Pathology Review Logistics High Level Requirements ...

Pathology Review

Logistics High-Level Requirements

Document

June 2011

Pathology Review – Logistics high-level requirements document

M:\Strategic Development\Healthy Futures Programme\Service Reviews and Projects\Pathology (new)\2. Design & Delivery\Logistics\High Level Requirements\Pathology_Review_Logistics_High_Level_Requirements_Document_v1 1[1].doc

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Contents

1 Document management.............................................................................4

1.1 Document status................................................................................4

1.2 Version Control ..................................................................................4

1.3 Document Authorised By ...................................................................4

1.4 Document Reviewed By.....................................................................4

2 Executive Summary ...................................................................................5

3 Introduction.................................................................................................6

3.1 Background........................................................................................6

3.2 Purpose .............................................................................................6

3.3 Scope.................................................................................................6

4 Logistics Pathology Project Overview .....................................................7

4.1 Problem statement.............................................................................7

4.2 Approach ...........................................................................................7

4.2.1 Requirements Prioritisation .....................................................8

4.3 Stakeholders......................................................................................8

5 Overview of Current Logistics Arrangements .........................................9

5.1 Laboratory Locations .........................................................................9

5.2 Service User Locations ......................................................................9

5.3 Map Showing Laboratory and Service User Locations ......................10

5.4 Transfer of samples from Community Locations to Laboratory..........11

5.5 Transfer of samples from Hospitals to Laboratory .............................11

5.6 Transfer of samples between Laboratories........................................11

5.7 Transfer of samples out of normal working hours ..............................11

5.8 Diagram Showing Current Logistics Arrangements ...........................12

6 High level requirements.............................................................................13

6.1 Access ...............................................................................................13

6.2 Communication..................................................................................13



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6.3 Environmental....................................................................................14

6.4 Future ................................................................................................14

6.5 Governance .......................................................................................14

6.6 Information.........................................................................................14

6.7 Operational ........................................................................................14

6.8 Security and Resilience .....................................................................15

6.9 Support ..............................................................................................16

7 Key findings from other areas...................................................................17

7.1 General Comparison..........................................................................17

8 Solution constraints...................................................................................18

9 Assumptions...............................................................................................19

10 Recommendations and next steps ...........................................................20

10.1 Understanding “As-Is” processes.......................................................20

10.2 Understanding the “To-Be” processes ...............................................20

10.3 Service Specification..........................................................................20

11 Template Version Control ..........................................................................21

A. Disadvantages of current Logistics arrangements .................................21

B. List of Information Sources.......................................................................22

C. Glossary of Terms ......................................................................................23

D. Clinical Guidance .......................................................................................24

E. Reference Documentation .........................................................................25

F. Findings Of Requirements Prioritisation Survey.....................................27

F.1 Survey aims and approach ................................................................27

F.2 Analysis of respondents.....................................................................27

F.3 Analysis of Requirements ..................................................................28

F.4 Top Logistics Requirements ..............................................................29

F.5 Additional Logistics requirements ......................................................30

Mark Sims June 2011



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1 DOCUMENT MANAGEMENT

1.1 Document status

Version no. 1.1

Status Final

Author Mark Sims

Approver Pathology Review Project Board

Date for approval/ Date approved

5th July 2011

Agreed circulation of this version

Project Board

1.2 Version Control

Version Date Name Comment

0.1 04/05/2011 Mark Sims First Draft

0.2 17/05/2011 Mark Sims Incorporated additional material from Ruth Hallett, workshops and clinical guidance.

0.3 31/05/2011 Mark Sims Minor changes to requirements numbering

0.4 23/06/2011 Mark Sims Added survey results and general tidying

0.5 28/06/2011 Mark Sims Further changes following review with RH and RS

1.0 28/06/2011 Mark Sims Update to final version

1.1 06/07/2011 Mark Sims Added Project Board comments

1.3 Document Authorised By

Name Date Role

1.4 Document Reviewed By

Name Date Role

Ruth Hallett 12/05/2011 Project Manager

Ruth Hallett/Richard Smale

27/06/2011 Project Manager/Project Director

Project Board 05/07/2011 Project Board



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2 EXECUTIVE SUMMARY

An exercise has been undertaken to define and prioritise stakeholder Logistics requirements to support a consolidated pathology service for implementation by a lead provider.

Requirements were initially identified through a range of means, including 1:1 interviews and workshops. They were then summarised and prioritised, by a wide range of stakeholders, using an electronic survey tool.

