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Barnsley & Rotherham Integrated Laboratory services Department: Pan Pathology

Filename : Barnsley User Survey Report QMS No : DOC 135 – Barnsley QR-PQ-102 - Rotherham

Version : 2019 of 26

Author : Natalie Holmes Approved by : Lab Managers

Active Date : 25/06/2019 Review due : 30/06/2020

Barnsley User Survey 2019 Report

Pathology would like to express their thanks to all those who were able to complete this year’s survey.

INTRODUCTION

ISO Standards sub-clause 4.14.3 set requirements that the laboratory management shall seek information

relating to user perception as to whether the service has met the needs and requirements of its users.

This survey has been performed to comply with these standards, and in doing so, will bring to the

attention of the laboratory management any areas of services provided by the laboratory that require

improvement.

The user satisfaction survey ran between 10th April 2019 to 17th May 2019 and its purpose is to obtain

feedback from our users on the quality of the services provided by the laboratory.

The information gained from this survey will enable laboratory management 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.

METHOD

The satisfaction survey was carried out using a questionnaire which was developed in consultation with

BRILS Management Team, Clinical Heads of Department and the Laboratory Director, and comprised of

18 questions designed to elicit users’ general views on the quality of the services provided by Pathology.

The respondents were asked to rate their satisfaction using the following response options: Yes or No,

except in the case of a question asking how the reposndent would like to receive communications from

the laboratory (answers available were “Email”, “News Page via the Website” or “Newsletter”). A

percentage distribution of responses was used to present the data and cumulative percentage

dissatisfaction compared to cumulative percentage satisfaction.

The respondents were also instructed to use ‘not applicable’ where appropriate. The penultimate

question asks users to provide any comments to improve the service, and the final question asks users to

provide feedback of any positive experiences with the service. These have been collated and have been

discussed at a feedback session to the BRILS Management Team and actions identified where

appropriate. Responses are detailed at the end of the report. All responses received are duplications of

the text received.

Separate user surveys have been completed for Community users (DOC 329), Phlebotomy (DOC 331), and

Funeral Director (DOC 333).

Questionnaires were sent via survey monkey to

Trust users – via the communications team, direct email lists and hard copies sent to Education

Centre during Lunch and Learn.






RESULTS OF SURVEY Question 1: Staff Group

A total of 24 responses were received from users within the Trust, these are broken down into Hospital

Medical and Nursing staff as detailed above. Of the two respondents who answered “Other”, their

responses were: Medical Secretary and Allied Health Professional from another Trust.

Question 2: Name (Optional)

This question was optional and was included to allow for specific personal feedback to be given where

relevant and to enable the incentive of a box of chocolate to be delivered to the winning participant in

the draw. For the purpose of confidentiality, the names of participants will not be included in this report.

16 respondents gave their name, whilst 8 respondents opted to submit their response anonymously.






Question 3: Department/Ward (Optional)

Department/Ward Number of Participants

Paediatrics 2

Pharmacy 1

Diabetes Centre 1

ENT OPD 2

Medicine 2

Paediatric Secretaries 1

Anticoagulation Clinic 1

Ward 33 1

CCU 1

General Surgery 1

Cervical Screening, Royal Hallamshire, Sheffield 1

CRT 1

Continence and Urology Service, Grimethorpe LIFT 1

ICU 1

Community – Dearne Neighbourhood 1

19 respondents chose to include the department in which they worked, whilst 5 respondents chose to

submit their survey anonymously. The above table shows that responses were received from a wide

variety of clinical areas within the hospital, covering inpatients, outpatients, surgical areas, professionals

from other Trusts and some community based health care professionals. A number of different

departments/wards were represented in 2019 compared to 2018.

Question 4: Contact Details (Optional)

Respondents were given the option to provide their contact details, should they require a direct response

about any of their answers to the questions in this survey.






Question 5: Were you aware that our user information can be obtained via our website?

This question was added to guage how many users were aware that user information was available via

the hub. A hyperlink to the Laboratory Medicine webpage on the Hospital Hub was also included in this

question to educate users about the location of user information. 33.33% of respondents who stated

that they were not aware that the user information was available via the hub. More users are aware of

the website than in 2018, where 41.46%-51.22%, stated that they were not aware that there was a

Pathology website. Given that a third of users are still not aware of the website, the Pathology

Department will further promote the website in collaboration with the hospital digital communications

team.






