Departmental specific information

Investigations for malignant cells

Fresh specimens should be sent to the laboratory as soon as possible to minimise deterioration of the cell content as interpretation may be adversely affected if there is significant delay. Specimens which are fixed prior to receipt by the laboratory (i.e. miscellaneous brushes) are not however critically affected by delays. Advice is always available from the laboratory - Extension 32446.

Turnaround time

We aim to provide 80% of results within 72 hours of specimen receipt in the laboratory unless a second opinion and / or ancillary tests are required. Urgent specimens will take an absolute minimum of 2 hours to be reported if fresh upon receipt. (Some fine needle aspirates and specimens received fixed may be available for reporting sooner.)

You will need to carefully discriminate between routine and genuinely urgent cases. The latter disrupt normal laboratory practice with significant knock-on effects for other specimens. For urgent requests submit an extension/bleep number for reply.

All gynaecological cytology and cervical screening is performed at the Queen Elizabeth Hospital in Gateshead. For any further information, please contact: 0800 953 7610

All Diagnostic Cytology samples must be kept refrigerated. It is essential that samples are transported to the pathology department as quickly as possible to avoid degeneration.

(a) Sputum

Specimen: Fresh early morning deep cough sputum is required, i.e. first sputum production of day, before the patient has eaten or cleaned teeth.

(b) Serous Effusions

No anticoagulant or fixative.

Specimen: Fresh. Large volumes of fluid should be physically mixed and a representative universal container of fluid sent. Any clots present should be sent in the fluid as these often contain large numbers of cells. Specimen to reach the laboratory within two hours. (If necessary may be kept overnight in the fridge but sub-optimal results may be obtained.)

(c) Urine

NOT Boric Acid universal.

Specimen: Fresh. Specimen must not be first urine of the day. A whole specimen of urine should be collected after the patient has walked around (if mobile) for a little while. Specimen must reach laboratory as soon as possible as urine is hostile to the cells and degeneration is very rapid. They must be in a white top universal (20ml).

(d) Fine Needle Aspirates (All sites)

Specimen: Contents of aspiration needle should be blown with syringe onto an appropriate number of slides, spread quickly (as blood film) to produce monolayer and AIR DRIED AS RAPIDLY AS POSSIBLE which usually means wafting the slides in the air. Slides should then be sent in dry slide container to the laboratory as soon as feasible. If fluid is aspirated this should be sent to the laboratory in a sterile universal container as soon as possible. The discarded needle can be placed in the Cytolyt for a needle rinse preparation. Technical advice is available - Extension 32446.

(e) Bronchial Brush Specimens

Specimen: The brush should be immediately cut and dropped into a container of Cytolyt - supplies of Cytolyt should be available on all endoscopy sites.

(f) Bronchial Lavage/Washing Specimens

Specimen: Fresh. Lavage and trap specimens should be collected and sent to laboratory within two hours.

(g) EBUS

Specimen: Immediately place sample into a container of Cytolyt and transport to the histology specimen reception before 15:30 to be processed on the same day, samples received after this time may be subject to a 24hr delay.

(h) CSF

CSF samples for cytological investigations must be prepared urgently and ideally within 4 hours of the sample being taken to avoid degeneration.

Samples should be placed into a white topped universal without any fixative and sent with a Cellular Pathology request form.

At least 1ml of sample should be sent to ensure all required tests can be performed.

ALL cytology samples should be sent in the white refrigerator transport bags if sending from sites other than UHND

Minimum requirements

Samples should be sent to the laboratory fully labelled in a safe manner.

Samples should be in a separate transport bag with the completed request form attached. Sample containers and request forms must not be kept within a single bag to prevent contamination of the request form.

Samples can only be accepted for routine processing if there is no leakage, correct labelling, accompanying request form, no indication of high risk and appropriate container used.

Rejection of samples will depend on: -

Ability to obtain a repeat sample e.g. histology samples

The health risk to staff

Ability to correctly identify the patient

MINIMUM IDENTIFICATION FOR THE FORM:

Routine samples

• Full name or other unique coded identifier
• Date of birth
• Hospital Number or NHS Number
• Address for GP samples
• Source of request
• Consultant / Requesters code for OPD or Clinic requests
• Date and time of collection
• For confidential samples

Unique coded identifier

• Source of request
• Date and time of collection
• Additional information expected. Requester's code and signature.
• Hospital number mandatory for transfusion related requests

An appointment system is in place for all semen analysis at UHND. Patients who have not received an appointment from the Specialist Nurse led Fertility Clinic can call the laboratory to arrange an appointment time to drop off their sample. Samples will be accepted by appointment only. Samples are to be produced at home and brought to UHND for the appointment, preferably within one hour of production. There are no facilities at UHND available to produce samples.

