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Pathology Handbook

Pathology User Handbook

Section 1:   Introduction and General Information

Table of Contents

1.1  Introduction

This 9th  edition of the Laboratory Handbook has been updated to help you make the best use of the RUH Pathology Laboratories.  It is designed to provide details of the test repertoire, specimen requirements, reference ranges and test frequency.  As before, the information provided is an overview and if you require further information or advice please consult the relevant laboratory.   If you have any suggestions or criticisms of either the laboratory service or this handbook please let us know.  We continue to welcome any feedback.

The RUH Pathology Laboratories consist of four departments: Biochemistry, Haematology (including Blood Transfusion & Immunology), Cellular Pathology (Histopathology & Cytology) & Microbiology. The pre- and post analytical sections of Haematology and Clinical Biochemistry are amalgamated to improve efficiency. An on-site service for urgent bacteriology specimens is provided (see Microbiology section) all other microbiology specimens including Virology are transferred to the laboratory in Bristol. Details of services provided by all these laboratories are provided in this handbook.

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1.2  Laboratory Opening Hours and Contact Details

Pathology Service

Opening Hours

Contact Information

Pathology Specimen Reception

08:00 – 17:00 Monday - Friday

01225 824740

Results Service
(except Microbiology)

08:30 – 17:30 Monday - Friday

01225 824700

Microbiology
Results Service

08.30 – 17.30
Monday - Friday

Bristol HPA
0117 342 2514

(for Virology results tel 0117 342 5012)

09:00 – 17.00 Monday - Friday RUH Microbiology
01225 825428

Biochemistry Lab
Core Hours

(front door open from 08:30)

09:00 – 17:15
Monday - Friday

01225 824240

Biochemistry Lab
Urgents

(limited service outside Core Hours)

24hrs, every day

All samples from Acute Wards that are Clearly Labelled as Urgent will be fast tracked.  

Other Wards and GPs to contact Lab before sending samples. 

Outside Core Hours contact Lab via RUH Switchboard on 01225 42 8331.

Blood Bank
Core Hours
(front door open from 08:30)

08:00 – 17:15
Monday - Friday

01225 824734
Fax: 01225 824765

Blood Bank
Urgents

24hrs, every day

Contact Lab outside Core Hours via RUH Switchboard on 01225 42 8331 if necessary.

Haematology Lab
Core Hours

(front door open from 08:30)

09:00 – 17:15
Monday - Friday

01225 824728

Haematology
Urgents

(limited service outside Core Hours)

24hrs, every day

All samples from Acute Wards that are Clearly Marked as Urgent will be fast tracked. Other Wards and GPs to contact Lab before sending samples.

Outside Core Hours contact Lab via RUH Switchboard on 01225 42 8331.

Immunology Lab
(Front door open from 08:30)

09:00 – 17:15
Monday – Friday

01225 42 1406.

Microbiology
On-site Lab

09:00 – 17:00
Monday - Friday

08:00 – 12:00
Sat and Bank Holidays

01225 824747

Please telephone for urgent requests except blood cultures and clearly label specimen as urgent.

Microbiology
Urgents

All other times

Contact On-call BMS staff via the RUH Switchboard on 01225 42 8331 to process appropriate specimens in the On-site lab.

Some urgent specimens eg BAL samples may need to be transported to UH Bristol for processing which should be arranged with the BMS staff as above. 

Histopathology

09:00 – 17:30
Monday - Friday

01225 824750 or 01225 82 4720

Outside these hours, contact the On-call Pathologist via the switchboard. 

To book a frozen section call 01225 824750 or 01225 82 4720 in advance.

Cytology

09:00 – 17:30
Monday - Friday

01225 824721

Outside these hours, contact the On-call Pathologist via the switchboard on 01225 42 8331

Outpatient Phlebotomy

09:30-15:30
Monday - Friday

01225 824842 (based in Medlock Neurology OP Dept.) 

No appointment needed. 

See RUH intranet for any planned closures for the week ahead.

Office Enquiries

09:00 – 17:00
Monday - Friday

01225 825504

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1.3  Other Useful Telephone Numbers

Contract, Service or Business Enquiries:

Dr A J Taylor 

Specialty Lead

01225 824715

Nigel Roberts

Pathology Services Manager

01225 824727

Mrs Mandy Budds

PA to Pathology Managers

01225 825504

Lesley Shipway

Quality Manager

01225 821770

Clinical Staff:

Biochemistry

Dr Andrew Taylor

Medical Consultant

01225 824715

Miss Jane Lewis

Consultant Clinical Scientist  

01225 824711

Miss Beverly Harris

Principal Clinical Scientist

01225 824713

Haematology

Dr CRJ Singer  

Consultant

01225 824488

Dr SA Wexler

Consultant

01225 824487

Dr C Knechtli

Consultant

01225 824463

Dr J Crowe

Consultant

01225 821799

Ward Registrar 

 

