bottles , difficult to access information what to use and similarly with the ACR urine moving from syringe style bottle to White topped was

very chaotic .Not supplied & communication

17 I am not close to this, but not aware of specific issues OK18 We can only obtain a limited suppy of test forms at any one time. This means more frequent orders have to be placed. Insufficient19 Unable to obtain Ubags for children, recently found it very difficult to get red top bottles. Confusion regarding the new swabs - the email sent to teach us

how to use did not make it clear what the new swabs would look likeNot supplied & communication

20 Obtaining urine containers Insufficient21 do not get supplies N/A22 I have been told that we are limited as to how many urine dipsticks and CTCG swabs we can order due to budget restrictions. I never receive the

number of urine stix I request, and this can be very stressful in the reality trying to manage stock levels in general practice. This means that I am frequently made to call pathology supplies and plead for the supplies I need. This is a waste of my time, and is frustrating. We are not abusing these consumables in general practice, and only use them when clinically necessary. Therefore we should receive the ones that we request without issue.

Insufficient

23 we do phlebotomy service at the practice. Which is convenient for patients, especially those disaballed and chronic conditions who can not travel far for blood tests. Recently the supply of bottles have stopped. We have sent relavent senior staff emails but no response. There is no cost to yourselves as the staff cost and other costs associated is paid by the staff. We are saving costs and extra burden to those who do phlebotomy services locally. There are no justifiable reasons why the bottle supplies have stopped.

Insufficient

24 Supply of TQuest forms can sometimes be delayed. Delay25

Delays and frugal in deliveryDelay & Insuccient

26 don't use the service N/A

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Question 4 Is the information we provide clear and relevant to the service?


Response Count

Very clear 0.0% 0 Unclear 9.3% 5 Adequate 37.0% 20 Clear 48.1% 26 Very clear 5.6% 3 What additional information would you prefer? 7


Is the information we provide clear and relevant to the service?

Very clear

Unclear

Adequate

Clear

Very clear

Numbe r W ha t ad d itiona l info rma tio n wo uld yo u p re fe r? Ca teg o rie s1 Some of the electronic test results comes under admin which makes difficult to file in patients record. IT2 It would be useful to have more info about tests especially where grouped eg hepatitis ones More info on

grouped tests3 An online system to see results and also how to organize tests�

An online system to chase test results that frequently aren't sentImprove IT

4 Hba1c result still contains too much information. Long explanation and at the very bottom a result, which one can almost miss. Otherwise results are clear on the whole.�One other issue: some departments (nephrology) still don't seem to use eGFR as a measure of kidney function. Their letters use Creatinine as a measure (I know not a pathology issue, but a bug bear)

Hba1c too much information

5 Adequate but not great. I also work in Southend where the clinical advice from the biochemists occur more often eg eg if the there is a problem with the prolactin levels or thyroid levels are abnormal or even glucose

Better clinical advise

6 replies to concerns, need contact details of all who deal with pathology services and BOTTLES (stock) Contact names and numbers

7 n/a N/A

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Question 5 Do you have electronic links with Pathology to?

Answer Options Yes No Response

Count

Request tests 30 21 51 Receive results 56 2 58


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Question 6 Are you satisfied with the existing specimen collection and transport systems?


Response Count

Very dissatisfied 9.6% 5 Dissatisfied 11.5% 6 Neither 21.2% 11 Satisfied 50.0% 26 Very satisfied 7.7% 4 Comments 22


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Numb e r Co mme nts Ca te g o rie s1 The collection people should be flexiable always in a hurry unable to wait fro 5minuites Collection time2 on occasion courier company have not come to collect samplss leaving practice staff to take samples to lab, or

recalling patients as samples have not gone to lab at correct timesCollection failure

3 existing specimen collection and transport systems are ectremely efficient and productive always on time and better for practice

Good service

4 We have a collection every day mid afternoon but only on two days do we have a ccollection in late afternoon. this discriminates against individuals who need tests but who work.

