title - northern devon healthcare nhs trust · web viewit is envisaged that each test will have...

Northern Devon Healthcare NHS Trust File name: NDHT Clinician Satisfaction Survey

Pathology Department of 22Q-Pulse No.: Q-SURVEY-7 Date of Report: June 2017

North Devon District Hospital

Pathology Department

Report of the NDHTClinicians’ Satisfaction Survey

(Conducted in May 2017)

Author/Approver: B. Seymour NDHT Clinician Satisfaction Survey Report



CONTENTS

0 INTRODUCTION................................................................................31.0 AIM AND OBJECTIVES..................................................................32.0 STANDARDS..................................................................................33.0 METHOD.........................................................................................34.0 RESPONSES TO SURVEY QUESTIONS......................................55. RESPONSE TO QUALITY IMPROVEMENT SUGGESTIONS.......19




0 INTRODUCTION

The 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 OBJECTIVES

The 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 STANDARDS

ISO 15189 ‘Medical laboratories – Requirements for quality and competence’.

3.0 METHOD

Survey 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:

The four returns from the ‘Other’ group were broken down as follows:

3 x Associate Specialists1 x Staff Grade

The specialities of all the respondents are shown below:-


Speciality of All Respondents TotalA&E 2Anaesthetics 1Anaesthetics/ICU 1Cardiology 2Care of the Elderly 1Dermatology 1Diabetes and Endocrinology 1Elderly Medicine 1Gastroenterology 2GP (previously geriatrics) 1Gynaecology 1Medicine 1Ophthalmology 1Orthopaedics 2Paediatrics 2Radiology 1Rehab/General Medicine 1Respiratory 1Respiratory Medicine 1Surgery 1Trauma and Orthopaedics 1Urology 1Grand Total 27



4.0 Responses to Survey Questions

All comments are reported verbatim apart from the anonymisation of names.

How satisfied are you with:-

Additional

Comments: 0





Additional Comments: 8

Posi

tive Easy to call the lab and get this info

Occasionally have asked for advice at specimen reception; staff always helpful

Neu

tral

Unsure where to find information regarding correct bottle selection for more obscure tests however lab staff very approachable via telephone or in person

I 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 tests

Neg

ativ

e

When 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 rooms

I 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 normetanephrine






Positive

Extremely good turnarounds.

Excellent histopathology turnaround times

NeutralThough 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.






Positive

The 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)

Neutral Very variable duration of results for urgent tests.

NegativeThe process of getting an urgent specimen done is not well known and sometimes it takes a while






Positive Have been down during the night for urgent ABGs -Biochemists always willing to help, even when sometimes I've not bleeped in advance.

Negative

Depending 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.





Positive Lab staff very good at phoning through urgent or unexpected results.

Neutral More 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 ?)

Neg

ativ

e Sometimes difficult to read on the pas system!

It is not clear which/when results are age related and when not

Not always clear on the system e.g culture reports





Positive Bit clunky at first but doesn't take long to get used to and very easy to use once you know how

Neu

tral

The 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.

Neg

ativ

e

It'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 use





Positive

It 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 work

Depending on the process, might be easier and less prone to errors





Positive

Only experienced contacting micro, who are easy to contact

The senior biochemist, clinical microbiologists and general laboratory staff and managers are approachable and helpful

Always 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.

Negative Clinical haematologists perhaps not so.





NeutralNot 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.

Negative

The 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.

Respondents were not asked to offer additional comments for this question.


Clinical advice & interpretation of

abnormal results

Accuracy of results

24 hour availability of tests

Good support services, e.g. I.T. &

Specimen Transport

Timeliness of results

Answer ranking



Additional Comments and Suggestions: 9

Posi

tive

They 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.

Neutral Treatment of some patients depend on the investigating results to plan their discharge.

Sugg

estio

ns

Timely 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).




Additional suggestions: 7

Sugg

estio

ns

This 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.




Additional comments: 11

Posi

tive It’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!

Neutral More up to date IT systems, sometimes faster turn over.Results system dated.

Neg

ativ

e

The 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.




Additional comments: 6

Posi

tive

Love 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.

Neu

tral

The 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 system

Negative The process of getting an urgent specimen done is not well known and sometimes it takes a while




5. RESPONSE TO QUALITY IMPROVEMENT SUGGESTIONS

No. Improvement Suggestion & Response (as of 19/02/18)

1

Improve 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.

2

Improve 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.

3

Improve 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).:-

4

Consider 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.





5

Update 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.

6

Implement 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.

7

Consider 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.

8

Consider 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).

9 Consider 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.





10

Consider releasing all results from a blood gas analysis, e.g. electrolytes.

Response:-

This has now been implemented.

11

Implement 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.

12

Consider 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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