Call 01225 428331 and Bleep 7702 
or call 01225 82 4423

Laboratory Registrar

 

Call 01225 428331 and Bleep 7559
or call 01225 824732

Cellular Pathology (Histopathology & Cytology)

Dr Leigh Biddlestone

Consultant

01225 825624

Dr Chris Meehan

Consultant

01225 825716

Dr Simon Rose

Consultant

01225 825679

Dr Paul Kitching

Consultant

01225 826414

Dr Pinias Mukonoweshuro

Consultant

01225 825677

Dr John Mitchard

Consultant       

01225 824719

Dr Sarah Johnson

Consultant

01225 824722

Microbiology

Dr Sarah Meisner

Consultant Microbiologist

01225 825428

Dr Susan Murray

Consultant Clinical Scientist

01225 825428

Dr Rachel Mayer

Consultant Microbiologist

01225 825428

Dr Ebi Abrishami

Consultant Microbiologist

01225 825428

Laboratory Staff:

Biochemistry

Richard Headford

Laboratory Manager

01225 824714

Amanda Speed

Chief BMS

01225 824708

Richard Morgan

Chief BMS

01225 824709

Haematology

Nigel Roberts

Laboratory Manager

01225 824727

David Fisher

Chief BMS Blood Bank

01225 824739

 Nigel Roberts

Immunology     

01225 824727

Christine Williams

Chief BMS Haematology

01225 824728

Mandy Budds

Anticoagulation Administrator   

01225 825504

Cellular Pathology (Histopathology & Cytology)

Lucinda Payne-Johns

Laboratory Manager

01225 825717

Simon Blight

Chief BMS Cytology

01225 824746

Jackie Price

Chief BMS Histology

01225 824718

Microbiology

Laboratory

On-site BMS

01225 824747

Joanne Sell

Head BMS

01179 3425551

Jackie Watts

Deputy Head BMS

01179 3425551

BMS

Virology           

01179 3425552
Will Gottard HPA Regional Director of Operations 01179 3425551


GP Requesting & Reporting

Kevin Hudson

 

01225 824475

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1.4  General Information

Phlebotomy

Blood samples are collected on wards each morning by small teams of phlebotomists managed by Medicine or Surgery. ICE requests should be completed by 7am and left for the phlebotomists. An Out-Patient phlebotomy service is provided by pathology in the Medlock Neurology Out-Patients from 9.30am – 4.15pm Monday to Thursday and 9.30am – 3.30pm on Fridays; an additional service is provided to Oncology Out-Patients between 9.00am and 1pm, Monday to Friday.

The phlebotomists are not permitted to accept inadequately completed requests and these will be returned for completion prior to venepuncture.

At all other times, or if the request is urgent, the sample should be collected by the requesting medical staff. Delivery of urgent or on call samples to the laboratory must be arranged by the requesting clinician.

The only time paper requests forms will be accepted is when the ICE system is down. There are emergency packs available to each ward for this occurence.

Each set of samples from a patient should be sent in sealed specimen bags, and accompanying paperwork should be put into the smaller sleeve attached to the bag. A phlebotomy training programme is also available on request – please contact Mandy Budds, P.A. to the Laboratory Managers on (01225) 825504 for further details.

Transport for GP Specimens

Specimens are collected from GP surgeries and local hospitals at a fixed time each weekday by the District Transport System.  If transportation can be arranged specimens can be received at any time and emergency tests can be performed outside normal working hours.  Most GP specimens arrive in the laboratory in the late afternoon.  Please see Departmental Lists for the expected frequency of analysis and availability of results.

Completion of ICE (electronic) Requests

For all RUH inpatient requests, for Haematology, Chemistry and Microbiology, an electronic request through Sunquest ICE should be made. For other areas requests can be electronic or via paper requests.

Care should be exercised in selecting the right patient, searches are available via NHS number, RUH number, Surname, Forename and DOB.

Guides and tutorials on using ICE are available please contact ruh-tr.ClinicalComms@nhs.net or from within the RUH check out the intranet Home -> Staff Development -> Training & E-learning -> ICE -> Modules

User Set up

For inpatients upon completion of a request barcode labels will be produced, no paper request forms are used, the samples are labeled with printed barcode labels, placed in a bag and sent to the lab. Unfortunately this system can't be used for blood transfusion and histology. Labels are available from Pathology stores.

For secondary care a special A4 sheet of paper is used that contains 4 sticky labels, these are obtained from pathology stores. The samples are labeled and placed in a sealable bag and along with the form sent to the laboratory. For more than 4 labels reprint the form.

