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Cellular Pathology User Survey Feedback 2023

The cellular pathology user survey is run annually to collate feedback, comments and suggestions from the users of the Cytopathology, Histopathology and Mortuary services at the Royal Devon and Exeter Hospital. Four user surveys were sent out in July 2023 for 4 weeks – ‘General Cellular pathology’, ‘ROSE clinic’, ‘PVSA’ and ‘Mortuary funeral directors’. All users were sent an email with a link to the survey.

Many thanks to our users for taking part in our annual user surveys, this helps us to improve our service and all feedback is greatly appreciated.

Cellular Pathology Service
13 responses from variety of hospital consultants, 1 x GP and 1 x CNS

Histology/Diagnostic Cytology reports (1 response):
‘Honestly having worked elsewhere our reporting is easy to understand and relevant.’

Turnaround times (3 responses):
‘Appreciate delays due to staffing’
‘Prostate biopsy turn around time has improved significantly’
‘Turnaround times are exceptional in lung, not always equivalent in other areas.’

Specialist teams (2 responses):
‘The head and neck pathology and cytology teams are excellent’
‘Head and neck are brilliant’

Overall service (2 responses):
‘A leading light in a hospital of darkness’
‘Brilliant service, excellent people’

Suggestions for service improvement (6 responses; 4 Histology, 2 Cytology):

You said: ‘We need more renal pathologists to improve the turnaround times of renal biopsies. Even “urgent” biopsies take a lot longer than previously.’ (From a Consultant Nephrologist)
We said: We are aware of the need for additional pathologists in many specialities and we are currently recruiting and training new pathologists

You said:Better IT support is needed for remote reporting.’ (From a Consultant Nephrologist)
We said: We will be implementing digital pathology later in the year which will support remote reporting for our Pathologists.

You said: ‘Would like to know all margins sizes for high risk tumours not just the closest particularly when close and re excision needed’ (From an Ophthalmology Consultant, WEEU)
We said: Thank you for taking the time to provide feedback and highlighting this area. All excisions of high risk cutaneous lesions excised around the eye should be reported on a minimum dataset proforma that requires reporting of the closest peripheral and deep margins. Reporting of margins will vary from case to case depending on the type of excision, orientation and laboratory sampling. All clinically significant margins < 1mm should be reported if possible. I will feedback your comments to the specialist teams involved in reporting. If you have any other concerns please get in touch. (Dr Claire Murray, dermatopathology lead)

You said: ‘Needs more pathologists for faster turn around’ (From a Consultant Nephrologist)
We said: We are aware of the need for additional pathologists in many specialties and we are currently recruiting and training new pathologists.

You said: ‘Greater availability of staff (i.e more biomedical scientists) in a time where clinicians will have to do more diagnostics (as radiology so stretched) the availability of ROSE is key. We are incredibly fortunate to have any, but more would strengthen services.’ (From a Respiratory Consultant)
We said: Thank you for the feedback. We are currently training more staff to deliver ROSE. However, we have to strike a balance between capacity, efficiency and consistent safe delivery of the service. Please get in touch with us about how you want to expand the diagnostics, we will do our best to support it.

You said: ‘Seems like a remote service; we do not do lumbar punctures for cytology on Fridays, samples tend to sit around over the weekend and more often than not the report returns as unable to interpret’ (From a Consultant Neurologist)
We said: Thanks for the feedback. Unfortunately, we are not funded to provide weekend service. However, we can definitely process the sample taken on Fridays provided your team can communicate with laboratory before the procedure and the sample can arrive in the lab during its working time. This works well for BAL in ILD patients for differential counts where sample has to be processed as soon as possible after collection to preserve the morphology. We process the samples taken on Fridays. The respiratory team communicates with the lab before the procedure. We will be happy to discuss this with you.


Post Vasectomy Semen Analysis (PVSA)
3 responses (1 urologist, 2 GPs). All Questions answered as excellent, good or not applicable.

Turnaround times (1 response): ‘Laboratory advice accessible and helpful. Turnaround times very good.’

