Basingstoke and north hampshire hospital pathology user handbook

Transport of specimens from clinics and surgeries

All pathology specimens must be placed in primary containers and labelled fully with three independent patient identifiers (Full name – Surname and Forename, DOB, and NHS number (see exceptions p13). If the NHS number is not available the Hospital number. In emergencies only the Patient’s first line of address may be utilised. Place the specimen into an approved sealed specimen bag with enough absorbent material to contain the entire sample should a leak occur. Place the request form into the side section of the bag if using ‘Ziplock bags’ (separate from the specimen - avoids contamination if spillage occurs).

The patient details including all relevant clinical details must be written clearly onto the request form.

Infection risk specimens must have a “Danger of Infection” sticker attached to the specimen(s) and the request form.

Specimens should be transported to the laboratory as rapidly as possible after collection to ensure that no significant deterioration occurs before processing.

All samples must be transported to the laboratory in a sealed Transport Box. The box must be clearly labelled with the International BIOHAZARD label, UN3373 Biological Substance Category B diamond and contact details in case of accident/incident.
If initial risk assessments of a patient indicate possible TSE or Hazard Group 4 organisms i.e. Viral Haemorrhagic Fever the requesting doctor must contact the Consultant Microbiologist for advice before specimens are taken and dispatched.
All transport drivers MUST carry ”instructions in writing” in accordance with the Transport of Dangerous Goods Regulations (ADR), Chapter 5 (section 5.4.3.4), within the vehicle while Pathology specimens are on board.
NOTE: All van/car drivers must carry spill kits and gloves. (HSE “safe working and the prevention of infection in clinical laboratories and similar facilities” 2003 Appendix 4, section 22)
Research and Development

It is the Department's policy to encourage appropriate research and development and to promote personal, professional development. Many of the medical and scientific staff take an active part in medical education and research.

Screening Programmes and other non-NHS work

The Department is involved in health screening programmes and is happy to provide quotations for individually tailored schemes and private work. Please contact the Blood Sciences Manager.

The department is also involved in several non-NHS schemes and performs pathology testing that includes:
Private hospitals Health screening

Education courses Quality Control

DVLA

Availability of Results

The Departments endeavour to process all specimens received in the most timely and accurate way possible. Urgent results may be available within the hour, following prior discussion with the laboratory. Results for routine haematology and biochemistry tests are available via the Pathology computer within 4 – 8 hours.

Most tests are performed the same day but some take several days and are performed in batches. Special investigations may be sent to other centres and these results can take two weeks, sometimes longer.

Turnaround Times

A full table of representative turnaround times is in the Test Index. Turnaround times are routinely monitored as part of the Laboratory’s Continual Quality Improvement Programme.

Reports

Grossly abnormal results will be telephoned.

All pathology results are available on the ward terminals through the ICE result reporting module, and in times of ICE failure through the ward enquiry programme, as soon as they have been authorised for release. Please look here first before phoning the laboratory. Hard copy print outs of Chemical Pathology, Haematology and Microbiology results can be generated from these terminals to minimise risk of transcription errors.

Standard format reports are computer generated several times a day and can be viewed through the ICE results reporting system for all GP surgeries that have access. This includes access to Hospital generated results giving GP’s access to full patient histories. Surgeries that are linked to the NHS Net and have EDI links have the results automatically sent to them, EXCEPT Histology/Cytology reports. Hard copies are still sent for Histology/cytology and for other departments if electronic transfer is not possible.

The reference/normal or therapeutic ranges are quoted on the report form for most assays. These are current ranges and may supersede other listed ranges.
A Clinisys WinPath pathology computer system is in use covering all disciplines including microbiology, histology, haematology, blood transfusion and chemical pathology. Access to the system is available on ward and clinic areas through the hospital network.

WinPath supports a unique password for each user. New members of hospital staff requiring access should contact Mr Alex Kelly, computer manager, on ext 3288 for password privileges and training.

An individual password is needed by each person removing blood from the blood bank. This will be arranged when attending the blood bank training session. Contact Mr Roger Chant ext. 4756.
All new house officers are given pathology computer training as part of the induction programme when password access will also be organised

Out-of-hours service

An 'on-call' service is provided by haematology, microbiology and chemical pathology staff outside routine laboratory hours and at weekends and bank holidays. The investigations provided by the 'on-call' service are limited to those shown below.
Using the service
Specimens for haematology and chemical pathology should be placed in the red box through the metal grille in pathology reception. Immediately results are available they will be entered on the computer so interrogate your VDU rather than telephoning the BMS. Please be tolerant in cases of delay as yours will not be the only patient requiring the service.
All urgent microbiology specimens out of hours must be delivered to pathology reception as above but a doctor should always speak personally to the on-call microbiology BMS about the request.
Service offered
The work for Chemical Pathology and Haematology should be considered as two categories:

• 
  Investigations that are required to make immediate clinical decisions about the patient's management. For such requests it is essential to contact the on call biomedical scientist but do not do so until the blood has been taken and the samples collected by the porters.
  

• 
  Investigations that are required for less urgent clinical decision making/need to know within a few hours/should be available for next morning. For such requests there is no need to contact the biomedical scientist provided the samples are received in the laboratory before 2400 hrs. The on call staff remain in the department through the evening and weekend and will analyse all samples with tests on the list below whether they have been contacted or not. They also remain on site at night but may be resting so if tests are required after about 2400 hours but before next morning you should contact the relevant BMS on call.
  

Ammonia, CSF and Troponin must always be notified

For investigations other than those detailed below you may be asked to contact the appropriate Consultant Pathologist. The requesting doctor may also be asked to do this for listed tests if the request seems unreasonable. Non-urgent biochemistry requests may include other tests, but these will only be analysed:

- if available on main analyser

- if time permits

otherwise samples will be secured and analysed next routine working day.

Requests for work with no element of clinical urgency must not be made outside normal working hours unless the patient will not be available in routine hours.
The following investigations are available as out-of-hours tests: