There have been extensive studies on patient turnaround times at various units in the hospital settings. However, there is scarcity of studies that actually explored real-time patient experiences at the laboratory section/department of hospitals in sub-Saharan Africa. This study thus sought to use real time observations of patient-laboratory practitioner interactions to provide empirical data regarding actual lived patient experiences at the laboratory units of two hospitals and explored the depth of pre- and post-sampling information provided to patients by laboratory professionals. The study found a discrepancy between the actual experiences of patients (as observed by the researcher as well as stated from the patient perspective) and information given by the laboratory professionals concerning the communication of the turnaround times to patients. Although, an overwhelming 93.3% of laboratory professionals intimated the importance of communicating the testing turnaround time to the patients, only half of patients (50.6%; 45/89 patients) indicated knowing when their respective test results were going to be ready. Thus, although the laboratory professionals acknowledged the need to communicate testing turnaround time to patients, these are not routinely communicated to patients in the course of work. This was duly acknowledged by some laboratory professionals who variously stated that “the pressure from high workload was a major barrier to effective patient communication”. Indeed, what was stated by the patients more reflect the realities of the patient-practitioner communication as it conforms to the researcher’s observational data. The 50.6% of patients who were not informed about the testing turnaround time as found by this study is however lower than the 88% reported in a national survey in Ethiopia (13). Incidentally, majority of the individuals who reported knowing their respective testing turnaround times were those undertaking blood chemistries. It is important to note that irrespective of the time in the day in which the patient accessed laboratory services, with the exception of fasting blood glucose which was undertaken using rapid diagnostic test kit, all those undertaking blood chemistries were always informed to return the next day for results. Even though the LPs indicated this to be the status quo because it took relatively longer to complete one cycle of testing on the blood chemistry analyser, this researcher is of the view this practice needs re-consideration as it does not auger well for prompt medical decision making. Taken together with the supposition that about 70% of clinical decisions are estimated to be based on laboratory results (9), quality of laboratory services at the two hospitals is questionable as the timeliness aspect of quality is not routinely addressed.
Interestingly, although 60% of the LPs stated that informing patients about the specifics of their laboratory testing was the sole prerogative of the respective prescriber, only 29.2% (26/89) of patients indicated such explanations were given by their prescribers. It is important to note that a greater proportion of the patients that were informed by their prescriber about the laboratory testing specifics were from the UCC hospital which serves mainly tertiary students. Although this study neither collected data from the perspective of the prescribers of laboratory tests, nor undertake observations of prescriber-patient interaction, future studies that address this gap in the present study will provide a comprehensive understanding of the patient-practitioner interaction during hospital visit. This is important considering that if both prescribers and laboratory professionals each make the assumption that the other professional was responsible for explaining laboratory testing, the patient stands to lose from this vital aspect of clinical service. In the absence of such data, the findings reported herein strongly argues for the need for engagement of all practitioners directly involved in either requesting or undertaking laboratory assays for patients to clarify responsibilities. This is important considering that a previous study in Tanzania found associations between inadequate explanations regarding laboratory procedures and anxiety in patients (14).
Interestingly, LPs’ and patient engagement during sample taking at the study sites is reduced to the barest minimum. For example, despite recommendations that patient identification should be established using a minimum of three identifiers (15), patients were identified at both laboratories only by their respective names; no recourse to other means of establishing patient identity are explored at the two laboratory units. The existing work paradigm is therefore prone to patient misidentification. Besides, none of the laboratories has written standard operating procedures (SOPs) regarding LP-patient interaction. Clinical laboratory practice is globally regulated by the use of SOPs that ensures standardization of practice (16). In the absence of such SOPs, whatever constitutes an appropriate level of care is left to the discretion of the professionals with its attendant practical implications. Thus, there are wide variations in the services offered to patients even within the same facility. For example, whereas some LPs ask patients to leave the phlebotomy unit with instruction to apply pressure on a piece of cotton applied to the phlebotomy site, other LPs ensured that blood flow has ceased at the phlebotomy site, apply adhesive to cover the open wound before asking the patient to leave. As a consequence of this, it is not uncommon to find blood-stained pieces of cotton littered at the patient waiting area with its attending biohazard risks. These variations in practice are so widespread that even protocols for managing blood spills are variable; for example, whereas other professionals use alcohol to clean blood spills, other professionals rather use bleach to do same. Even though this study was limited to the two hospitals’ laboratories and may therefore be premature to generalize the findings to other facilities, it is plausible to suppose that this might be happening in other laboratories and therefore needs holistic approach to ensure standardization of patient care. Although it can be argued that the existence of SOPs will not automatically lead to elimination of all forms of practice variations, this researcher is of the view that the implementation of SOPs will dramatically reduce these variations in care and assure consistency in patient care delivery in the laboratory units. A critical avenue that enables health professional to update their practices is through contextually relevant continuous professional development (CPD) programmes. Thus, the national association of the laboratory professionals should consider engaging relevant stakeholders to facilitate such CPD seminars to begin the process of standardization of patient-laboratory professional interactions.