Question 6: If yes, are you satisfied with the usefulness of the Laboratory Medicine website as a source of

information for each laboratory?

Comment Response

I've never used the Pathology website. The Pathology Website is available via the following link: http://www.barnsleyhospital.nhs.uk/pathology/ It contains lots of useful information about Pathology and the testing process, including sample & request labelling, sample types/requirements/containters for all tests, result availability and turn-around times, laboratory accreditation, key contacts plus lots more!

Have never used it

It can be difficult to navigate around the site. Especially so for the POCT user guides as it reverts to the old site.

If there is information that you are struggling to find, please contact the laboratory.

http://www.barnsleyhospital.nhs.uk/pathology/






Question 7: Are you satisfied with the range of investigations provided by the laboratory?

100% of respondents were satisfied with the range of investigations provided by the laboratory in Blood

Sciences, Blood Transfusion, Microbiology. In Cellular Pathology, 92.86% of respondents were satisfied,

however 7.14% were not. The issues that have been highlighted via associated comments that were left

are in the table below and responses to each issue are provided.






Comment Response

Would be useful to have Xanthochromia for CSF here to get early / urgent results for ?subarachnoid haemorrhage

Testing for Xanthochromia is done on dedicated equipment and requires staff training. The limited number of tests makes it difficult to provide a service on both sites. If our current service is not meeting your needs pleae contact our clinical team to discuss further.

Being able to perform PCR in house would improve our Paediatric service and free up beds more quickly.

Thank you for your support for this test, unfortunately we are not able to introduce new tests at present due to the proposed SYB ICS plans for a South Yorkshire pathology network equipment tender however this is on our wish list of things we want to introduce but at present is not cost effective.

Use to check blood results and check CT scans, EEG's from other hospitals. Also check radiology reports from Barnsley and other hospitals.

Thank you for your positive comments. We are pleased that you are satisfied with the range of investigations that we provide.

On the whole I would say we are highly satisfied with the range of investigations offered.






Question 8: Are you with the air tube system used to transport specimens to the laboratory?

53.33% of respondents were satisfied with the air tube (pod) system used for transporting specimens to

the laboratory, which is lower than in 2018 (81.48%-82.14%). Where associated comments were left,

responses are detailed in the table below.

Comment Response

Sometimes breaks, often run out of "PODS". The air tube (POD) system is managed by estates. We have passed on this feedback to the Estates department.

Most of the time no PODs/broken system.

There is often a delay in samples being received in the laboratory from phlebotomy Very often this is faulty. Also the Diabetes Centre gets 'stray' samples from other areas. This can happen overnight when no one is in the Centre so the samples are not found until morning

would be helpful to have a central chute from OPD

Great when it works! Thank for your feedback. We are pleased that you are satisfied with the air tube system. Yes , when it is working.






Question 9: Are you satisfied with the format/layout of the test request form for handwritten non-

electronic requests?

100% of users were satisfied with the format/layout of the handwritten request forms in Cellular

Pathology and Microbiology and 94.74% were satisfied in Blood Sciences, whilst 69.23% were satisfied in

Blood Transfusion. Where associated comments were left, responses are detailed in the table below.






Comment Response

Blood transfusion should also ideally be electronic.

Request forms in blood transfusion need to be handwritten as BSH guidelines state ‘it is imperative that patients are robustly and correctly identified at all stages of the transfusion process.’ Doing this minimises the possiblity of bleeding the incorrect patient (WBIT). Wrong blood in tube (WBIT) is a 'never event', it should not happen, however on occasions it does. The consequences of transfusing somebody with blood of the incorrect blood group is very serious and can be fatal. Therefore, handwritten requests, alongside samples being labelled at the bedside, are essential as this adds another safety measure in the Transfusion care pathway.

Blood transfusion form can be confusing as there are two formats, don't really know what the difference is.

There are 3 types of Transfusion request forms within the Trust: Routine, Antenal and Neonate request forms. Routine forms are for general use when requesting group & screens, DAT tests and blood products. Antenatal forms are purely for use by the antenatal clinic. Neonatal forms are to be used for patients <4months old. We are aware of there are 2 types of routine forms in circulation around the Trust; newer and older versions. However, both are acceptable. If you require further clarification or would like a bespoke tutorial please don’t hesitate to contact the Transfusion Practioner or Transfusion Manager with any queries.

Some Endocrine DFT's are not available on the system still for requesting.

