Enhancing patient safety by improving the specimen self-collection

process in a GP surgery

Hui Mei Wong1 , Prasanna Balavigneswaran2

1 North Middlesex University Hospital, 2 Fernlea Surgery

Introduction

The COVID pandemic has accelerated the use of virtual consultations in General Practice surgeries. Whilst this has improved access to GPs, remote consultations limit a clinician’s ability to examine patients and collect investigation samples, thus relying largely on patients providing self-collected specimens to aid the diagnostic process. However, the self-collection process is susceptible to errors and samples are more likely to be rejected when compared to samples collected by clinicians. We designed this quality improve ment (QI) project in response to clinicians raising concerns around the frequency of rejected self-collected pathology samples, leading to patient frustration and delayed diagnoses, both of which negatively impacted patient care.

Our primary aim was to reduce the proportion of rejected self-collected samples by 20%. Our secondary aims were to improve the self-collected specimen process by improving confidence of the reception staff providing the specimen bottles, and reducing the time taken for clinicians to request a self-collected specimen.

Self-collected specimen process map

Factors contributing to rejected specimens

PDSA cycle Results

Conclusion

• Reception staff confidence increased from 6.2 to 9.0 (on a 10 point scale)

• The mean time clinicians took to complete a full test request form decreased from 73.2s (range: 53.0s-94.0s) to 40.3s (37.0-44.0s)

Next Steps

• Sending text message reminders to patients with instructions on selfcollection; consider including instructions in multiple languages.

• Consider pre-labelling specimen pots

• Consider removing the ‘emailing’ process from the process map

This QI project resulted in a 36% reduction in the number of rejected self-collection samples. Our QI project reduced delays in the diagnostic process, thus improving patient safety and patient experience. We were also able to improve the administrative team’s confidence in providing the correct specimen bottles and almost halved the time it took for a clinician to order a self-collected specimen. We learnt that by engaging the wider multidisciplinary team and patients, we were able to minimize errors in the process. Following this PDSA cycle, we propose several changes that could be implemented to further improve this process.