Completion of Request Forms

Separate request forms are required for:

Blood Transfusion

Red

Kleihauer

Purple

Microbiology

Blue

Virology

White/black

Antibiotic assays

Yellow

Histology

White

Non-gynae cytology

White

Gynae cytology

NHSCSP form HMR 101

Haematology, Biochemistry and Immunology

Requests can be made on one form:
brown (GP) or green (non-GP)

  1. Please complete all sections of the correct request form using a ball point pen (addressograph labels can be used on forms only)
  2. It is essential that you include a summary of the relevant clinical details and therapy as the laboratory may initiate further appropriate tests on the basis of the results obtained and clinical information provided. 
  3. For tests which you request infrequently it is recommended that you discuss the patient with the Duty Clinical Staff. Failure to do this, or to record adequate clinical details on the requests form may result in the request being rejected.
  4. It is important that a minimum data set is available to ensure that results are assigned to the correct patient and returned to the correct clinician. 
  5. Please include the following information on your request form:
    (please print legibly)
    1. Hospital number or NHS number (if available).
    2. Date of birth (this will be used for positive identification if the patient does not yet have an RUH hospital number;  age is NOT an acceptable alternative). 
    3. Surname
    4. First name(s)
    5. Sex
    6. First line of address
    7. Postcode
    8. GP code/Consultant in charge
    9. Address for report

Failure to complete forms correctly results in delay and inefficiency.  If a report is required, you must include the correct hospital, ward and consultant codes or GP codes.  A properly addressed report cannot be issued without this information. 

All request forms must be signed by the requesting clinician before the specimen is taken.

Blood Bank requests must include reasons for transfusion

If it is necessary that an urgent result be telephoned for an RUH inpatient, this must be discussed with the laboratory.  As soon as urgent samples are analysed, the results are available on Ultraconnect or ICE.

Labelling of Samples

It is essential that all tubes/specimen containers are carefully labelled and dated to ensure that the correct analysis is attributed to the correct patient.. Samples should always be labelled with the following information:

  1. Hospital Number, or for the community, NHS Number
  2. Surname (please PRINT)
  3. First name
  4. Date of birth
  5. Date and time of sample collection

Please Note:

High Risk Samples

Universal precautions are applied throughout the Trust but all samples taken from a patient known or suspected to be a health hazard to laboratory staff should be clearly labelled "DANGER OF INFECTION" or "HIGH RISK" on both the form and sample and separately packaged in biohazard bags.  Individual departments should be contacted if further guidance is required.

Unnecessary confidential information e.g.. HIV, Hepatitis B or C positive, should not be disclosed on the request form without attaching consent form with request.

Specimens from patients known or clinically suspected to be infected with other Hazard Group 3 (e.g. Mycobacterium tuberculosis, Salmonella typhi or S.paratyphi, Coxiella burnetti (Q fever), and Brucella spp should have a "Danger of Infection" sticker attached to the specimen container and request form. This also applies to patient potentially infected with Hazard group 4 infections eg viral haemorrhagic fever or CJD but samples from patients with these conditions should be discussed with laboratory staff ideally before they are taken, but certainly before they are sent to the laboratory.

This applies to all the following potentially infected body fluids:

Please refer to relevant Infection Control Policies on the RUH Intranet

Results

Results are available to ward staff and linked General Practices on the Ultra Laboratory and ICE computer systems and can be accessed by ward or practice terminals as soon as the analysis is completed and authorised; for those Practices interfaced by GPlinks, the results are transmitted to mailboxes several times throughout the day and night. 

New hospital medical staff should ensure that they have been adequately trained to access this system and have been issued with a password.  There are agreed protocols in each laboratory identifying those abnormal results which will be communicated immediately to the requesting clinician by telephone.

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1.5  Outline of RUH Pathology Services

24 Hour Service

The Clinical Biochemistry and Haematology laboratories are open at all times. However, prioritisation of requests is undertaken, particularly when fewer staff are available (Restricted Period: 17:15 to 08:00 and weekends and public holidays).  During the Restricted Period, requests for tests outside the 'Routine Range of Tests', as described in the sections for each laboratory in this Handbook will be referred for discussion with the Duty Clinical staff.

Urgent Requests During Core Working Hours

Please label request forms as "Urgent" and telephone the Laboratory

Biochemistry/Haematology

01225 824740

Blood Bank

01225 824734

Frozen Sections

01225 824750/20

Microbiology

01225 824740

Send samples directly to the laboratory clearly labelled "Urgent"
Include a contact or bleep number for results to be returned by phone.

Urgent Requests Outside of Core Working Hours

Please label request forms as "Urgent" and bleep the Laboratory

Biochemistry

Bleep through Switchboard

Haematology/Blood Bank

Bleep 7555

Send samples directly to the laboratory clearly labelled "Urgent". Include a contact or bleep number for results to be returned by phone.

The following urgent samples are processed in the Microbiology laboratory at the RUH:

  1. Blood cultures
  2. CSFs
  3. Specimens for urgent microscopy & culture excluding high risk specimens and sputa or other samples with a risk of tuberculosis. Urgent virology samples are processed at the HPA laboratory in Bristol (0117-342 5551 or via BRI switchboard out of hours: 0117-922-0000)

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