> I have been watching the discussions on Biochemistry workload with interest. I have been appointed on a six month contract to investigate the use of Pathology services (i.e. Biochemistry, Haematology, Immunology and Microbiology, Histopathology is excluded from my investigations) at Rotherham DGH. I recognise and agree with many of the factors that have been raised as issues/influences on increasing Biochemistry workload. In Rotherham analysis over the last three years clearly shows that increased demand is out-stripping the increase in patient throughput. Another factor that I don't believe has been mentioned is that on average the patients today in hospital are more severly ill and may well require more investigations.
>
> My experience in Rotherham suggests that a significant factor is that there is a mutual communication/education gap that exists between Pathology and the 'customer' wards/units/departments. It seems the main reasons for this are : lack of time/resource; traditional practises; and in some cases, an unwillingness to fully co-operate/collaborate with changes.
>
> I have also found, unfortunately, that much of the critical information required to better manage Pathology workload is NOT embodied in protocols or guidelines in use in the hospital. It probably wont be news to most of you that, it would be an error to assume that ALL junior doctors and nursing staff have ready access to documented protocols that advise them what pathology investigations are appropriate, even less so to information that helps them to decide how frequently to repeat tests. Furthermore, even if the latter have been created and are readily available its also not the case that staff take advantage of them. Ownership of knowledge and its use in the wards is also a hampering factor in obtaining practical and readily available guidelines.
>
> Having said all the above, it also true that most nurses successfully and accurately follow the guidelines they have.
>
> Any attempt to manage (or control) demand for pathology investigations must consider how the decisions are currently made.
>
> I am currently busy trying to collect information on how and what clinical information is used to drive the choice of pathology investigations by most consultants and nurse practitioners, and a sample of the junior doctors. The level of detailed information required to obtain this is likely to be too great to get a complete picture in my remaining time. However the information gathered should also highlight how much variation in practise there is across medical teams, my work has already established the variation in practise across the hospital directorates, including some excellent and poor practise. I am also looking at methods of providing automated feedback to consultants on how well their teams are at working with pathology (specifically in the first instance simply looking at how well the investigation request forms are completed).
>
> As far as my findings go I am sure that some places will be better and others worse.
>
> Rotherham DGH is about to embark on internal trading for all Pathology services (already present for Blood products and some Microbiology investigations). Over spends have occurred in the budgeted areas and one of the big issues is how the management will handle transgressions over budget.
>
> Peter Cudd BSc PhD
>
> Pathology Workload Officer
> Ext. 4251
>
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