More information is required to adreess this. Please contact us to discuss further.

I only use electronic requests

In Pathology, we try to encourage electronic requesting as much as possible. Electronic requesting is beneficial in ensuring that all required patient information and clinical details is conveyed to the laboratory in an easy to read format, which helps laboratory staff to process the samples is the most appropriate manner for the clinical situation. Thank you for requesting electronically!






Question 10: Do you use electronic requesting?

75% of users request electronically. This is a decrease from the 2018 user survey where 97.14% of Blood

Sciences Users and 94.44% of Microbiology Users use electronic requesting via ICE.






Question 11: Are you satisfied with ICE when requesting laboratory tests?

91.30% of users are satisfied with electronic requesting via ICE, which is comparable to the results of the

2018 user survey. Where associated comments were left, responses are detailed in the table below.

Comment Response

Great system, seems pretty reliable, sometimes the seach function for tests is difficult to find tests on

We would need further information – please contact one of the Pathology Information Systems manager to discuss – CB

See above. I also have had issues with the samples showing as reported with DFTS

We would need further information – please contact one of the Pathology Information Systems manager to discuss – CB

Highly satisfield Thank you for your feedback. We are pleased that you are satisfied with requesting tests via ICE.






Question 12: Are you satisfied with ICE when reviewing laboratory results?

More users (91.67%) were satisfied with reviewing laboratory results via ICE than in 2018 (26.83%-

87.17%). Where associated comments were left, responses are detailed in the table below.

Comment Response

But I can no longer see results from other areas. We would need further information – please contact one of the Pathology Information Systems manager to discuss.

Results are often updated on the system although the results themselves don't change. But they appear as a new result and its therefore not possible to check the audit trail to see if someone has already seen the results in the previous version.

The issue of results reappearing (even when final) should now be resolved following work done by the Trust Integration team. Please contact one of the Pathology Information Systems managers if you have specific examples.

I think in the past the sample request status changed from specimen collected to sample received or something similar, now it does not do this it does increase the number of phone calls to the lab to ensure it has been received.

This issue is currently under investigation with the Trust’s Integration Team.

See above. I also have had issues with the samples showing as reported with DFTS

We would need further information – please contact one of the Pathology Information Systems manager to discuss.

Highly satisfied Thank you for your feedback. We are pleased that you are satisfied with requesting tests via ICE.

2.44%






Question 13: Are you satisfied with the usefulness and availability of advice and assistance provided by

laboratory staff?






100% of users were satisfied with the usefulness and availbility of advice and assistance from laboratory

staff in normal working hours in all disciplines.

Outside of normal working hours 100% of users were satisfied with the usefulness and availability of

advice provided by laboratory staff in Cellular Pathology, alongside 93.33% for Blood Sciences, 91.67%

for Microbiology and 84.62% for Blood Transfusion.

Where associated comments were left, responses are detailed in the table below.

Comment Response

I personally only speak with laboratory staff during normal working hours and I have always been satisfied with the assistance provided.

Thank you. The positive results have been fed back to Laboratory Managers to feed back to staff as part of staff meetings. The results have also been passed onto the Pathology Business and Service manager for inclusion in Staff Briefings. Compliments relating to individual staff members have been fed back to the individual.

Not used by our team Thank you for your comment. We hope that if you do need to speak to any of our laboratory staff that you are satisfied with the usefulness and availability of advice that you receive. Laboratory contact details can be found on the website.

Have not contacted micro or cellular pathology out of hours

If samples are received out of hours we often get phone calls very late regarding abnormal results making it too late for us to action them with patients

We strive to report results as soon as possible after receiving them in the laboratory. Please contact us with specific examples so we can investigate why you are receiving results late in the day.

I have always contacted Dr. Straffen for issues with DFT's I am concerned regarding the availability of staff when she retires.

Dr. Straffen retired on 12th May 2019. We have appointed two Consultant Clinical Scientists, Mrs. Dibden and Dr. Woodrow. Contact details are provided on our website.






Question 14: Are you satisfied with the usefulness and availability of advice from clinicians?






100% of users were satisfied with the usefulness and availbility of advice and assistance from Clinicians in

normal working hours in Blood Sciences, Blood Transfusion and Cellular Pathology. 92.31% were satisfied

in Microbiology.

Outside of normal working hours 100% of users were satisfied with the usefulness and availability of

advice provided by Clinicians in Blood Sciences, Cellular Pathology and Microbiology, alongside 88.89%

for Blood Sciences.