The exercise established the following top ten priorities:

Logistics Requirement Must Should Could Won't Not Answered

Urgent samples to be readily identifiable and accessible on reaching laboratories 126 12 0 0 8

All transport to be in accordance with relevant guidance and standards. 99 28 4 0 15

Full audit trail of the handling of samples. 92 34 8 1 11

Collection arrangements to meet needs of service users 90 44 2 1 9

Pathology logistics to be easy to access and use 90 40 1 0 15

The end to end solution able to operate in spite of disruption. 89 36 4 0 17

Alternative transport to be instantly available if pneumatic tubes are not working. 88 29 8 2 19

Sample collection times to meet the needs of patients. 81 45 8 2 10

Logistics solution to ensure the viability of samples when tested. 78 38 8 0 22

Able to quickly adapt to support changes to the service 74 56 2 0 14

All of the identified requirements have been ranked and potential lead providers will be asked to outline their Logistics solution and how it would address these requirements. The prioritised list also informs the Commissioning Framework for the consolidated pathology service.



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3 INTRODUCTION

3.1 Background

The Pathology Review covers the pathology services at the Health Protection Agency (HPA), North Bristol Trust (NBT), University Hospitals Bristol Foundation Trust (UHB) and Weston Area Healthcare Trust (WAHT).

It is being undertaken in response to Lord Carter of Coles’ report, which argued for the consolidation of services in order to improve:

• Quality

• Responsiveness

• Cost Effectiveness

However, it must also deliver savings of 20%.

Although the primary focus of the work is the reconfiguration of the clinical and laboratory services provided by pathology, there is consensus amongst the clinical work streams that successful large scale change will be dependent on three key enablers:

1. The development of an integrated management structure for pathology services.

2. The development of an integrated transport system.

3. The development of an integrated IT system. The service model that is evolving is likely to be a hybrid hub and spoke model which balances the requirements for clinical and laboratory adjacencies. Whilst some requirements may depend on the exact configuration, many will apply regardless and, indeed, should this change in the future.

3.2 Purpose

The document is intended to present a prioritised list of high level requirements that will be used as the basis for a service specification for pathology logistics. This, in turn, will be used to drive either a service re-design or procurement exercise. Findings also feed into the Commissioning Framework for the Pathology Review.

3.3 Scope

The Pathology Review covers the pathology services at the Health Protection Agency (HPA), North Bristol Trust (NBT), University Hospitals Bristol Foundation Trust (UHB) and Weston Area Healthcare Trust (WAHT).

The Trusts in Gloucestershire and Bath are also actively participating in the Review to determine the potential benefits which could be realised by their inclusion within a wider integrated service.



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4 LOGISTICS PATHOLOGY PROJECT OVERVIEW

4.1 Problem statement

The Pathology Logistics project is necessary as there is currently no documented consensus across the participating organisations of what a logistics service will be expected to do in order to support a consolidated pathology service.

4.2 Approach

Material for this document has been gathered using several methods, for example:

• 1:1 interviews

• Workshops

• Web-based research

• Site visits/telephone calls

• Work shadowing

• Review of clinical guidance and documentation from other areas. In selecting interviewees a pragmatic approach was taken due to time constraints. For high level information at least one representative from EACH of the four organisations was used. For more detailed operational information, interviewees were chosen from AT LEAST one of the organisations. All interviews were documented and interviewees given the opportunity to review for completeness and correctness. The information gathered has been further analysed in a spreadsheet so that it can be sorted, filtered and cross-referred as required. It is stored against the following categories:

Category Description

As-Is What happens now (NB this has been used not only for the 4 in-scope organisations, but also the reference sites).

Problems Things that stakeholders have said are wrong with current arrangements

Requirements Things that stakeholders would expect the new IT arrangements to do

Best Practice What other areas have done

Quick Wins What it might be possible to do to secure benefits early on

Questions Further research needed identified during interviews etc

Links References to useful information (e.g. on the web or stored locally on a shared drive).

For the purposes of this document, items stated as problems have been re-presented as requirements.



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4.2.1 Requirements Prioritisation

Section 5 is a simple (qualitative) list of the requirements identified by at least one of the stakeholders consulted to date. Since it may be necessary to take a staged approach to implementation, a prioritisation exercise was undertaken using an electronic survey. The results can be used by the lead provider to understand what is most important to each stakeholder group when comparing the costs and benefits of meeting the requirements. A summary of the results is shown in appendix F.

4.3 Stakeholders

A stakeholder map for the project is stored at: http://www.avon.nhs.uk/pathologyreview/Docs/Pathology%20Stakeholder%20Map%20Version%200.8.pdf

A full list of information sources used to inform this document may be found at appendix A.



