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291909519050075596753022600018288007175500 North Devon District Hospital Pathology DepartmentReport of the NDHTClinicians’ Satisfaction Survey(Conducted in May 2017)116649551371500Contents TOC \o "1-2" 0 INTRODUCTION PAGEREF _Toc506808219 \h 31.0 AIM AND OBJECTIVES PAGEREF _Toc506808220 \h 32.0 STANDARDS PAGEREF _Toc506808221 \h 33.0 METHOD PAGEREF _Toc506808222 \h 34.0 Responses to Survey Questions PAGEREF _Toc506808223 \h 55. RESPONSE TO QUALITY IMPROVEMENT SUGGESTIONS PAGEREF _Toc506808224 \h 190 INTRODUCTIONThe Pathology Department complies with ISO 15189 ‘Medical laboratories – Requirements for quality and competence’. Clause 4.14.3 sets the requirement that the laboratory shall seek information relating to user perception as to whether the service has met the needs and requirements of users. This survey was undertaken to comply with this clause, and in doing so, has brought to the attention of laboratory management areas where we could improve the Pathology service.1.0 AIM AND OBJECTIVESThe purpose of the survey was to assess the level of satisfaction of NDHT clinical/medical staff, (from NDHT hospital locations 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 STANDARDSISO 15189 ‘Medical laboratories – Requirements for quality and competence’. 3.0 METHODSurvey Monkey was used to create an 18 question long survey designed to elicit NDHT clinicians’ views about the Pathology Service at North Devon District Hospital. The questionnaire is available as a separate attachment in Q-Pulse (Q-SURVEY-7). NDHT Medical Staffing distributed a link to the survey to all senior medics/clinicians in the Trust by email. The Medical Education Centre supplied a list of all junior doctors’ email addresses and the survey link was sent to them using this list. 18 responses were received.The email with survey link was resent 2 weeks after the initial email to hopefully persuade more users to be complete the survey. This resulted in a further 9 responses.There were 27 returns in total and the categories of staff responding were as follows:15113012827000The four returns from the ‘Other’ group were broken down as follows:3 x Associate Specialists1 x Staff GradeThe specialities of all the respondents are shown below:-194373593980004.0 Responses to Survey QuestionsAll comments are reported verbatim apart from the anonymisation of names.How satisfied are you with:-2419352032000Additional Comments: 0How satisfied are you with:-23304512509500Additional Comments: 8PositiveEasy to call the lab and get this infoOccasionally have asked for advice at specimen reception; staff always helpfulNeutralUnsure where to find information regarding correct bottle selection for more obscure tests however lab staff very approachable via telephone or in personI have found it quite difficult to find this information on Bob but the laboratory staff have always been very helpful when I have phoned. I suspect part of this is that I joined the trust mid cycle so missed induction where this may all have been explained.There could be more of the vacutainer detail posters on the wards to avoid using the wrong ones for rarer testsNegativeWhen asking the first reply relates to adult "result" even when saying I call from paediatrics.This information is not available to at the point of contact eg clinic roomsI may know the right answers but either the OPA nurses or the phlebotomy team may not be able to get the right information to ensure that the specimens and collected or delivered to the laboratory correctly. Two examples: plasma renin and aldosterone levels and 24 hour urine collection for metanephrine and normetanephrineHow satisfied are you with:-38798512509500Additional Comments: 3PositiveExtremely good turnarounds.Excellent histopathology turnaround timesNeutralThough there may be a variable time for results to be forwarded from other labs. Sometimes this may be a week, occasional more than a month.40767053911500How satisfied are you with:-Additional Comments: 4PositiveThe lab have always been very helpful when I have had poorly patients and have turned things around much faster than in other trusts I have worked at.Satisfied (but not particularly relevent as rarely request tests urgently)NeutralVery variable duration of results for urgent tests.NegativeThe process of getting an urgent specimen done is not well known and sometimes it takes a whileHow satisfied are you with:-Additional Comments: 3PositiveHave been down during the night for urgent ABGs -Biochemists always willing to help, even when sometimes I've not bleeped in advance.NegativeDepending on which technician you get you can either get a person who is angry that they have to process specimens or someone who is brilliant and helpful. Unfortunately I have had technician berate