Narrative reporting is recognised by Public Health Wales as an important public health tool because of the effect we have seen initially in the Hywel Dda University Health Board but now moving to other parts of our service.
Mike Simmons gives a brief introduction to explain why this development is important
The initial findings from the Hywel Dda Microbiology Service was reported in our paper in the Journal of Infection Prevention. We showed in that paper that our urine numbers dropped within three months of starting narrative reporting of urines and at the end of the first year, our sample numbers were down by 12,000. Our positive to negative ration also increased, which to us suggested we were influencing sampling decisions. The greatest number of urine samples come from primary care and you can listen to Dr Carwen Jones, a GP in Carmarthen, reflecting on the impact we were having on his practice.
Subsequently, when asked if we could support our clinical colleagues in the Betsi Cadwaladr service as a result of recruitment difficulties there, we were able to recruit an additional consultant for the Hywel Dda Service. This meant we were able to support the North Wales service by undertaking their urine sample reporting. For us, this would allow us to test a second time, if we could replicate what we had seen in West Wales. We predicted with almost double the number of urine samples per month in their service compared to the Hywel Dda initial starting point, we should see a reduction of 2,000 samples per month in their samples.
We started in August 2018 and at the end of a year, we had indeed reduced the number by 2,000 per month. In December 2019, with the imminent departure of the additional consultant employed in Hywel Dda, that service had to cease support to North Wales but prior to that happening, training in narrative reporting was undertaken with the North Wales service and narrative reporting of urines has continued. This was undertaken by the first Clinical Biomedical Scientist to be appointed in Wales.
In preparation for the Bevan Commission Showcase in June 2021, we took the opportunity to look at what has been happening with the urine numbers in both Hywel Dda and Betsi Cadwaladr Health Boards:
We explore these results in more detail under the Outcomes tab.
Interpretive comments have as mentioned previously always been something that have been included to a greater or lesser extent. Since starting this journey in 2014, we have noted a paper by Vasikaran and colleagues, explains the value in detail and is worth reviewing by way of background to what we are doing within this microbiology programme. The uniqueness of our approach is the recognition that the placement of the comment in microbiology terms, is that it should appear before any sensitivities if it is to have the greatest impact on disrupting the thinking process of the clinician reading the report.