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5 OVERVIEW OF CURRENT LOGISTICS ARRANGEMENTS

The following information may be subject to change and should be re-checked prior to implementation. Please note that the bracketed letters in bold refer to the annotations in figure 2, below.

5.1 Laboratory Locations

Laboratories are located at the following sites:

Location Responsible Organisation

Southmead Hospital North Bristol Trust

Frenchay Hospital North Bristol Trust

8th Floor, BRI UH Bristol

8th Floor, BRI Health Protection Agency

Myrtle Road Health Protection Agency

Weston General Hospital Weston Area Healthcare Trust

5.2 Service User Locations

Users of pathology services include:

• Community-based o GP Practices o Independent Sector Treatment Centres (e.g. Emersons Green) o Private Hospitals o Prisons o Community Hospitals (e.g. Clevedon) o Out of Hours providers (e.g. Frendoc, Harmoni)

• Hospital-based o Southmead o Frenchay o Bristol Royal Infirmary o St Michael’s Hospital o Children’s Hospital o Weston General Hospital



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5.3 Map Showing Laboratory and Service User Locations

The map below shows the locations of the laboratories (rectangles) and service users (circles). The coloured shading depicts the areas covered by the pathology transport functions of each trust.

Figure 1

Key:

Colour Description

Blue North Bristol Trust

Green UH Bristol

Yellow Health Protection Agency

Red Weston Area Healthcare Trust



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5.4 Transfer of samples from Community Locations to Laboratory

Samples are transferred by vans (A) controlled by the four organisations. Transport is shared with other services, such as sterile services, pharmacy, post room etc. In Weston (B), the service is outsourced. Elsewhere vans are currently run in-house by transport departments although NBT are in the process of outsourcing their service. The HPA van rounds complement the UH Bristol ones but elsewhere there is little overlap. The collection times offered to GPs vary across the area as does the length of routes, which may be dependent on geography and access to motorways. In NBT, all PCT samples are processed at Southmead site (C). However, samples from surgeries in the Frenchay, Kingswood and Yate areas are transported to the Frenchay Laboratory (D) for onward transport to Southmead

5.5 Transfer of samples from Hospitals to Laboratory

Where a laboratory exists on the same site as where the sample is taken, transport to the laboratory will be via porter (E). However, where the facility is available (e.g. in critical areas) and is appropriate to the type of sample, transfer may be by pneumatic tube (F). Transfers from hospitals where there is no laboratory (e.g. St Michaels (G) and Children’s hospital (H)), may be by van or porter. A pneumatic tube (I) exists between St Michael’s and the BRI.

5.6 Transfer of samples between Laboratories

Vans are used to transport between the various sites, for example:

Route Run By Frequency

BRI (J) to Myrtle Road (K) for HPA virology

HPA 6 times daily on weekdays 2 manual transfers on Saturday, 1 on Sunday.

Bath RUH (L) to BRI HPA 4 times daily on weekdays (09:00 to 17:00) Single collection at 09:30 on weekends

Frenchay and Southmead NBT Hourly between 10:00 and 18:00

BRI, HPA and Southmead NBT 2 per day

Weston and Southmead NBT 1 per day

BRI and NBT UHB 09:00 and 14:00

Weston and BRI Weston 1 per day at 09:00 (onward transport to NBT via UHB van)

5.7 Transfer of samples out of normal working hours

Outside of normal working hours, urgent samples may be sent by taxi.



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5.8 Diagram Showing Current Logistics Arrangements

Figure 2

Key:

Colour Description

Blue North Bristol Trust

Green UH Bristol

Yellow Health Protection Agency

Red Weston Area Healthcare Trust

A

A A

A

A

A B

C D

E

E

E

E

I

F

F

G

H

J K

L



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6 HIGH LEVEL REQUIREMENTS

The requirements in the lists that follow have largely been identified by stakeholders, primarily via 1:1 interviews and workshops. Several have also been derived from sources such as clinical guidance or best practice elsewhere. The electronic survey allowed a wider group of stakeholders to review the initial list and state a priority for each item (as well as adding anything not already covered). However, here were many more responses from some groups than others. Laboratory staff, for example, formed about half of the responses while there were only 4 responses from patients. The priorities shown in the following sections represent the overall view. Priorities for some groups may differ significantly. Full results will be available to the lead provider, in MS Access, to allow analysis by stakeholder group. Requirements are presented, within each section, in descending order of priority (Pty), which is derived from the list ranked according to number of “Must Have” clicks where:

• H (High) Requirements appearing in the top third

• M (Medium) Requirements appearing in the middle third

• L (Low) Requirements appearing in the lower third.

6.1 Access

Ref Requirement Additional information Pty

6.1.1 Pathology logistics must be easy to access and use.

Ready access to information about collection schedules and out of hours services

H

6.2 Communication


6.2.1 Arrangements must be in place to ensure that the necessary people are made aware of samples to be processed, where they are and when they will arrive at the laboratory.

e.g. laboratory staff, clinicians, porters, drivers etc Must apply out of hours. M



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6.3 Environmental


6.3.1 The logistics solution should minimise the impact on the environment.

Consider the use of electric vehicles. Do not unnecessarily increase vehicle movements.

L

6.4 Future


6.4.1 Logistics solution must be able to quickly adapt to support service changes.

e.g. Additional collections/deliveries, new services etc

M

6.5 Governance


6.5.1 There should be a full audit trail of the handling of samples.

Should show date/time, person involved, what was done (including means of transport) etc for the end to end process.

H

6.6 Information


6.6.1 Data about logistics must be recorded to support the production of Key Performance Indicators and other information to manage and improve the service

To include the availability of pneumatic tube systems

M

6.7 Operational


6.7.3 Collection arrangements must meet needs of service users

To include 7 day working, out of hours etc. H

6.7.10 Must provide the ability for service users to send samples to any laboratory required.

At present always goes to same lab but this facility must be available should there be a clinical requirement Service users should not need to be aware of where samples are processed.

H



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6.7.1 Sample collection times must meet the needs of patients.

M

6.7.2 Logistics function must be responsible for the end to end process of collection from all service users up to delivery at the laboratory.

To include: GPs, Acute, 3rd party providers, out of hours etc.

M

6.7.6 Logistics solution must ensure the viability of samples when tested.

M

6.7.11 Urgent samples must be readily identifiable and accessible on reaching laboratories

M

6.7.4 Logistics function must support the “pull” of work through laboratories by service users.

L

6.7.5 Deliveries to laboratories must match their capacity to handle the work.

L

6.7.7 Logistics solution must ensure that samples are delivered to laboratory within agreed time limits.

L

6.7.8 The needs of other non-pathology logistics users must be accommodated.

e.g. Sterile Services, Pharmacy, Mail etc L

6.7.9 Logistics function must deliver consumables to service users.

*** Consider whether scope should cover ordering of consumables? ***

L

6.8 Security and Resilience


6.8.1 All transport must be in accordance with relevant guidance.

Trained to cope with spills etc. Subject to Carriage of Dangerous Goods (CDG) Act.

H

6.8.3 The end to end solution must be able to operate in spite of disruption.

e.g. Accidents, volume of traffic, holiday traffic, snow, heavy rain, road works, repairs Also holidays, sickness etc

H

6.8.5 Alternative transport means must be instantly available if pneumatic tubes are not working.

H

6.8.4 Pneumatic tube systems must be resilient

M



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6.8.2 A range of transport options should be available.

e.g. Motorcycle for urgent deliveries Consider sharing with other transport means – e.g. buses

L

6.9 Support


6.9.1 Must be simple for users to request ad hoc arrangements.

e.g. additional collections, urgent requirements. L



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7 KEY FINDINGS FROM OTHER AREAS

A number of other pathology organisations were contacted to establish their strategic direction, approach, progress and any lessons learned. The organisations were:

• All Wales

• Greater Manchester Pathology Network

• Kent & Medway Pathology Network

• Pathlinks

• Leeds

• North East Pathology Network In addition, visits to the NHS Blood Transfusion service at Filton were arranged and details of NHS Pathology (a joint venture between Frimley Park and Royal Surrey County Hospitals) have been obtained from their web site.

7.1 General Comparison

In general, work on consolidating logistics arrangements was less well-advanced than IT for the organisations contacted. Manchester, the North East and Leeds stated that they have left their existing arrangements in place although the North East has provided additional transport to support new Hubs. Kent and Medway have also left their existing local logistics arrangements in place but introduced a service to transport samples between laboratories. Having considered outsourcing this service, they concluded that it was cheaper to run internally. However, they will look at all options when reviewing logistics as a whole. NHS Pathology runs its own dedicated (i.e. not shared with other services) pathology transport facility consisting of 28 vehicles. Collections are made from GPs - at times agreed with them with up to four collections daily - and can accommodate weekend and extended clinics. They also offer a secure external lock box facility, allowing collection after the surgery has closed at the end of the day. Ordering of consumables is also available via the NHS pathology web site. Both Kent & Medway and the North East are actively considering the use of Radio Frequency Identification (RFID) tags for tracking samples and/or routing to the most appropriate laboratory.