The laboratory opening hours are: 8.30am - 4:30pm, Monday to Friday. You can call the laboratory on: 0191 3332446

Turnaround time

We aim to provide most of our results within 48 hours of specimen receipt in the laboratory however when that is not possible our turnaround time for Andrology is 7 days from receipt.

Sample requirements

• The laboratory supplies batch tested and quality assured 60ml white specimen containers. Containers that have not been batch numbered and weighed cannot be used as we cannot guarantee their quality or toxicity.
• A completed Cellular Pathology Request form. SAMPLES WILL NOT BE ACCEPTED WITHOUT A COMPLETED REQUEST CARD.
• Patient Instruction Sheet.

Routine specimens

All routine specimens for histological examination should be placed as soon as possible into 10% neutral buffered formaldehyde solution (this can be obtained from the Histology Department).  The specimen to fixative volume ratio should be approximately 1:20, therefore specimens should always be sent in an appropriately sized container.  Please note that this ratio may not be achievable for larger specimen types.  Specimens unable to be sent to the laboratory the same day should be left in fixative at room temperature (not in a refrigerator).  Please note that specimens unable to be placed in fixative should be stored in a dry pot and kept in a refrigerator (not at room temperature) for a maximum period of 72 hours. Instructions for completing request cards can be found here.  Ice forms can also be used and must be completed in full.

Turnaround times

(a)     For urgent frozen section specimens - results will be telephoned back, usually within 30 minutes of receipt of the specimen within the laboratory (a typewritten report will follow subsequently).

(b)     For formalin fixed specimens turnaround time depends upon several variables including the specimen size and type, time of receipt etc.  These affect fixation and processing schedules.  Please discriminate very carefully any specimen on which an urgent report is required - specimens identified as such have a marked knock-on effect onto ALL of the rest of the laboratory activity and will therefore affect turnaround time for the rest of your biopsies.

The histology department works towards the following turnaround times

• 7 days - Urgent cases
• 14 days - Cancer two week wait
• 21 days - non-urgent cases

The above times relate to the interval between the specimen being taken and the report being signed and verified by the pathologist.

The department participates in number or EQA schemes for routine, special stains and immunocytochemistry.

Specimen packaging

Histology containers should be placed in either the sealed wallet attached to the request card, or within a clear bag. The request card and the first sealed bag should be placed into a second bag and sealed to avoid contamination of the request card.

Specimen transport to pathology

At Bishop Auckland General Hospital and Darlington Memorial Hospital, yellow top specimen containers are able to be carried (without the use of a trolley) to the pathology reception where they will be placed in the inter-site transit bags.

At University Hospital of North Durham, all specimens should be directly delivered to Cellular Pathology during opening hours, or Pathology Specimen reception outside of opening hours.

At all sites, pathology specimens in a white specimen bucket must be transported to the pathology laboratory via the use of a solid wheel based trolley. Formalin containers should not be transported within patient/visitor lifts, and if large quantities, should be transferred in an unoccupied lift to prevent over exposure to Formalin.

Histology Specimens must NOT be transported through the Air POD system.

Remote clinics, GP Surgeries, other to Histology, UHND

Specimens should be placed in a central area and will be collected via the trust courier system who use dedicated pathology transit containers

Note: If a courier is not available, provided the samples have been placed within Formalin, they are stable to wait for the next transit.

Transport containers

Histology samples are classified as a Category B Biological Substance and as such should be packaged as follows:

1. Histology Pot sealed (Primary Packaging).
2. The Primary Package should be placed within another bag or container with sufficient absorbent material to absorb the blood / formalin that can leak from the container (Secondary Packaging).
3. The secondary packaging should then be placed within a box or rigid outer container that clearly shows the UN 3373 Hazard Diamond with the phrase Biological Substance Category B visible. The size of the diamond must be a minimum of 50mm on each side.

What are turnaround times and how are they measured?

The local cellular pathology turnaround time (TAT) for each specimen type is defined as the time of the receipt of the specimen into the cellular pathology laboratory (located at UHND) to the time when the initial report is available to the requester. Cellular pathology TATs targets are agreed with our service users.

Why are cellular pathology turnaround times longer than other areas of pathology?