Collection time

5 Would like twice daily collections Collection time6 One patient's HVS sample was lost, Lab staff states that there was no record of the swab on their system. N/A7 prefer collection in the afternoon rather then 10.30 am Collection time8 We have a collection at 10:30am we would like this to be in the afternoon. Collection time9 our courier comes at 8.15am which means that lots of specimen have to be stored in the fridge overnight. Collection time10 Reception staff have told me that the courier (George) is very rude. Behaviour11 Speicmens are collected very early int he morning, It would be useful if it could be collected say 10 am onwards. Collection time12 Later collection would be better, in particular since the lab now processes routine samples in the evening. Collection time13 Ours are collected at 10am this should be later Collection time14 coudl come in the evening more often Collection time15 would like the evening collection to be later than 3pm [which is when it comes] Collection time16 do not use N/A17 rather fragmented and I believe delivered under 3 exisiting contracts but we've got used to working round it Collection time18 Our courier does a good job under the circumstances: he is usually against the clock, and the limitations of traffic and

practices not being ready when he arrives are difficult to manage.Good service

19 We need the transport system as it is an extremely beneficial services to practice population. N/A20 Further flexibility for evening collections would be welcome. Collection time21 I do a lot of my own bloods. I am very logistically constrained as to the times and venues that samples are picked up.

In addition because they go on a milk run around the borough many become uselessCollection time

22 n/a N/A

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Question 7 Please indicate your level of satisfaction with the test repertoire provided by each Pathology service you use

Answer Options Very dissatisfied

Dissatisfied Neither Satisfied Very satisfied

Response Count

Biochemistry 1 5 4 40 6 56 Haematology 1 2 3 41 9 56 Immunology 2 2 8 27 5 44 Cytology 1 3 7 29 6 46 Histology 0 1 6 20 4 31 Microbiology 0 6 6 32 9 53 Virology 1 3 8 27 6 45 What additional tests do you require? 7


Numb e r W ha t a dd itiona l te s ts d o yo u re quire ? Lis t1 BNP please BNP2 BNP BNP3 Vitamin d, Vit D4 we want to be able to order LFT's individually not as a group please LFT 5 Don't need additional tests but find the naming of some of the tests unhelpful- eg the various hepatitis B test6 dont know7 BNP for heart failure�

for cervical cytology recently there were mismatches in results vs recall recommendation�occasionally for specimens such as nail clippings, species are listed but no advise on sensitivities and treatment options given

BNP

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Question 8

For the pathology services you use, do you receive your results in a timely manner that meets your clinical need?

Answer Options Never Rarely Usually Mostly Always Response Count

Biochemistry 1 5 18 23 10 57 Haematology 1 4 18 24 10 57 Immunology 0 4 17 18 3 42 Cytology 0 2 16 21 5 44 Histology 0 3 18 13 2 36 Microbiology 2 3 16 25 6 52 Virology 1 3 18 19 5 46 Please give examples where problems have occurred 19


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Numbe r Plea se g ive exa mp le s whe re p ro b le ms ha ve o ccurred Ca te go rie s1 Not being called about abnormal potassium readings or severe anaemias Urgents2 on occasions results are needed urgently, lab is not allowed to fax results which delays process and patient experiance to practice Urgents3 fairly regularly get lost results and it is very difficult to contact the lab to ask for copy to be downloaded; rings engaged or no-one answers Lost4 Cytology report paper copy is always delayed.�

Chlamydia test - results are not sent back to surgery, always have to chase it up�virology and biochemistry are the same, we always have to follow it up.�Phone line is difficult to access.

Hard copies not received

5 daily Delayed6 some vitamin D results never arrived some months back (seemed like a batch) Lost7 At Langthorne Health Centre there are 3 single handed GP Practices. Lots of B/T results are still going to the wrong GP's. This is causing major

problems. If we request the results that have been sent to wrong doctor via the links again they do not always get done. Also it takes time to get through to request.

Registration errors/Sender codes?

8 rsults often late or lost. Hae been put through to various people re this only to end up finding sample lost. Samples impossible to track fro WXH to Royal Londons lab fro WXH requiring me to call up 2 hospitals and lose more time

Lost

9 The biggest problem is that results do not go back to the named Dr that ordered them so this can be very frustrating Registration errors/Sender codes?

10 failed to do tests requested on pathology form�failure by lab to communicate results to GP�failure in complaint mechanism (Barts path lab get back in timely manner to queries raised - has been on occasion weeks later.


