Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : EC19 - EC22 Full Version

Evaluation of Patient Satisfaction with Clinical Laboratory and Phlebotomy Services in a NABL Accredited Laboratory in a Tertiary Care Hospital, Eastern India: A Cross-sectional Study


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51300.16322
Kavita Aggarwal, Sumit Jhajharia, Tapaswini Pradhan, Viyatprajna Acharya

1. Associate Professor, Department of Biochemistry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 2. Associate Professor, Department of Biochemistry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 3. Professor, Department of Biochemistry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 4. Professor, Department of Biochemistry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Correspondence Address :
Dr. Kavita Aggarwal,
Associate Professor, Department of Biochemistry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
E-mail: kavitakims@gmail.com

Abstract

Introduction: Clinical laboratories play an indispensable role in patient care. Laboratory results help in approximately 70% of medical decision making. Patients are the best source of information on quality of service provided by an Institute, as their feedback can help in future planning and taking corrective action.

Aim: To evaluate patient satisfaction with clinical laboratory and phlebotomy services in a National Accreditation Board for Testing and Calibration Laboratories (NABL) accredited laboratory in a tertiary care hospital in Eastern India.

Material and methods: This was a hospital-based cross-sectional study, conducted from May 2021 to June 2021, on the patients visiting the central laboratory of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha. A total of 265 participants above the age of 18 years were included in the study. They were provided with a feedback questionnaire (13 questions). A 5-point Likert scale rating of very dissatisfied, dissatisfied, neutral, satisfied and very satisfied was used. Descriptive statistics such as number and percentage were used to present the data.

Results: Out of the total, 96% was the response rate, hence, the complete questionnaires analysed were of 254 participants (130 males and 124 females). Out of the total 254 participants, 155 (61%) were very satisfied, 61 (24%) were satisfied, 28 (11%) were neutral and 10 (3.93%) were dissatisfied with the overall laboratory services. Laboratory test results were reliable scored very high and was reported to be very satisfactory by 177 participants (69.68%), satisfactory by 51 participants (20.07%) and 165 participants (64.96%) were very satisfied and 58 participants (22.83%) were satisfied with staff courtesy, skill and behaviour. However, none of the participants were very dissatisfied and 10 (4%) were dissatisfied, expected the laboratory services to be little better. For explanation of test results 79 participants (31.10%) were very dissatisfied and another 114 participants (44.88%) were dissatisfied. A total of 34 participants (13.38%) were very dissatisfied and another 50 participants (19.68%) were dissatisfied with the given information about location and time of report collection.

Conclusion: Patient satisfaction is an important indicator of the quality of service delivered. The overall satisfaction level with the laboratory service was 85%, showing a majority of the participants were satisfied or very satisfied with the overall services of the laboratory. There is a need to improve on cleanliness and more emphasis is to be laid, on transmission of accurate and adequate information to the patients.

Keywords

Medical diagnosis, National accreditation board for testing and calibration laboratories, Patient care

Clinical laboratories play an indispensable role in patient care. Laboratory results help in about 70% of medical decision making (1). Inaccurate laboratory result may lead to wrong medical diagnosis or delay in diagnosis (2). Quality and safety in diagnostic testing are utmost important for achieving safe and high quality healthcare. One of the most important quality indicators in laboratory medicine is customer satisfaction. Measuring and improving patient satisfaction with clinical laboratory services are essential aspects of laboratory management (3).

Patient satisfaction is measured by perception of services received as compared to the services expected by the patient. Analysis of patient satisfaction is relevant because a satisfied patient is more likely to comply with the treatment regimen. Patients who are not satisfied with the services may have worse clinical outcome as compared to the satisfied patient (3),(4).

The International Standard (ISO) 15189 also requires monitoring of patient satisfaction as an indicator of quality management system (5). Maintenance of quality laboratory services requires continuous support and effort from patients, clinicians, laboratory personals and management. National Accreditation Board for Testing and Calibration Laboratories (NABL) administers laboratory accreditation under the direction of the Assessment Team and Accreditation Committee. NABL is a signatory to Asia Pacific Accreditation Cooperation (APAC) and International Laboratory Accreditation Cooperation (ILAC) Mutual Recognition Arrangements (MRA). (5) These are based on mutual evaluation and acceptance of other MRA partner laboratory accreditation systems. Such international arrangements allow acceptance of test/calibration results between MRA partner countries. The NABL Accredited laboratories are required to comply with all the requirements listed in the International Standard Organisation (ISO 15189:2012) (Medical laboratories- Requirements for Quality and Competence) (5).

Patients are the best source of information on quality of service provided by an institute and their feedback can help a lot in future planning as well as in taking corrective action. The factors that influence patient satisfaction of laboratory services includes competence and etiquettes of laboratory personals, availability of sufficient, clear and accurate information at different counters like registration, sample collection, report collection. Waiting time is also an important indicator of patient satisfaction (6).