Every histopathology specimen must be examined macroscopically and dissected by an appropriate member of staff in the laboratory. After dissection, small pieces of the sample are placed into a tissue processor machine. These machines are vital for fixing the specimens in formalin and impregnating the tissue with paraffin wax. This is a process that usually occurs overnight and ensures the sample is stable enough to store and perform any kind of future testing.

What about urgent results?

Preliminary reports may be issued for urgent or partial results e.g. a simple report may be released within a couple days of receipt, but the results of any immunohistochemical testing or molecular testing may be available at a later date. If any further testing is pending, this information will be included within the preliminary report.

The department aims to release 80% of urgent results within 7 days.

The histopathologists examine every case prior to producing a report and may contact the requester when clinically appropriate. Andrology samples are examined and authorised by a Biomedical Scientist.

Any urgent request must be communicated to the laboratory by using the cellular pathology request card, or by phone call. See individual handbook pages for further details.

Turnaround Times in Cellular Pathology

For more information regarding what types of specimens may be assigned a particular pathway, please see below:

UHND Histopathology have been making progress in delivering a system for eliminating large amount of formalin retained in theatres.

Formalin is a widely used tissue fixative that preserves tissue samples in as close to a life-like state as possible for accurate diagnoses. The major limitation of formalin is that it is hazardous (especially in large quantities) and is a controlled substance in the Trust.

To limit the amount of staff across the Trust exposed to formalin and produce a safer system of working, UHND Histopathology ran a trial period receiving benign organ resections and found the tissue received to be adequately preserved when it is refrigerated and reaches the department in no longer than 72 hours.

When sending samples to histopathology the specimen will require a yellow topped pot containing formalin or a white bucket.

If in doubt, please contact the department on: 0191 333 2446 to clarify which method would be most suitable for your specimen

CDDFT Haematology Laboratories

The CDDFT Haematology laboratories are located at DMH and UHND. Each laboratory holds UKAS accreditation for ISO 15189:2012 (UKAS accredited testing laboratory No. 8770). The laboratories provide a range of primary Haematological investigations via automated and manual methods. Below is a list of all investigations provided by each site (unless stated otherwise):

• Full Blood Count
• Reticulocyte Count
• Blood Films
• Erythrocyte Sedimentation Rate (ESR)
• Coagulation Screening (PT, APTT, Fibrinogen)
• DDimer
• Malarial Parasites
• Glandular Fever Screening
• Sickle Cell Solubility (UHND only)
• Thrombophilia Screening (UHND only)
• Lupus Anticoagulant (UHND only)
• Anti-Xa Assay
• G6PD screening (UHND only)
• Haemoglobinopathy Screening (UHND only)
• Anticardiolipin antibodies (UHND only)
• Intrinsic Factor Antibodies (UHND only)

CDDFT Transfusion Service

The CDDFT Blood Transfusion Laboratories, located at UHND & DMH, provide a blood transfusion service to all of the trusts main hospitals, community hospitals, hospices and GPs. The Transfusion Department is both MHRA compliant and has been inspected by UKAS (accredited to ISO 15189:2012). The transfusion laboratory participates in all relevant external quality assurance schemes.

The Blood Transfusion Department test repertoire includes blood group and antibody screening (with associated antibody identification), compatibility testing (serological and electronic issue), phenotyping, antenatal serology, kleihauer testing and Direct Antiglobulin Test. The Blood Transfusion Laboratories provide the following services:-

• Blood Grouping and Antibody Screening - Routinely available on any patient if clinically indicated. For non-medical reasons e.g. travel, sport, insurance or employment, please contact the laboratory for arrangement under Category II Regulations.
• Antenatal Serology - A full antenatal serology service is available.
• Routine Crossmatch - Ideally 24 hrs notice should be given for a non-urgent cross-match. This is to allow sufficient time to investigate any abnormality detected in the antibody screen or cross-match. If 24 hrs notice is not given, it may not be possible to have blood available at the requested time if an abnormality is detected in the course of the investigations. This may result in the last minute cancellation of an elective operation/procedure.
• Emergency Crossmatch - The laboratory must be informed by telephone. In an emergency, crossmatched blood can normally be provided within one hour of receipt of the sample. Uncrossmatched Group O can be emergency issued to your patient within 5 minutes of requesting on our acute sites (DMH & UHND). In exceptional circumstances, un-crossmatched O Negative (Flying Squad) blood may be used. This can be taken directly from the Blood Bank fridges located at DMH, UHND & BAH. If the Flying Squad blood is used, the laboratory must be informed immediately so that the blood can be replaced and a retrospective cross-match performed. The trust operates a Major Haemorrhage Protocol which all clinical staff should be aware and familiar with. Please refer to POL/Transfusion/0003 Major Haemorrhage Policy for full details (access via Staffnet 'Policies and Procedures' section).
• Issue of Blood Products - A stock of fresh frozen plasma and cryoprecipitate is kept at UHND and DMH blood banks and is available on request (thawing time 30 minutes). Platelet concentrates are not routinely stored on site and have to be transported from the Blood Transfusion Services in Newcastle on request.
• De-reserving of Blood - All blood will be de-reserved and removed from the Blood Bank fridge 48 hours after the time it was required. If blood needs to be reserved for a longer period of time, this must specifically be requested.
• Issue of Batch Products - A stock of albumin, prophylactic Anti-D, Beriplex and Novoseven is kept at UHND and DMH and is available on request. A small stock of prophylactic Anti-D is also kept at BAH. Please refer to appropriate transfusion clinical policy for further details, accessed via Staffnet 'Policies and Procedures' section.