11 All GP practices need to be linked to the hospital computer system so we do not have to phone the lab at WX. Also some things are now only done at Royal London whose switch board system is awful - you can spend hours going round in circles not able to talk to anyone. We are not sure what is done at royal London an what is done at Whipps The Southend system of ICE is a lot more efficient, they have had it running for years. linking GP's with secondary care saves time money and improves clinical safety. im not sure if this type of system is available at whipps or if other practices have it but we don't

Need IT links

12 Stool cultures take longer than helpful often Delayed13 The results are not always sent back to the correct inbox [ie to the doctor ordering the test or the doctor names as usual doctor on our software this

means someone at the practaice has to spend up to 15 monutes redirecting them each day please can you fix this- we have asked before and nothing improved


14 we are constantly having to phone to get our results because they do not come on the links and each time we are told the same thing, our results have been sent to another doctor in Walthamstow called Dr Philip (our practice is in Ilford) he happens to have the surname of our Gps first name. We have had communications with regarding it but it is still happening on a regular basis.


15 none N/A16 Not being made aware when the computer system was down at the hospital end leading to delay in transmission of results. Communication

17 Cytology results are not coded properly and we have to code manually each result as they come as partially filed on our clinical system. Something needs to be done about this issue. We have INPS Vision system and this has always been a problem and has never resolved inspite to numerous phone calls.

IT

18 I would say comfortably at present around 10% of samples are useless because the phlebotomists have either not taken enough sample, the sample has become useless in transit, smashed or leaking bottles and the enigmatic "lab error- sample could not be processed". Given the risk we carry this is completely unacceptable and may warrant service re/decomissioning �Electronic reports depend on whether "the guy at Whipps is on holiday or not"

Unsuitable samples

19 Quite often,results get sent to wrong GP. Registration errors/Sender codes?

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Question 9

Do you find the reports clear to understand?

Answer Options Very unclear Unclear Adequate Clear Very clear Response Count

Biochemistry 1 1 11 37 6 56 Haematology 1 1 11 36 6 55 Immunology 1 1 12 26 2 42 Cytology 3 0 7 28 3 41 Histology 1 0 8 22 2 33 Microbiology 1 1 14 30 5 51 Virology 1 2 7 29 2 41 Please give examples where problems have been encountered 18


0

10

20

30

40

50

60

Do you find the reports clear to understand?

Very unclear

Unclear

Adequate

Clear

Very clear

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Numb e r Plea se g ive e xa mp le s whe re p ro b le ms ha ve b e en e nco unte re d Ca te g o rie s1 Would be useful to have more explaination sometimes on blood film reports as to whether they need further action Report content2 The added comments from electronic results stops the result from filing into patients notes. IT3 changes to range normal levels4 Please put the HBa1c actual result near the TOP of the report - it is buried under a lot of explanatory text�

Please put the Trichomonas culture result from HVS just under the initial report - NOT at the bottom of the report underneath all the guidance notes. I almost missed a positive TV the other day as it "falls off the bottom of the screen"

Report format

5 sometimes results have been labelled contaminated, insufficient labelling when staff know that they were sent out to the correct standard

Labelling of samples

6 I usually state which antibiotic I am starting a patient on but sometimes results come back without listing resistance/ sensitive to the drug I have given

Result content

7 It would be helpful to order the results so they are at the top of what is sent, not a list of pieces of irrelevant information which may mean the result eg hba1c or vit d2 disappear off bottom of screen. Coded results are needed for syphilis, HIV, smears, rubella, hepatitis etc so they can be filed directly into emis.

Report format

8 separate results fro banks of tests, serum save results, results being sent in wrong format for system 1 to file IT9 nervous about paediatric reference ranges for haematology being accurate Report content10 N/A N/A11 As above mainly re Hba1c. Sometimes with microcytic anaemia, it would be helpful if a thalassaemia or Ferritin test could be

automatically organised to avoid further phlebotomy to our patients.Service

12 Sometimes the amount of free text associated with results has an impact on how easy they are to read when rendered on the INPS Vision screen

Report format

13 woudl be helpful to have more advice regarding slightly abnromal immunology resulst written with teh result. Microbiology retsult tiem very variable, also woudl be helpful to have complete sensitiviies of micribes so we don;t have to ring up for sensitiviteis if ptr is allergic or mutipple resisitnances,

Report content

14 Frustrated that bloods are not sent back to named clinician, despite requests being generated electronically, with printed clinicians names on!!!!!!