Where associated comments were left, responses are detailed in the table below.

Comment Response

I do not require contact with clinicians in my role. Thank you for your comment. We hope that if you do need to speak to any of our laboratory staff that you are satisfied with the usefulness and availability of advice that you receive. Laboratory contact details can be found on the website.

I have not had any reason to seek assistance.

Not used by our team.

Have only ever discussed with microbiology clinicians in hours. Can be difficult to contact them if not in department. Do not always answer the bleep. Often taken multiple attempts through the day to discuss a patient.

As there are only 2 medical staff in the department if one is on leave it may make it difficult to contact them as they have meetings and ward rounds to fit in as well as answering queries. We apologise for the delays you may experience in being able to obtain advice, but if unable to contact them please contact the laboratory staff on 01226 432687 and leave a message and they will get back to you as soon as they can.

Only contacted microbiology of the above list, and only in hours as only registrars are allowed to call

Thank you for your comment. We hope that when you have contacted Microbiology, that you are pleased with the service provided. Please be aware that if you need to contact Clinicians from any other disciplines, the contact details are available on our website.






Question 15: Are you satisfied with the report turnaround times?

80% of users were satisfied with the turn around times for Blood Sciences and Microbiology, and 92% of

users were satisfied with the turn around times for Blood Transfusion and Cellular Pathology. Fewer

users are satisfied with turn around times than in 2018. Where associated comments were left,

responses are detailed in the table below.






Comment Response

On the whole the turn around is very good

Thank you for your comment. We are pleased that you feel our turn around times are good.

Can take time with certain tests. Thank you for your comment. Please appreciate that different tests take different lengths of time to process. If you are concerned about a specific test, please contact the laboratory with examples to allow us to investigate.

Sometimes we can get results pending for quite a few days.

Often delays when waiting for results in clinics or out of hours, frequent problems with analysers.

Thank you for your comment. We are currently investigating the possibility of replacement equipment within the laboratory, which should alleviate the frequent problems with analysers.

Several samples that are requested via the Diabetes Centre are send aways. The most problematic of this appears to be renin/ aldosterone which are taking longer and longer to come back.

We are sorry to hear the service is not meeting your requirements. We review our referral laboratories on a regular basis and will look into your comments.

Blood culture results do not always generate an automatic 36h negative response. Some CSF cultures have generated reports stating negative at 48 hours, however 48 hours have not passed since sample was taken!!

Paediatric blood cultures should have an automatic 36hr result issued if they are no growth, however this is 36hrs from when it is loaded onto our analyser to start incubation not from the time the sample was collected. Adult blood cultures are reported as negative after 48hrs. CSF samples are read in batches in a morning and early afternoon so we accept this might be a few hours before 48hrs exactly, however if it was going to be positive the organisms would have grown usually within 24-36 hours. We will remind staff to check the times carefully to ensure that as near to 48 hours have elapsed before plates are discarded as negative.






Question 16: Are you satisfied with the report content, clairty and interpretive comments?

100% of users were satisfied with the report content, clairty and interpretive comments. Where

associated comments were left, responses are detailed in the table below.

Comment Response

Again , Xanthochromia reports when they appear on ICE are very confusing. In first instance , it looks like xanthochromia is negative but if read carefully it says bilirubin not detected but xanthchromia is pending. And after a few days xanthochromia comes up as negative.

We will review this test code to see if this can be improved.






Question 17: Are you aware of the criteria by which samples are accepted or rejected in Blood

Transfusion?

This question was designed to determine the awareness of sample acceptance in Blood Transfusion and

determine the need to provide further education about mimumum criteria for sample acceptance. A

Hyperlink to the Sample Acceptance Criteria page of the Blood Transfusion webpage was included in the

survey question to raise awareness of the criteria. 33.33% of users were not aware of the mimimum

sample acceptance criteria for Blood Transfusion samples. Pathology will provide further communication

to clinical areas about the criteria by which samples are accepted or rejected.






Question 18: Are you aware of the criteria by which samples are accepted or rejected in Pathology?

This question was designed to determine the awareness of sample acceptance in Pathology for

Biochemistry, Haematology, Cellular Pathology and Microbiology and determine the need to provide

further education about mimumum criteria for sample acceptance. A Hyperlink to the Sampling and

Request Labelling page of the Pathology webpage was included in the survey question to raise awareness

of the criteria. 33.33% of users were not aware of the minimum sample acceptance criteria. Pathology

will provide further communication to clinical areas about the criteria by which samples are accepted or

rejected.