Cleanliness and infection control measures in patient waiting area, sample collection area and toilet are also very crucial especially during these times of Coronavirus Disease 2019 (COVID-19) infection. Although, there are many studies on pre-analytical errors in medical laboratory, there is scarcity of research that assesses actual patient experiences at the medical laboratory units of hospitals in India. Gupta A et al., reported the highest rate of satisfaction (76%) in case of parameter-ease to find collection sample room and lowest rate of satisfaction (22%) was scored by the parameter-staff’s wearing proper uniform (7). Dawar R identified five areas in which there is a need for improvement namely ability of the phlebotomist to put patient in ease; ability of the phlebotomist to answer questions; increasing toilet cleanliness and comfort; availability of all the tests requested by physician and information about bruise (8). Therefore, the present study was planned to analyse patient satisfaction with clinical laboratory and phlebotomy services in a NABL accredited laboratory in a tertiary care hospital in Eastern India.

Material and Methods

This was a hospital-based cross-sectional study, conducted from May 2021 to June 2021 at the sample collection unit of central laboratory of Department of Biochemistry, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India. Informed consent was obtained from the participants. Institutional Research and Ethics Committee clearance was obtained for the present study (letter no KIIT/KIMS /IEC/715/2021).

Sample size calculation: Required sample size was calculated using the following formula:

n=z2 P (1-P)/d2

Where n was the sample size, Z=95% was the statistic corresponding to level of confidence, P=94% was assumed patient satisfaction obtained from a similar study done in Delhi, India and d=3% was precision or margin of error between the sample and the population (6). The calculated sample size was 241 participants. Assuming a non response rate of 10%, sample size required is 265.

Inclusion criteria: Participants above the age of 18 years, who visited the sample collection centre of the central laboratory during the study period, were included in the study.

Exclusion criteria: Patients with critical illness, psychiatric disease and paediatric patients were excluded from the study.

Questionnaire

The participants were provided with a feedback questionnaire, (13 questions), which was self-designed based on previous studies [6-10]. The questionnaire was prepared in English language and internal consistency was checked using Cronbach’s alpha coefficient and it was found to be 0.874 (Cronbach’s alpha coefficient >0.7 is acceptable). The satisfaction level was measured using a 5-point Likert scales ranging from very dissatisfied to very satisfied (1 to 5 points). The questionnaire was given and filled by the participants at the time of report collection.

Statistical Analysis

Microsoft (MS) Excel spreadsheet was used to create the database. Descriptive statistics such as number and percentage were used to present the data.

Results

A total of 265 participants were included in the study and the response rate was 96%. Hence the total questionnaires and responses analysed were of 254 participants. There were 130 males and 124 females. The mean (±SD) age of participants was 42 (±21) years. The number and percentage of participant’s satisfaction and dissatisfaction are presented in (Table/Fig 1). Out of the total 254 participants, 155 (61.02%) were very satisfied, another 61 (24.01%) were satisfied, and 28 (11.02%) were neutral 5with the overall laboratory services. Only 10 (3.93%) participants were dissatisfied with the overall laboratory services. Majority of the participants 177 (69.68%)were very satisfied with the reliability of the test results. A large number of participants 165 (64.96%) were very satisfied with staff courtesy, skill and behaviour. The highest dissatisfaction rates were observed for explanation of test results with a rate of 31.10% followed by information about location and time of report collection was given with a dissatisfaction rate of 13.38%.

Discussion

The present study was designed with the aim to evaluate Patient satisfaction with clinical laboratory and phlebotomy services in a NABL accredited laboratory in a tertiary care hospital in Eastern India. The present study revealed that the overall satisfaction level with the laboratory service was 155 (61.02%) were very satisfied and another 61 (24.01%) were satisfied which showed a majority of the participants were satisfied with the overall services of the laboratory. The index result is in concordance to the studies done by Khatri A and Sharma S, and Gupta A et al., who reported an 86% and 94% overall satisfaction, respectively, both of which were on the patient satisfaction about the phlebotomy services (7),(11).

The study laboratory is NABL accredited since last six years, so a lot of focus is given on improvement of quality of services, therefore, participants satisfaction was recorded to be high.

The reception, sample collection room and toilet were easily accessed by 86.21% participants showing that, the location of the laboratory services was user-friendly and well-labeled. Majority of the patients were satisfied with the waiting time at reception and blood collection. This finding could be the due to the Hospital Information Management System (HIMS) and bar-coding system in the hospital. This is in concordance with the study done by Khatri A and Sharma S and Dawar R who reported a high satisfaction level 91.6% and 99%, respectively, with the waiting time at registration and sample collection (8),(11). Accessibility of different hospital facilities like the reception, sample collection room, site of laboratory, toilet and others can influence patients’ gratification regarding the hospital service. In a previous study done by Hailu HA et al., patients complained that they lost a long time by searching for the locations and were very disappointed (12).