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8 SOLUTION CONSTRAINTS

Ref Constraint Detail

8.1 Third party logistics user requirements

The flexibility of a shared transport facility may be restricted by the need to balance the needs of pathology with other service users.

8.2 Finance The choice of Logistics solutions will be restricted by the funding available. However, changes may allow savings to be made elsewhere (e.g. by levelling demand on laboratories etc)

8.3 Resource & Expertise At a time of significant change, and with many other priorities, the availability of suitably skilled people and other resource will need to be considered.

8.4 Lead Times The time needed to prepare for Logistics improvements (e.g. service re-design, procurement etc) may affect the viability of some solution options.

8.5 Existing arrangements/ contracts.

Solutions may be restricted by remaining life on any existing contracts.

8.6 Clinical Model Interim Requirements

IT systems will need to be changed incrementally and produce real benefit to support the schedule of changes to clinical arrangements.

8.7 Standards Solution must adhere to applicable legislation/ guidance regarding transportation/handling

8.8 IT Implementation IT-dependent logistics aspects (e.g. communications/sample tracking) will need to be accommodated by the pathology IT workstream.



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9 ASSUMPTIONS

Ref Assumption Detail

9.1 Executive Engagement The Executive team is fully behind work to implement a logistics solution to support a consolidated pathology model and is prepared to commit funding and resources.

9.2 Stakeholder Engagement

Fully supported by all pathology stakeholders.

9.3 Integrated Management Structure

A single management structure will exist for pathology and will be empowered to drive forward the necessary changes.

9.4 Lead Provider A single body, accountable to the Integrated Management Structure, will be identified and be willing to design and implement a solution – including work to support interim changes to the pathology service. The lead provider will continue to fully engage with all stakeholders to ensure that their requirements are considered.

9.5 Phased Approach It is assumed that changes to the clinical model will be phased in over time and that interim solutions will be required to meet the needs of each change.

9.6 Existing transport assets

It is assumed that existing pathology transport and any associated contracts will be under the direct control of the lead provider.

9.7 Coordination with pathology IT Implementation Project

IT-dependent logistics aspects (e.g. communications/sample tracking) will need to be accommodated by the pathology IT workstream.



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10 RECOMMENDATIONS AND NEXT STEPS

The results of the IT & Logistics prioritisation survey have been loaded into an MS Access database. All of the data is broken down by stakeholder group to allow further analysis if required. The prioritised requirements will also be fed into the new Commissioning Framework. As attention turns to the structure of the pathology consolidated clinical model, the intention is to increase the level of detail available by undertaking the following work.

10.1 Understanding “As-Is” processes

By participating in workshops being run by NHS Improvement, the “As-Is” process flows will be mapped and problem areas quantified.

10.2 Understanding the “To-Be” processes

By participating in workshops being run by NHS Improvement, requirements specific to the “To-Be” processes will be identified. It may be necessary to test proposed changes to identify/quantify the main Logistics challenges.

10.3 Service Specification

The prioritised requirements list will be used to generate a service specification for Pathology Logistics. External logistics expertise will be consulted during this exercise.



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11 TEMPLATE VERSION CONTROL

Version Date Name Comment

0.1 Ruth Hallett Template creation

0.2 26th April 11 Richard Smale Comments

A. DISADVANTAGES OF CURRENT LOGISTICS ARRANGEMENTS

The following table lists things identified by stakeholders and interviewees as wrong with the current Logistics arrangements.

Ref Problem Impact

A.1 The times that samples are collected from practices are often not suited to GP requirements.

Samples have to be taken early in the day to meet collection times. Times may not be convenient to patients. Staff may have to be diverted from other tasks.

A.2 Current logistics arrangements create a peak in demand at laboratories.

Laboratory capacity has to be geared to the peak demand.

A.3 Time has to be spent sifting deliveries to laboratories in order to identify samples that need to be processed urgently

Wasted time and cost spent sifting batches. Risk of urgent samples being missed.

A.4 Users of pathology services can only send samples to a single laboratory location.

Increased time before sample can be analysed if not processed at receiving laboratory.

A.5 General lack of coordination Issues such as delays in sending samples are often not communicated. Lack of robust processes for notifying laboratory staff when urgent samples are sent out of hours. Risk of unviable samples

A.6 Excessive variation in time to transport samples to laboratory.

Can sometimes take hours for samples to come from the same building Risk of unviable samples

A.7 Pneumatic tubes break down often enough to be a problem

Have to use other transport means.

A.8 Sample collection service is not readily available out of hours.

Can result in patients being referred to acute setting.

A.9 The current use of taxis is not good practice.

Due to potentially hazardous substances



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B. LIST OF INFORMATION SOURCES

Source Type Organisation Contact(s) Perspective

Interview UHB Liz Worsam Laboratory manager view

Interview UHB Gary Higgins Project overview

Interview NBT Paul Virgo Laboratory manager view

Interview NBT Brendan Hanrahan Finance/overview

Interview UHB Wolf Woltersdorf Clinical lead view

Interview NBT John Siggins IT support view

Interview UHB

Andrew Hooper, Gary Higgins, Stephen Hann IM&T/Clinical systems

Interview HPA Will Gothard, Jo Sell, Jacki Watts Logistics requirements

Interview HPA

Dave Wright, Will Gothard, Sue McCulloch, Alasdair Mills IT requirements

Interview WAHT

Andrew Day, Dave Gibbs, Kemlo Rogerson Overview and detail

Interview GPs Andrew Appleton GP view

Interview AIMTC Andy Kinnear Independent IT view

Interview UHB Wayne Tainton Pathology IT support/management

Interview UHB Mike Stear GE Ultra reporting facilities

Interview NBT Ian Massey Pathology IT support/management

Interview HPA David Carrington Overview

Interview LRG Daphne Havercroft Patient view/Independent project management view

Interview UHB Steve Hann Clinical systems view

Interview AIMTC Stuart Andrews, Tom Humphries

Independent view of IT infrastructure

Interview GPs Mary Backhouse Commissioning GP view

Interview WAHT Kim Wright Clinical systems (inc integration)

Interview Multiple Avon Pathology IT Team

Pathology IT support/management

Verbal All Wales Brent Varley Independent IT/ Logistics management view

Verbal Greater Manchester Jeff Seneviratne

Independent IT/ Logistics management view

Verbal KMPN Peter Huntley Independent IT /Logistics management view

Interview UHB Maureen Hornsby Other transport user

Workshop All Project Team Review approach and capture additional views

Workshop All Lab Managers Review approach and capture additional views

Interview All Rachel Wilson GE Ultra supplier

Interview WAHT Bev Dickinson 3rd party primary care provider



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Source Type Organisation Contact(s) Perspective

Interview All Suzie Chalmers ICE supplier

Interview NBT Caroline Jones, Ian Massey ICE support/management

Interview All Lucy Barker, Carine Verstraete

Procurement processes and independent logistics advice

Interview Pathlinks Ralph Osgerby Independent IT/ Logistics management view

Interview UHB Stewart Cundy In house transport provider view

Interview LRG

Jane Bollin, Daphne & Neil Havercroft; Jenny West Patient view

Phone call PCSA Denise Williams

Workshop UHB UHB Drivers Driver shadowingl

Interview North East Chris Charlton Independent IT/ Logistics management view

Interview Leeds Tony Kaye Independent IT/ Logistics management view

Site Visit UHB UHB Drivers In house transport provider view

Workshop All Acute Clinicians Review approach and capture additional views

Workshop All GPs Review approach and capture additional views

Documents All Review of Clinical Guidance folders

IT/logistics-related Clinical Guidance

Interview All Miranda Pring Clinical Pathologist view

Interview All Joss Palmer Connecting care (systems interoperability)

Interview Emersons Green Treatment Centre John Redfern

Independent Sector Treatment Centre view

Interview NBT/UHB Rob Pitcher Histopathology management view

C. GLOSSARY OF TERMS

Term Description

Analyte Substance to be analysed.

Assay Procedure for measuring the biochemical or immunological activity of a sample.

Barcode Visual representation of a number that can be read optically by machine (bar code reader)

Centrifuge Machine that rotates samples at different speeds to separate out liquids/solids of different densities. May be used to increase the “life” of samples for analysis.

Cerner Millennium

Hospital-based Electronic Patient Record system in use in Weston and shortly to be installed in North Bristol

EPR Electronic Patient Record.

CPA Clinical Pathology Accreditation; Defined Standards of Practice (co-owned by Royal College of Pathologists)

GE Ultra Existing laboratory systems (LIMS) in use by NBT, UH Bristol and HPA.

HL7 Set of standards allowing healthcare systems to inter-operate.



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Term Description

ICE Product originally developed in Anglia but acquired by Sunquest for ordering pathology tests and returning results.

ICE Open Net

Product to allow results from an ICE system to be viewed on any other connected ICE system.

Interface Equipment/software for linking two or more systems together.

ITIL Information Technology Infrastructure Library; Standard approach for IT Service Management

IVD In vitro diagnostics; medical devices intended to perform diagnoses from assays in a test tube.

Keystone System for transferring pathology results into GP systems.

LIMS Laboratory Information Management System

MHRA Medicines and Healthcare products Regulatory Agency

NHS No. Unique 10-digit number allocated to a patient when they first register with a GP surgery in England and Wales.

NLMC National Laboratory Medicine Catalogue

Order Comms Electronic system (e.g. ICE) for ordering pathology assays.

PAS Patient Administration System.

POCT Point of Care Testing: Testing undertaken outside of the laboratory at the point at which care is provided. Also known as Near Patient Testing.

Profile Group of tests designed to establish/eliminate specific condition

Request

A request for one or more investigations within a PATHOLOGY SPECIALTY, from a single sample, or group of related samples, taken from a PATIENT or other human or non-human source and sent to a pathology laboratory at one time.

Sample Specimen (e.g. blood) taken from patient or other source to be analysed.

Sendaway Assay that must be performed at a different laboratory.

SNOMED-CT

(Systematized Nomenclature of Medicine -- Clinical Terms); A computer processable collection of medical terminology.

System C Hospital-based Electronic Patient Record system shortly to be installed in UH Bristol.

Telepath 2000 Laboratory System (LIMS) in use in Weston

VPLS Virtual Pathology Laboratory System; GE Ultra product allowing web-based access to laboratory results.

D. CLINICAL GUIDANCE

References in the following table relate to Logistics-specific entries in clinical guidance provided by pathology leads and held as hard copy by the project office.

Guidance Reference

Clinical biochemistry departments to have written procedures to describe correct specimen collection and transport requirements. Also specific IT requirements for service B5 (unique doc no. G027)

Storage, transport and distribution of blood must conform to part 4 of schedule BT1

General IT & Logistics requirements 05 - KMPN Service specification sections 8 and 9



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E. REFERENCE DOCUMENTATION

Description Link/Location

Royal College of Pathologists home http://www.rcpath.org/

Code of practice for histopathologists and histopathology services jan 2010

http://www.rcpath.org/resources/pdf/g030codeofpracticehisto2009_jan10.pdf

Pathology Action Learning sets Various initiatives that look at transport, logistics and other aspects of pathology

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_077090.pdf

Logistics overview containing strengths and weaknesses and functional requirements.

Available from Project Office on request

Feedback from questionnaire to GPs and Acute clinicians. Contains some IT and logistics views.

Available from Project Office on request

NHS Improvement - pathology home page

http://www.improvement.nhs.uk/diagnostics/PathologyImprovement/tabid/56/Default.aspx

Animation showing pneumatic tube operation (Aerocom) http://www.safelink.ie/flash/ac50.html

Link to Royal Surrey pathology pages http://www.royalsurrey.nhs.uk/pathology

Learning from Pathology Service Improvement Pilot Sites and Improvement Examples

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=Q04ozDjBYfM%3D&tabid=73

National Portal for Laboratory Medicine. Various docs: * IT Strategy Analysis (LIMS not fit for purpose) * Path Networks & Innovation (RFID tubes costing a few pence, types of network) * Quality (Tesco tracks its beans better than NHS tracks brain biopsy) * Vision (Summary of pathology capability, applicable standards) * Order comms survey www.laboratorymedicine.nhs.uk



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Description Link/Location

The Future Delivery of Pathology Services in Wales Some "visionary" easy-to-remember principles outlined - e.g. "Do-once-and share"

http://www.wales.nhs.uk/documents/PFSD-August-2008-Ebook.pdf

Health, Safety & Security Measures Contains some IT guidance/requirements for microbiology for Microbiology Laboratories

http://www.google.co.uk/url?q=http://www.dh.gov.uk/prod_consum_dh/idcplg%253FIdcService%253DGET_FILE%2526dID%253D137088%2526Rendition%253DWeb&sa=U&ei=_MG2Tf-6LoOE5AaZuazYDw&ved=0CBMQFjAA&usg=AFQjCNFzmNKS1_XhkDZdaMpjAqVjAhozXQ

What matters to patients Available from Project Office on request

Pathology KPIs

http://www.rcpath.org/resources/pdf/key_performance_indicators_in_pathology_3_2.pdf



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F. FINDINGS OF REQUIREMENTS PRIORITISATION SURVEY

F.1 Survey aims and approach

The aims of the survey were to:

• Understand relative importance, to stakeholders, of High Level Requirements already identified.