me that they have been unable to sleep as I have forgotten to bleep them after midnight and walked the specimens to the lab during the night.Blood cultures continue not to be put on computer when taken, resulting in a delay in culture result, resulting in a delay in discharge of patient and extended length of antibiotics given.29083017907000Additional Comments: 5PositiveLab staff very good at phoning through urgent or unexpected results.NeutralMore information could be provided for interpretation. In chronic disease management the results should also be available for the patient too in a form that they can understand and that can promote or encourage good self-management skills. (infographics ?)NegativeSometimes difficult to read on the pas system!It is not clear which/when results are age related and when notNot always clear on the system e.g culture reports Additional Comments: 13PositiveBit clunky at first but doesn't take long to get used to and very easy to use once you know howNeutralThe computer system is hard! Once you get the hang of it is ok but it tricky. Again I probably missed the induction session where all the key bits were explained.It took a bit of time to understand the system, but i still think that we need to update/change the software.It is archaic. Producing timelines/ graphs of change in values over time would be useful.I'm used to the Labcentre interface now but initially found it clunky and difficult to navigate.NegativeIt's terrible, it needs to be updatedOld system, difficult to navigate, messages attached to results not always easy to bring up and understandNot user friendly in form of complicated sequences when changing and old lay out (could have more results on one view)It is extremely clunky and out of date. Not at all intuitive to use and need to go backwards and forwards too much to find what you need. No search facility.Not very intuitive. Fine if you got a hospital number and want to look up a single result. Should have a laminated card how to look up results by name and how to list multiple results, e.g. FBC or U&ENot user-friendly. Historical system.Probably the worst computer system this hospital uses. Multiple reasons for this.It is very old and out of date. Graphs should be available and it should be easier to use3105156159500Additional Comments: 4PositiveIt is faster.I've used an electronic ordering system in GP before, which works well when the specimens are to be taken at a later date. I think I need to get used to Trak care before considering a electronic path system -but if the two could be integrated well it would be useful.Neutralneeds both as the IT system does not allow to have a connected computer everywhere I workDepending on the process, might be easier and less prone to errorsAdditional Comments: 4PositiveOnly experienced contacting micro, who are easy to contactThe senior biochemist, clinical microbiologists and general laboratory staff and managers are approachable and helpfulAlways received helpful advice. I like to pop round and speak to the lab in person sometimes. MIcrobiologists always respond promptly to phone calls for advice.NegativeClinical haematologists perhaps not so.Additional Comments: 4NeutralNot always but due to computer system!Sometimes can't access the additional messages or information on Labcentre which later arrive on paper. I've phoned and sought clarification.NegativeThe lab comments are often unnecessary and make getting the results even longer.Too many routine comments, particularly the AKI - cannot remember having seen an abnormal one.Considering the Pathology Dept in the following scenario: A sick patient is brought into the ED/MAU.96202520764500 -389350109396Clinical advice & interpretation of abnormal resultsAccuracy of results24 hour availability of testsGood support services, e.g. I.T. & Specimen TransportTimeliness of results00Clinical advice & interpretation of abnormal resultsAccuracy of results24 hour availability of testsGood support services, e.g. I.T. & Specimen TransportTimeliness of results3255321118110Answer ranking4000020000Answer rankingRespondents were not asked to offer additional comments for this question.446405-127000Additional Comments and Suggestions: 9PositiveThey do a pretty remarkable job as it is!I've never encountered a situation where discharge has been delayed due to a Pathology issue. Occasionally when working in ED I've needed a result to decide if a patient needs to be admitted for investigation or could be discharged e.g. d-dimer or Troponin. These are done in appropriate time though.NeutralTreatment of some patients depend on the investigating results to plan their discharge.SuggestionsTimely results.If blood test results were available more quickly it may be possible to discharge more from ED, rather than admit them.Electronic