Suggestions for service improvement (1 response)
You said:For a fertility test there is a special form that needs to be downloaded and printed, which is very inconvenient. I think this is probably not your service, though if the two could be linked in some way as if the cytology shows sperm then we move to a second test looking for motility and have to go through a different laboratory for that. A bit more of a joined-up service would be helpful.’ (From a Consultant Urologist, Tiverton Hospital)
We said: The second sample is now analysed by cytology within 1 hour to provide motility information for special clearance. Fertility service is only required if vasectomy reversal


Rapid Onsite Evaluation Service (ROSE)
10 responses (4 consultants, 1 radiologist, 1 SpR, 1 nurse, 2 HCAs, 1 practitioner). Most Questions answered as excellent, good or not applicable apart from:
Q5. Are you satisfied with the turnaround times of the laboratory?  – 1 x dissatisfied response. 
Q6. How would you rate the arrangements for the collection and transportation of specimens to the laboratory? –  1 x average response

Rapid On-Site Evaluation (ROSE) Cytology Clinic (5 responses)
‘It is truly an excellent service with very flexible and happy-to-help individuals’
‘They offer a truly exceptional service.’
‘ROSE is beneficial to both patients and the endoscopy team, we are fortunate to have it.’
‘The Biomedical Scientists who attend for ROSE are a pleasure to work with.’
‘Great service. Friendly and helpful cytologists’

Cytopathology reports (2 responses)
‘Fastest turnover of any cytology department I have ever worked with. Truly exceptional and positively impactful on patient care’
‘Results always discussed in detail at the lung MDT safe written report being issued’

ROSE service overall (6 responses)
‘Visiting clinicians are always amazed about the service on offer and the rapidity with which for the results are made available. ROSE also ensures that we try to obtain sufficient material to allow for IHC as well as looking for mutation markers that will impact patient treatment. It is extremely rare that a repeat procedure is required to obtain further tissue.’
‘An essential and well-regarded component of our diagnostic services’
‘I don’t see anything that needs improvement’
‘I cannot think of anything that could be done better.’
‘Excellent all-round’
‘It is excellent, it does not require improvement.’

Suggestions for service improvement (2 responses)

You said: ‘Faster turnaround in some cases; some are very fast already – thank you’
We said: We will review the reasons for some cases taking longer to report.

You said: ‘2nd opinions may be best sought from those with specific expertise in cytopathology!’
We said: We will pass on your comments to the reporting pathologists


Mortuary Service
All comments are from funeral companies.

You said: If a PM has taken place families have been told that they need to register for funeral to take place which is inaccurate as Cremation form 6 or Order for Burial issued and no other paperwork is required for funeral.
We said: This has been fed-back to bereavement staff and additional training given regarding the Coronial process in regards to documentation.

You said: Several patients have been released with hospital equipment still attached e.g. breathing tubes & catheters still in.
We said: It is standard practice for medical intervention equipment to be left in place on deceased patients, this is to prevent further leakage from these points. However should you prefer this equipment is removed upon collection, please speak to the technician assisting and they will be happy to accommodate.

You said: Sometimes the wait can be very long when collecting from the Mortuary.
We said: We appreciate that on occasion there may be a period of waiting when collecting patients, unfortunately this is unavoidable due to the nature of the task being completed. It is not possible to speed this up, or deal with multiple companies at the same time without compromising patient care. We are considering trialling an appointment system, however this may be difficult to accommodate based on the volume of patients being collected daily.

You said: Earlier opening for collections, eg 8.30am if possible.
We said: The current opening hours are to allow other Mortuary activities to take place before collections begin. We are happy to accommodate earlier collections on a case by case basis, please contact the department should this be required.

You said: A clearer system of communication to contact the mortuary team especially if an urgent enquiry.
We said: We have increased administration staff to assist with enquiries to the department, in addition the Mortuary email is monitored regularly. Please flag any urgent enquiry and it will be dealt with as a priority.

You said: Quicker decisions made, in some situations it appears obvious that a post mortem will be required and it takes 1 week before the decision is made to have a post mortem. This is obviously out of the control of the mortuary staff.
We said: We would encourage any company experiencing delay to contact the Coroner Service directly.

You said: Feedback regarding cleanliness of patients
We said: We take onboard concerns regarding the cleanliness of the deceased. Please be assured that this is taken very seriously by the Mortuary team. All patients are checked for their condition on a regular basis and this is documented on our computer system. Where possible, patients are cleaned regularly if required, and placed into fresh linen. It should be noted however that there is a limit as to what the staff can achieve, especially given the unpredictable nature of the circumstances of the deceased’s death; and the natural process of decomposition. Any concerns should be directed to a member of the team.

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