• Extend reach of requirements gathering exercise to wider audience.

• Ensure nothing missed Questions identified in an earlier draft of this document were entered into an electronic survey tool provided by Google Docs and distributed initially to recipients of the Pathology Review Newsletter. However, invitations were later extended to other interested parties. Respondents were asked to rate each requirement using the MoSCoW ratings where:

• M: Must have

• S: Should have if at all possible

• C: Could have if does not affect anything else

• W: Won’t have (but would like) There was an opportunity to specify any requirements not already covered. Although the survey was anonymous, further analysis was enabled by capturing the stakeholder “Interest” and the Laboratory most often used or worked in.

F.2 Analysis of respondents

There were a total of 146 responses, broken down as follows: Interest Responses

Pathology Staff/Pathologist/Scientist 71

Secondary Care (Hospital Consultant etc) 30

Primary Care 22

IT Support 9

Public/Patient 3

Commissioner 3

UHBristol Director of Research 1

NHS Management 1

IT management 1

Independent Sector 1

Healthcare IT provider 1

GP Consortium IT Lead 1

Community Infection Control 1

Bristol Community Health 1

Total Responses: 146



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Alignment with Laboratories (workplace) was: Workplace Responses

North Bristol Trust 48

UH Bristol 42

Weston Area Healthcare Trust 37

Health Protection Agency 8

Multiple 6

Not Applicable/Don't Know 5

Total Responses: 146

Given that the Pathology Staff/Pathologist/Scientist “Interest” category accounts for almost half of the responses, the analyses that follow are presented for “Pathology Staff” and “Other”.

F.3 Analysis of Requirements

The following figure shows the number of “Must Have” responses to each of the logistics requirements, which suggests that respondents have been selective in choosing between requirements.

0

20

40

60

80

100

120

140

Must

In the analyses that follow, requirements are ranked by the count of “Must Haves”, then by “Should Haves”, by “Could Haves” etc.



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F.4 Top Logistics Requirements

The following figure shows the top ranked requirements overall.












Amongst pathology staff, the responses were:










Pneumatic tube systems to be resilient 44 16 4 2 5


Logistics function to be responsible for the end to end process (i.e. collection to delivery at the lab). 40 23 2 1 5



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Amongst other respondents, responses were:











Logistics function to be responsible for the end to end process (i.e. collection to delivery at the lab). 31 27 1 0 16

F.5 Additional Logistics requirements

Respondents were given an opportunity to comment and identify any additional logistics requirements not already covered by the survey. Comments are shown in the following table and, where they relate to an existing requirement, the requirement reference is shown. Additional Logistics Requirement/Comment Related Requirements

SLA required to define the interval for delivery of a sample to the appropriate lab. For example: delivery of tumour specimens to the path lab: theatre to lab 20 minutes. 5.7.7

Robust and fast transport of material between UHB level 9 and NBT 5.7.2, 5.7.6, 5.7.7

Where there are multiple specimen receipt areas, system should be in place to ensure the samples arrive at the correct area in a timely fashion with minimal manual intervention. There should be the ability to hand off samples between disciplines/labs where…(NB: rest of comment truncated) 5.7.2, 5.7.6, 5.7.7

Sample collections from primary care bases/GP Practices MUST fit in with Surgery times. Sample collections from GP Practices to be at least twice a day, not once a day, including an evening collection thus allowing tests to be done during the afternoon/e 5.7.1, 5.7.3

Distance from centralised lab is not an excuse to require earlier collections: Collection times need to be set to support the lab's users' and processing times must be adjusted accordingly to deal with "late" delivery. 5.7.1, 5.7.3

Good systems for transport from community 5.7.1, 5.7.2, 5.7.3, 5.7.6, 5.7.7



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Additional Logistics Requirement/Comment Related Requirements

Rapid turn around of urgent samples Absolute security of sample delivery 24/7 Robust contact of users with clinically important out of range results Instant release of results - no delay associated with "awaiting verification" Near patient testing 5.5.1, 5.6.1, 5.7.11

The main issue for general practice is with extended opening -we need to accommodate the needs of our working population so put in a lot of time and effort staying open later or on Saturdays, only to have to bring the patient back on a week day morning to… (NB: rest of comment truncated) 5.7.1, 5.7.3

Should be a dedicated transport system. No more taxis 5.7.1, 5.9.2

Care required that control of ad hoc requests is in built otherwise costs escalate. 5.5.1, 5.6.1

Pathology Review Logistics High Level Requirements ...

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