ordering and pod transport system to improve speed.Improving speed of turn over.For A&E troponin and d- dimer results are often determining eligibility for discharge-would be nice to get them in a timely manner.Results to patients themselves to promote self-management (as discussed as a previous response).709295698500 Additional suggestions: 7SuggestionsThis is difficult. In places I have worked previously the grouping of tests for specific clinicians and their specialist interest or clinics has worked really well. The danger with this is that there has to be a degree of clinical judgement and the more sets you have the more likely people are to get tests that they didn't clinically need with results that are then difficult to interpret.More test groups would also help.If moving to electronic test requesting this could be done on one of the pages/have links to extra info which might be useful and tell you turnaround times for tests etc also.On Alex ward we have lots of elderly patients with multiple co-morbidities, so a bespoke selection is often more appropriate for these patients.Online.Would need to be very easily accessed, electronically, perhaps as an app on BOB.I've seen it work very well when ordering tests online, difficult to know with passport ordering as only so much can fit on the form and Bob is always a nightmare to use.748030-11049000Additional comments: 11PositiveIt’s fast and efficient.Every department has strengths and weaknesses: approachability for clinical advice is excellent.I will inevitably be biased here, being a former MLA! Keep up the good work!NeutralMore up to date IT systems, sometimes faster turn over.Results system dated.NegativeThe fact that you can have to get into an argument with the pathology technician to get the full ABG slip is unheard of.Previously worked in RCHT, requests and results were electronic. Labelling samples was easier - Llama labelling for transfusions and due to electronic requests could put specific labels on blood tubes.Old computer system. No pod system. No electronic ordering. Hand written labels. All more time consuming/much less efficient.Every department has strengths and weaknesses: IT is poor.In Australia pathology results were fast and appeared as available on "patients in department” list. At the moment we log on to the system, then the patient just to check if results a available-which is a waste of time. Printer often gives results in big batches several hours later.One problem - microbiology results such as hepatitis B and C - results are not on computer. Reminds me of a 1970s hospital where you phone the lab for the result and then the poor lab technician has to rummage around in some files. Can we feature on "Heartbeat"?But the computerised system is the worst I have seen anywhere in the NHS.524510-5524500Additional comments: 6PositiveLove labcentre, it’s really fast despite not being pretty to look at, very functional. It will be hard to beat in terms of efficiency of results. Great lab staff on hand to give advice. Great microbiology advice from Consultants. Very quick urgent test results by telephone.Helpfulness of lab staff when phoned for advice is much appreciated. The " newsletters" are useful for keeping clinicians educated and up to date.The histopathology department is excellent with accurate reports, helpful Consultants and staff and rapid turnaround times. The microbiology department and Consultants are very proactive in the management of relevant patients.NeutralThe MAU question is mandatory: I have no experience there as a paediatric doctor - paediatrics have not been considered in this survey!I would find a Blood gas machine helpful on MAU and/or Glossop ward as these are frequently needed on these wards and would make it easier and quicker to treat patients. Previous hospitals I've worked in have machines on the respiratory wardsReason for 4 not a 5 is the computer systemNegativeThe process of getting an urgent specimen done is not well known and sometimes it takes a while5. RESPONSE TO QUALITY IMPROVEMENT SUGGESTIONSNo.Improvement Suggestion & Response (as of 19/02/18)1Improve accessibility to information relating to specimen container types and specimen collection requirements.Response:-We are currently in the process of upgrading part of the Pathology Handbook. This will include a much improved ‘Search for a Test’ function which will eventually include all tests across all pathology disciplines. It is envisaged that each test will have specific details of type of specimen container, how much specimen to collect, turnaround times, and special instructions – however, this may take a considerable amount of time as there are a vast number of individual tests to be uploaded. 