Comparison of Patient Satisfaction between Medical Staff and Clinical Nurse Specialist Performing Bone Marrow Investigation Procedure.

Bone marrow investigation is an important haematological investigation used to determine a wide range of diverse conditions. Historically the investigation was carried out by a member of the medical haematology team; recently there has been an increasing trend towards non-medical staff taking on the role. At South Tyneside NHS Foundation Trust the Haematology Clinical Nurse Specialist (CNS) was trained and deemed competent by the Consultant Haematologists to carry out this complex procedure. To evaluate the benefits of this change in practice we designed a patient satisfaction survey to determine whether the patient experience is influenced by whether the procedure was carried out by the CNS or a member of the medical team. A simple questionnaire was formulated which was given to patients following bone marrow investigation. The questionnaire was completed and returned anonymously to the audit department for collation of results. Twenty-four patients in total returned questionnaires, twelve from medical staff and twelve from the CNS operators.

There was no variation in explanation of the investigation given to the patient between the two groups. However, all 100% of the patients seen by the CNS were given written information regarding the procedure, whereas only 22% of the medical staff group furnished information to the patient. There was no overall difference between the two groups with respect to opportunity to ask questions relating to the procedure before it was undertaken. Those procedures carried out by the CNS were completed one to two days of the decision to biopsy in 92% of cases, whereas this was only achieved in 44% of those patients seen by a member of the medical team. In addition, there was no difference in the pain experience of either group, with twenty to thirty percent requiring analgesia in both cohorts. The CNS was more likely to supply a follow up appointment to the patient for the test results. In summary, there is no apparent difference in patient satisfaction between medical staff and CNS when bone marrow investigation is required. However, the CNS is more inclined to support verbal information with written documentation and to carry out the procedure within a more rapid time frame. When re-structuring haematological services locally, the role of the CNS in respect to bone marrow investigation should be considered as crucial, particularly regarding significant investigative procedures such as bone marrow biopsy. Importantly, this must be supported by suitable training and competency assessment.