Laboratory test results were reliable scored the highest level of satisfaction in the present study, which is indeed very encouraging. Reliability of the test result is the most important factor which affects the participant’s satisfaction level. This finding is in agreement with the study done by Koh YR et al., they reported participant’s satisfaction level of 66.7% for reliability of test results (13). The 55.11% of the participants reported that the sample collection procedure was comfortable. Privacy during sample collection was taken care well, as only 12 (4.72%) participants were dissatisfied and very dissatisfied with the privacy issue. This finding is the result of frequent training and assessment of the laboratory staff which is a routine protocol according to NABL accreditation. However, majority of the participants 123 (48.42%) were neutral regarding the cleanliness of sample collection and toilet. Gupta A reported a high level of satisfaction with cleanliness of sample collection and toilet, 304 (25.3%) participants were very satisfied and another 492 (41%) were satisfied with cleanliness (7). Contrary to the present study, Khatri A and Sharma S, reported a high score for dissatisfaction (35.8%) for toilet cleanliness and comfort. Health facilities are meant to provide healthcare as well as promote preventive health behaviour amongst patients by inculcating clean and hygiene practice among the patients (11).

Cost of the test is also a very important parameter which decides the satisfaction level of the patients; in this study only 24.01% of the patients were highly satisfied and satisfied with the cost of the test. A study done in public hospitals of Ethopia by Hailu HA et al indicated that 83% of the respondents were satisfied with the payment of the services, while 17% of the respondents perceived that laboratory test charges were not fair (12). Study done by Lee SI and Koh YR et al has also reported, cost to negatively affect the satisfaction level (13),(14). Studies done in India by Khatri A and Sharma S, and Gupta A et al have not taken cost into account as these were done in the government hospital setting where cost is taken care by government, while hospital in the present study is privately owned and operated therefore cost to run a NABL Accreditated laboratory is high which will result in high cost for the tests (7),(11).

A total of 152 (59.84%) participants were very satisfied and 64 (25.19%) were satisfied with the availability of all the test requested. Dawar R also reported a high level of satisfaction 68% with the availability of test results (8). Majority of the participants were dissatisfied with the information about the location, and time of report collection and explanation of test result, which is consistent with the study done by Hailu HA et al., they reported 26% of the respondents were unsatisfied with the explanation or advisory services provided for them before sample collection, nearly 18% of the participants did not get clear and adequate information, where, when and how much specimen has been collected. 20.8% of the respondents were not informed clearly when, where, and how they will receive their laboratory results (12). Clear and smooth communication is a vital for patient satisfaction. If a patient feels estranged, uninformed about the service and test results, it may affect their recovery process. Hence, it is important to inform patients, prior to the procedures, by the laboratory personnel. Short description of test results can be added in the test report.

Turnaround Time (TAT) is one of the important quality indicators. Although TAT is well established in the study laboratory and taken care of, but, it was not intimated to the patients probably due to negligence and lack of written SOP (Standard Operating Procedure) for the same. A study done in Tanzania associated inadequate explanations regarding laboratory procedures to anxiety in patients (15). Explanation of test results should be taken care of, either, in written or verbal form to the participants.

The laboratory services play an indispensable part in diagnosis and management of various healthcare services, therefore, laboratory and hospital management should pay immediate attention to the areas which need improvement in order to improve satisfaction level of the patients.

Limitation(s)

There were no open-ended questions and the researchers did not collect data about the number of needle pricks and bruise size in the phlebotomy service survey.

Conclusion

Patient satisfaction is important indicator of the quality of service delivered. The overall satisfaction level with the laboratory service was 85.03%, showing a majority of the participants were satisfied with the overall services of the laboratory. Cleanliness of sample collection and toilet, explanation of test results and cost of the test scored very low on satisfaction scale. There is a need to improve on cleanliness and more emphasis should be given to transmission of accurate and adequate information to the patients.

Acknowledgement

The authors are grateful to all the participants of the present study and wish to thank laboratory staff for their help in questionnaire distribution and collection.

References

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Hallworth MJ. The 70% claim: What is the evidence base? Ann Clin Biochem. 2011;48:487-88. [crossref] [PubMed]
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Badrick T. Evidence-based laboratory medicine. Clin Biochem Rev. 2013;34(2):43-46.
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Shahangian S and Snyder SR. Laboratory medicine quality indicators: A review of the literature. Am J Clin Pathol. 2009;131(3):418-31. [crossref] [PubMed]
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Tables and Figures
[Table / Fig - 1]
DOI and Others

DOI: 10.7860/JCDR/2022/51300.16322

Date of Submission: Jul 09, 2021
Date of Peer Review: Aug 07, 2021
Date of Acceptance: Mar 30, 2022
Date of Publishing: May 01, 2022

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 10, 2021
• Manual Googling: Mar 11, 2022
• iThenticate Software: Apr 16, 2022 (23%)

Etymology: Author Origin

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