IT

15 Normal ranges are helpful but not to be relied on clinically- eg cholesterol levels wher ewe have to interpret in light of clinical context but don't see how you could do more to help with this�I still don't like the HVS reports- think the trichomonas results should be up the top and the long disclaimer about GC to then follow the results

Report format

16 none N/A17 always partially file see above comments on Cytology results received Report format18 Hep B and C samples- lots of duplication of reporting, just give me one report Report format

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Question 10

If sending work which requires urgency how satisfied are you in receiving the result in a timely manner?

Answer Options Very dissatisfied Dissatisfied Neither Satisfied Very

satisfied Response

Count

Biochemistry 4 4 8 33 4 53 Haematology 4 3 8 34 4 53 Immunology 2 3 7 26 0 38 Cytology 2 4 8 25 1 40 Histology 2 3 6 23 0 34 Microbiology 3 5 8 31 1 48 Virology 2 4 7 26 1 40 Comments 12


Numbe r Co mme nts Ca teg o ries1 I've never tried to get urgent micro but when I've marked results urgent please phone, I have not ever that I can

recall been phoned; also there seems to be no obvious system to phone/fax critically abnormal resultsCommunication

2 never get urgent results with in 24-48hrs Results3 communication shambles Coomunication4 Seems to work better if a phone call accompanies the request marked urgent. �

Usually very out of range results are phoned through appropriately, but sometimes one gets missed - a sodium of 125 was only picked up in my routine inbox recently...

Communication

5 Is rare to require this. mostly ok but in cases where result needs to be done urgently is difficult to organise. Same day results could prevent referrals etc

Communication

6 microbiology results for some reason even though have been coded with correct requesting GP code, have always been sent to principal at practice, even though all other tests are sent to requesting GP

IT

7 Not had to do it recently N/A8 n/a N/A9 I have never sent any urgent work- the routine turn around times are very good N/A10 na N/A11 There is no facility for urgent tests to be flagged in TQuest IT12 You frankly don't do urgent anymore Service

0

10

20

30

40

50

60

I f sending work which requires urgency how satisfied are you in receiving the result in a timely manner?

Very dissatisfied

Dissatisfied

Neither

Satisfied

Very satisfied

Page 23 of 31

Question 11

Do you find it easy to contact the departments by phone or email for clinical and technical advice?

Answer Options Very difficult Difficult Neither easy Very easy Response Count

Biochemistry 2 15 18 15 3 53 Haematology 2 18 13 18 2 53 Immunology 0 9 15 9 1 34 Cytology 0 12 14 11 1 38 Histology 1 9 13 6 0 29 Microbiology 2 17 12 18 1 50 Virology 2 7 14 12 2 37 Please give examples where this can be improved 21


0

10

20

30

40

50

60

Do you find it easy to contact the departments by phone or email for clinical and technical advice?

Very difficult

Difficult

Neither

easy

Very easy

Page 24 of 31

Numb e r Ple a se g ive e xa mp le s whe re this ca n be imp ro ve d Categories Sug e stio ns1 Sometimes there is a delay in getting through and Phone2 Virology and Microbiology out of hours are very very difficult Pnone3 A clear list of telephone numbers to contact for results or clinical advice for the various departments would be great; Phoning

switchboard is a frustrating experiuence, often engaged, and then asking for department.Phone List of phone

numbers4 communication tel numbers Phone List of phone

numbers5 switch board to not always put you through to the right number eg when request a haematologist might get the lab results line. Phone6 Sometimes takes a long time to get through. Phone7 send email sometimes takes a day to repond, sending faxes even worse Email/fax8 definitely more difficult since the hospital merged; not sure who to phone anymore for advice�

very difficult to inquire about results which are still pending or missing,Phone

9 Is hard to get through lines engaged and should not be at the stage where have to telephone for results - have got better recently (required to call less)

Phone

10 N/A11 difficult to reach the person Phone12 Phone often just rings and rings Phone13 the direct phone numbers are still unclear to many members of our practice Phone14 At Whipps the biochemistry will not give results for haematology not to mention we shouldn't have to if we had a link and access to

all radiology and lab results at the hospitalPhone

15 Takes too long to get through to lab.often difficult to track down a doctor if specific advice needed. Phone16 not phoned for advice only to receive results Phone17 I do this very little now since we have Cyber lab, when I have done it occasionally the usual problems with internal paging not

working have been a problem at times.�E-mail response times- I've only tried haematology have been patchy- sometimes unacceptably slow

Email

18 Pathology department access is difficult now as previously we received information over the phone but now we have to wait. Phone19 Easier access to the on call registrar for microbiology Phone20 Availability of staff has deteriorated massively since the merger Phone21 it is very difficult to reach by phone. Phone

Page 25 of 31

Question 12

Are your queries resolved to your satisfaction?

Answer Options Very dissatisfied

Dissatisfied Neither Satisfied Very satisfied

Response Count

Biochemistry 2 4 11 28 5 50 Haematology 2 3 11 31 4 51 Immunology 1 1 7 25 0 34 Cytology 2 2 9 23 0 36 Histology 1 2 6 21 0 30 Microbiology 2 4 11 25 5 47 Virology 2 2 7 22 4 37 Please give examples of experiences you may have had 11


0

10

20

30

40

50

60

Are your queries resolved to your satisfaction?

Very dissatisfied

Dissatisfied

Neither

Satisfied

Very satisfied

Page 26 of 31

Numb e r Ple a se g ive e xa mp le s o f e xp e rie nce s yo u ma y ha ve ha d Ca te g o rie s1 I had a query with virology on a saturday and almost 60 minutes later I was being asked to contact the microbiology

technician to ask if the microbiology technician will leave a message for the virologist the following day. Microbiology out of hours also very difficult to get a response from they seem over worked and too few of them�In the out of hours setting biochemistry do not seem very helpful in giving details about the patient and invariably they have to be rung back for more information. I have no complaints with biochemistry in hours - indeed, my experience in seeking advice has been excellent.

Negative & Positive

2 daily Negative3 siad fax not received, ask to resend request Negative4 microbiologists particularly helpful Positve5 Pat in path lab is very helpful. Positve6 Who is the lead liasing Whipps cross and royal London with primary care, why have they not made themselves known to

every surgery to resolve any problems which may occur quickly - this would make it easier for problems to be resolvedNegative

7 No- have written numerous emails requesting results are forwarded to requesting clinician- currently I get the lot!!!! �Told glitch in system and will be being resolved!!! No evidence as yet!!!

Negative - IT

8 as above9 when I have accessed clinical advice usually a very helpful and useful response Positve10 Don't bother ringing anymore Negative11 Readcodes are still wrong have to be manually inputted into clinical system Nregattive -IT

Page 27 of 31

Question 13

Do you feel that you have adequate opportunity to discuss your requirements with representatives of the Pathology Service?


Response Count

Yes 39.2% 20 No 60.8% 31


CAG Answer Options Response

Percent Response

Count Tower Hamlets Yes 56.2% 13 No 43.5% 10 Newham Yes 25.0% 1 No 75.0% 4 Redbridge Yes 33.3% 4 No 66.7% 8 Barking and Dagenham Yes 66.7% 2 No 33.3% 1 Waltham Forest Yes 0.0% 0 No 100.0% 9

Page 28 of 31

Question 14

Pathology would be available to partake in GP educational activities and is currently developing Podcasts. If interested, what topics would be relevant to you?

Answer Options Response Count

19 answered question 19

skipped question 41

Numb e r Re sp o nse T e xt Ca te g o ry1 not sure General2 what coloured swabs to use for which tests and how to store it. How to properly collect samples for mycology and threadworms and what

equipment is oprovided to GP for this. How to advise pt to collect sample for chlamydia and gonorrheoa - ?early morning urine samples.Microbology

3 Low red cell indicies, abnormal wbc racial variants particuarly, mixed growth in preg women MSU's Haematology4 how to interprete reuslts for clinicians Results5 NA General6 Biochemistry topics such as endocrine results. Biochemistry7 good practice around length of time certain samples can wait as we only have 1 daily transport Supplies8 Faster access of results and efficient service General9 to improve service first General10 Interpreting infrequently done tests Results11 raised liver enzymes Biochemistry12 Triglycerides interpretation, High ferritin interpretation, GGT management General13 How to request certain tests (such as OGTT 24hr urine cats etc) Requests14 Rational test requesting� Understanding immunology requests Requests

and results15 Sounds excellent General16 Interpreting biochemistry results Results17 I think that this should be part of overall clinical pathways work General18 Supplies to GP surgeries Supplies19 No time. Just give us the service you are paid to General

Page 29 of 31

Question 15

How satisfied are you overall with the Pathology Service?


