Pathology Info
A Healthcare Commission review has found that pathology departments deserve praise for processing more tests more quickly but urges them to consider the consistency of their services and value for money.
These findings are released today in a Healthcare Commission national report on pathology services.
A survey of clinicians carried out as part of the review showed that most of them were happy with the quality of pathology services in their hospitals. Eighty one per cent praised the support and guidance received from pathology departments and 89% the quality of supporting information included in pathology reports.
The greatest problem seen by the clinicians who responded to the survey was in ensuring that results always reached the right person by the time that they were needed - only 46% of those surveyed agreed that the response was always timely and 62% that urgent results always got to the right person.
Pathology laboratories test 175 million samples each year at a cost of £2.5 billion and their findings affect over 70% of clinical decisions.
"Getting results - Pathology Services in Acute and Specialist Trusts" is the last of three reports from the Healthcare Commission, which together present a comprehensive assessment of diagnostic services in England during 2005/06. The Commission reviewed the performance of pathology laboratories using data from all 168 pathology services and a survey of 5,500 doctors and nurses.
The Commission highlights the following key findings in the report:
Despite increasing demand from clinicians, most pathology departments are turning tests around faster
Nationally the numbers of microbiology requests from clinicians have been rising by 9.5% a year, biochemistry and haematology by 6.4% and histopathology by around 1% a year. Demand from GPs has also grown particularly rapidly.
The Commission praises pathology laboratories for meeting this increased demand and for turning around urgent tests faster. For example troponin tests, to check whether A&E patients with chest pain have had a heart attack, were turned around 20% more quickly on average than in 2003 (from 75 minutes to 60 minutes).
However it found that there could be wide variation in how long it took the same laboratory to perform a specific test. The Commission urges trusts to agree targets with clinicians for speed of service that reflect clinical needs.
While praising trusts for the faster turnaround of urgent tests, the Commission also urges pathology departments to ensure they all consider value for money
Less urgent results and GP referred requests, such as tests for thyroid function, were also being turned around faster which raises complex questions as to whether the extra costs often required to achieve faster times in all non-urgent cases are justified.
Overall, there was a greater variation in costs among trusts than can be explained by the numbers and types of tests that they perform. For example, one in ten acute trusts spent less than £4.67 on each request for clinical biochemistry tests, while at the other extreme an equal number of trusts spent more than £8.45.
There was also great variation among trusts in levels of demand for pathology services. Doctors in one in 10 A&E departments requested more than four biochemistry tests for every patient seen, while a similar number requested less than one test per patient. The Commission says that all trusts should agree guidelines on appropriate testing.
The review found that at some trusts large numbers of tests on the same patients were repeated unnecessarily and at a cost. For example, there is seldom a clinical need to repeat a thyroid function test for an admitted patient within four days, but some trusts reported that 11% of these tests were repeated this often.
Commissioners of services and trusts should ensure that pathology departments with unit costs or productivity figures differing widely from the norm are providing good value for money.
Some trusts were also found to be slow to introduce more effective up-to-date technologies or to develop the potential of pathology networks set up under the Department of Health's Modernising Pathology initiative.
Healthcare Commission Chief Executive Anna Walker said: "Pathology departments are a vital function within the NHS and should be praised for the high quality of work they produce and the faster turn around of results they have achieved, despite a rise in demand from clinicians.
"Our review showed significant variation in costs for pathology services between different trusts. We would urge all trusts to benchmark their performance and ensure that they are providing their services with the best value for money."
More information about diagnostic services 2005/2006
Trusts have had full access to the data collected for this review since March 2006 and many will have used it to identify priorities for improvement. Comparative assessments of diagnostic services in acute trusts that used some of the data in these reports were published last August as part of the Annual Health Check. The current report provides more detailed findings.
Pathology services are usually organised into a number of separate disciplines. This report focused on the four biggest - clinical biochemistry, haematology, microbiology and histopathology. Larger trusts may have separate departments for other, smaller disciplines such as cytology, immunology, virology and infection control, and neuropathology. Pathology departments also perform post-mortems. Many haematology departments operate the trust's blood bank and supply phlebotomy (blood collection) services.
Nearly all NHS acute and specialist trusts still have their own separate pathology departments, although a few trusts have formed jointly managed services. A small proportion of specialised tests are referred out to other laboratories or regional laboratories. The pathology department at most trusts serves local GPs and clinics as well as hospital clinicians.
Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.
Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.
The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.
www.healthcarecommission.org.uk
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