2Improve information to clinicians on how to request urgent (out of hours) tests.Response:-This information is available to clinicians already in the pathology handbook on BOB, however we appreciate that it is not always easy to find. The updating of the handbook in 1, above will help, but in the meantime, a quick call to the laboratory will give you any information you require.3Improve turnaround times for blood cultures – process straight away when out of hours.Response:-The laboratory has recently installed a new blood culture analyser which includes a satellite unit (FX40) situated in the main pathology reception area. This allows for blood culture specimens to be loaded directly into the satellite unit to begin processing as soon as they are received in the lab, improving turnaround times, particularly when received out of hours. The new system has dramatically improved turnaround times (TATs) for blood cultures as can be demonstrated by the following graph (Paediatric blood culture results TATs).:-4Consider providing patients with some results to enable them to self-manage their condition.Response:-This type of initiative requires high level commitment from Trust and GP commissioners which has not yet been realised in this area, however at a local level the Point of Care Testing service (PoCT) has initiated such a facility where this can help individuals. For example a haemoglobin testing device was purchased and given to a patient for them to self-manage their long term anaemia condition. Also the PoCT has expanded their coverage of PoC (glucose meters) to local care homes. This helps to keep people at home whilst managing their conditions.No.Improvement Suggestion & Response (as of 19/02/18)5Update the Pathology computer system.Response:-As part of the Trust’s Electronic Healthcare Record system (Smartcare) one of the later phases includes the implementation of Trackcare Lab Enterprise – a new pathology computer system which is modern and based on a Windows style format. The system will include electronic ordering of pathology tests and automatic integration of pathology results directly into the patients Smartcare record. Unfortunately, this project has encountered delays with implementation and we now hope that it will begin late in 2018 or 2019.6Implement secondary care order comms, in conjunction with 5, above.Response:-As part of the Trust’s Smartcare system, Order Comms for the ordering of laboratory tests is within the Trust will be implemented. The pace of this project is, unfortunately not controlled by the Pathology department. We are would hope that it will be usable by the end of 2018 or early 2019.7Consider removing the AKI (0) lab comment from reports.Response:-The Principal Clinical Biochemist has agreed that the AKI guidance comment that is appended to every AKI result should be removed from AKI NIL reports. It has been escalated to the Pathology Applications Manager for action.8Consider bringing more send away tests back in house to improve turnaround times.Response:-The repertoire of tests that is offered to users is continuously reviewed and where it can be demonstrated that there would be a benefit to patients or users of the service, within the financial constraints that we work within, we implement the appropriate changes such as bringing tests back in-house. An example of this has been the repatriation of Flu A and B testing. Previously these tests were referred elsewhere for analysis. There has been a marked increase in the number of tests performed during the winter months but the turnaround time has improved to just over 3 hours on average (January 2018).9Consider implementing an air tube transport system for specimen delivery.Response:-Despite multiple attempts by Pathology over the past 10 years to get such a project underway, it has not been supported by the Trust and as such, there are no plans to initiate such a project.No.Improvement Suggestion & Response (as of 19/02/18)10Consider releasing all results from a blood gas analysis, e.g. electrolytes.Response:-This has now been implemented.11Implement NPEX for Micro send away tests, e.g. Hep B & C.Response:-The NPEx project is well underway and will be for microbiology tests and blood sciences tests. The RAG status is currently ‘green’ – going to schedule. The I.T connectivity is being set up and tested and the next stage will be to configure the application and begin testing and staff training.12Consider the need for more blood gas analysers on respiratory wards.Response:-The Point of Care Testing manager is currently in discussions regarding removing the blood gas analyser from pathology and siting it in the Medical Assessment Unit. This would increase direct access to blood gas testing for a high use area. There are also plans to increase blood gas testing provision on ICU and A/E. ................
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