Furthermore, this study found that patients generally have poor knowledge about their scheduled laboratory testing. Overall, only 28.1% of patients stated knowing the exact laboratory testing they were to undergo. When patients were asked to respectively give the names of the exact laboratory testing, less than 15% could correctly identify their respective testing. For example, some patients indicated that they were to undertake urine test; when these were compared to their respective requisition sheets, some were to undergo both urine routine examination and urine culture. Thus, these patients knew only of the laboratory test in general terms. Even though a higher proportion of patients accessing laboratory services at UCC hospital had tertiary education, only about a third of these patients stated knowing their respective laboratory testing (compared to 18.2% Ewim Polyclinic laboratory patients). Such poor understanding on the part of the patients may therefore not be necessarily a function of educational background of patients. This is an area that must be addressed by a concerted effort between healthcare professionals to ensure better patient understanding of laboratory testing and respective procedures. Future studies should consider patients accessing care at other departments of these hospitals for a comprehensive public health engagement initiative through systems thinking approaches.
It is important to point out that certain organisational factors and constraints at the two study sites prevented adequate patient-practitioner interactions. For example, a conducive environment that assures privacy and confidentiality is required for effective LP-patient interaction. However, it is near impossible to attain either confidentiality or privacy at the two study sites. At Ewim Polyclinic, documentation and phlebotomy sections of the laboratory unit are one and the same room; the waiting area is eavesdropping away. Consequently, whatever is discussed between the LP and patient is in the hearing of other patients in the waiting area. Although the waiting area at UCC laboratory was separate from the phlebotomy unit, the two phlebotomy stations are in the same small room. Thus, two patients being attended to gets to hear whatever the other patient is being offered. As space is a major constraint in most laboratories in sub-Saharan Africa, architectural designs of future hospitals should give adequate priority to the set-up of laboratories to ensure adequacy of laboratory practitioner-patient interactions.
There was a general disconnect between what laboratory staff stated in questionnaire responses as their standard patient care, and what was observed first-hand by the researcher. In the patients’ questionnaire responses, 41.6% of the patients stated that no information was given by the laboratory personnel prior to sampling. This agrees with the researcher’s observational data, but was contrary to responses provided by the laboratory professionals. One of the key strengths of the present study is collection of observational data which provided a priceless perspective in contextualizing the findings of research and allowed insight into the apparent disparity between the laboratory professionals and patient responses. The questionnaire responses by the laboratory professionals is suggestive that the laboratory professionals have the theoretical knowledge of what constitutes adequate practitioner-patient interactions. However, why they fail to actualize this knowledge when attending to patients require further investigation. Among the reasons offered by the laboratory professionals include the issue of heavy workload that makes it more demanding to effectively communicate with clients. With UCC and Ewim polyclinic laboratories averagely respectively attending to 94 and 62 patients/day, this heavy workload may be an important consideration in any attempt made to address adequacy of patient-practitioner interactions.
The major limitations of this study include the small sample size and the fact that the study was limited to the laboratory units of two hospitals. Even though the study had originally intended a larger sample size and additional hospitals, the COVID-19 pandemic and the subsequent global shut down restricted the sampling period. Notwithstanding these limitations, the methodological triangulation employed for data collection has increased the scientific rigour of the data reported herein and could thus be used to inform future studies as Ghana gradually returns to normalcy.