Response Count

Very dissatisfied 3.6% 2 Dissatisfied 16.4% 9 Neither 16.4% 9 Satisfied 60.0% 33 Very satisfied 3.6% 2


Page 30 of 31

Question 16

If you would like to meet with a representative(s) of the Pathology Service to discuss your requirements please enter your detail below


Response Count

Your name: 100.0% 15 Position: 93.3% 14 Email address: 86.7% 13 Telephone number: 86.7% 13 Practice name: 100.0% 15 Practice address 86.7% 13


Numb e r

Yo ur na me: Po s itio n: Ema il a d d re ss :T e lep ho ne numb er:

Prac tice na me : Prac tice a d d re ss

1 Practice Manager a st pauls way medical centre 99 st pauls way, london, e3 4aj2 Practice Manager Green Man Medical Service 1 Hanbury Drive, E11 1GA3 PRACTICE MANAGER h THE DRIVE SURGERY 68 THE DRIVE ILFORD ESSEX IG1 3HZ4 Practice Manager s Gants Hill Medical Centre 63/65 Ethelbert Gardens Gants Hll Ilford IG2 6UW5 GP partner Wanstead Place Surgery 45 Wanstead Place, London E11 2SW6 Salaried GP 7 St. Paul's Way Medical Centre 99 St. Paul's Way, London. E3 4AJ7 IM&T Manager St Stephen's Health Centre E3 5ED8 GP The Shrubberies medical centre 12 The Shrubberies George Lane, south Woodford, E18 1BD9 The shrubberies medical centre10 practice manager n stratford Medical Centre 60 Leytonstone Road, London E15 1SQ11 GP Bethnal Green HC 60 Florida Street12 practice manager boleyn medical centre 152 barking road east ham13 GP o t Chrisp Street Health Centre14 Practice Manager a Hampton Medical Centre 1 Pretoria Road, Leytonstone, London, E11 4BB15 Practice Manager Ecclesbourne Surgery E17 9DP

Page 31 of 31

Question 17

Thank you for the time spent completing this survey. Would you like to make any general comments/requests relating to the service provision?

Answer Options Response Count

14 answered question 14

skipped question 46 Numb e r Re spo nse T ext Ca te go ry1 IT leads and updated contact details for any queries IT2 shambolic General3 On the whole, apart from wrong GP's getting the results the pathology results service is much better. General4 Could we please have electronic results? IT5 it would be great to have a list of telephone numbers to gain easy access to the different pathology departments for inquiries Communication6 has gotten better recently General7 Woul be helpful to have easy way of working out which hepatitis tests to request in diff clinical scenarios (TQuest)8 Hi, My area of contact is on the IT side. Getting users set up at BH to enable them to use tQuest. Can an easier/quicker way be found to enable this

access? Locums are not set up for several weeks, leading to an increased workload for other members of the team to generate tQuest rx forms �Could we have a named member of staff to contact for this and any IT queries? Emails to the generic account do not always get a response.

IT

9 Pathology results are still not going to the correct user inbox. This is not only at this practice but seems a general thing with other practices. IT10 Feel free to contact me to discuss further General11 the main problem is that we can not provide the phlebotomy service at the practice which we have been doing for years. we have 9000 patients therefore

the impact is going to be high and those with chronic disease, disabled patients will not travel also with area parking restrictions, their health will be compromised.

Service

12 Cervical screening results are not coded properly�There is too much information on some results (eg HbA1c) - how do we feed this back?

Reports

13 Massive deterioration since the merger General14 The service was not properly thought through before the change.As City / Hackney and tower Hamlets are mostly Emis there wsa no thought to different

clinical systems, We are system one and I still have issues. There is also Human error in inputting and we still receive results that do not belong to the practice,

IT

Documents

Pathology User Survey Report 2013-14 - WhatDoTheyKnow · Pathology User Survey Report 2013-14 ... There have been instances of ... Service failure mainly surrounds communication with