Question 19: Is laboratory news and updates communicated effectively?

54.55% of users did not feel that laboratory news and updates were communicated effectively. The

laboratory is keen to improve communications to users.

Comment Response

We never get updated if there are problems with analysers unless we ring to query why results are taking a long time.

The laboratory is keen to improve communications to users and will be using the information from Question 20 of the 2019 user survey to determine how best to implement a regular communication. Procedures are in place to communicate any urgent issues via Trust Communications.

Don't receive any updates.

Have never seen any news or updates.






Question 20: How would you like to receive communications from us?

A majority of users (60.87%) stated that they would rather receive communications from the laboratory

via email, 21.74% via the website and 17.39% via newsletter. In reponse to Question 19 & Question 20,

the laboratory will look to develop a regular email communication to users.






Question 21: Do you have any comments to improve the service we provide?

Comment Number

Comment Response

Compliment

1 No, great service thank you! Thank you. The positive results have been fed back to Laboratory Managers to feed back to staff as part of staff meetings. The results have also been passed onto the Pathology Business and Service manager for inclusion in Staff Briefings.

Improvement Suggestions

2 Sometimes , patients are really hard to bleed. It would be nice to have that consideration in mind if a sample is being refused due to minor error (which can be explained as typographical etc) If a clinician confirms that this sample was taken by themselves , the lab should consider processing it as sometimes the blood group cross match needs to be done urgently.

As a department we are sympathetic to clinical pressures and we do understand patients can be difficult to bleed. However, errors in requesting, blood sampling, collection and administration of blood products lead to a significant risk for patients. BSH guidelines states (Robinson et al, 2017); Since the launch of Serious Hazards of Transfusion (SHOT) scheme in 1996, it has continually shown that ‘incorrect blood component transfused’ episodes are a frequently reported transfusion hazard. These wrong blood incidents are mainly due to human error leading to misidentification of the patient and can lead to life‐threatening haemolytic transfusion reactions and other significant morbidities. The National Comparative Audits (NCA) of England and Wales (2003, 2005, 2009, 2011) have shown that patients are placed at risk of avoidable complications of transfusion through misidentification and inadequate monitoring. We are governed by the MHRA who enforce the above guideline. The MHRA have the authority to come and inspect the Department with a maximum of 6 days notice and will audit the sample acceptance policy and process. If we are found to be accepting samples which are not 100% accurate it will lead to significant consequences for the department. Therefore, we operate a zero tolerance policy to any error (typographical or otherwise). This is

https://onlinelibrary.wiley.com/doi/full/10.1111/tme.12481#tme12481-bib-0048









Comment Number

Comment Response

solely for the safety of the patient. In an emergency situation where life is at risk, there are alternative options. This can be discussed with the laboratory if this situation occurs.

3 No improvements needed generally. Some poor planning: introduction of HS Trop. Little information or guidance circulated prior.

We have a change control procedure in place, this includes informing users well in advance of any changes to service. Unfortunately this is not always possible due to events outside our control. Following any change we review practice to minimise the possibility of any issues reoccuring. This took place after the introduction of hsTNI.

Question 22: Have you had any positive experiences with the service that you would like to feed back?

Comment Number

Comment Response

Compliment

1 Good advice particularly with regard confirming receipt of samples + good process time for "urgent" samples.

Thank you. The positive results have been fed back to Laboratory Managers to feed back to staff as part of staff meetings. The results have also been passed onto the Pathology Business and Service manager for inclusion in Staff Briefings. Where positive comments are specific to individual staff members/departments, these staff members have been made aware.

2 Always helpful when asking about results 3 Good turnaround of reporting.

4 I have always found the pathology department very professional, polite and effective.

5 Mostly positive interaction. 6 Always informative. 7 Staff are generally very friendly and helpful on

the phone, particularly in Microbiology.

8 VERY GOOD EFFECTIVE SEVICE FOR THE ENT OPD. VERY FRIENDLY STAFF, HELPFUL AND POLITE

9 Whenever I phone labs up checking for a result or just advice, they are always very helpful.

10 I have found <staff member name> to be helpful always and investigates any issues that I have encountered while performing DFT's. She also contacts me directly if there is any issues with tests that I have performed

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