Measurement uncertainty

Measurement uncertainty (MU) is defined as a parameter, associated with the result of measurement that characterises the dispersion of the values that could reasonably be attributed to the measurand. By quantifying the possible spread of measurements an estimate of the confidence in the result may be obtained.

MU stems from imprecision as a result of random effects on the assay systems and so laboratories have to minimise the effects of this and acknowledge this uncertainty.

Calculation of Uncertainty within CDDFT

Within the examination process the laboratory can calculate the measurement of uncertainty that is associated with a measured analyte. We can use our internal and external quality performance checks to assess the individual uncertainties within the measurement system. For further information on our internal and external quality control systems please contact the laboratory.

The MoU is the quantification of doubt, not error. The co-efficient of variation (CV%) or standard deviation (SD) can be considered as the combined uncertainty for results around the mean of a particular concentration of quality control material.

Working Example

For Haemoglobin, the Measurement Uncertainty in June 2017 (DMH) = 2.29%. Therefore, a Haemoglobin reported as 100g/L would have a Measurement Uncertainty of 97.7g/L - 102.3 g/L

Uncertainty of Measurement:

Uncertainty of Mesurement (UoM) is calculated for all FBC results for each QC lot number. The UoM is also calculated for other Haematology results and Coagulation results. These results are available on request from the Haematology Laboratory. If you require this information please contact Haematology DMH #43252 or Haematology UHND #32442.

Bereavement support office

The role is to offer support to families at what is a very difficult time for them.  An immediate point of contact so that they feel they are being listened to and dealt with in  a timely, organised way by people who understand their individual needs and who can give them time. An area where they will be given the first steps of guidance from registering the death to where, how and if they need any follow on guidance. To feel that this is not the end for them but that we are still there if they have any issues or just further support in the near future.

A quality bereavement service is an essential component of an end of life care pathway.

The aim is to:

• Assist staff in caring for the patient's families/representative around the time of death and assist in the issuing of 'The Medical Certificate of Cause of Death (MCCD)'.
• Provide appropriate support to families, carers and significant others who are subsequently bereaved.  Guiding and supporting the deceased representatives through the complexities of registering a death, making the initial contact with funeral directors, and any other complex administration and paperwork required. 
• Liaise with the Trust's contracted Funeral Director on all hospital funerals for deceased patients who have no next of kin or where the families have no financial means in which to pay for the funeral.
• Develop and update the booklet 'Information and Advice for the Bereaved' which is for all bereaved and given at time of death.

Quality of care is crucial for individuals at the end of their life

The experience around the time of death and how this is delivered and received by the Families/ carers and representatives afterwards can have an influence on the grieving process and the long term health of the bereaved.

Overall impression left with the individual of how as a Trust we cared/managed their loved one can be changed not because of the care given but the failure to manage the issuing of the MCCD, belongings and any other issues in the following hours after the death. A good experience around the time of death and afterwards can positively influence the grieving process.

We must always remember that the deceased is still a patient in our care until they leave the mortuary.

Requests

Hospital Autopsies

Before completing any consent form or request for a hospital autopsy, telephone the appropriate pathologist through their secretary (Ext. UHND 32457) Advice regarding what tissue is likely to be retained, who is eligible to obtain consent for the autopsy and consent for the possible subsequent retention of tissue can then be given directly.  The pathologists will ask for the case notes, request form and consent form to be sent to the laboratory.

If you are interested in viewing  findings then please provide availability details and contact numbers.

Coroners Autopsies

When reporting a death to the Coroner, the Coroner's Office should be contacted:

• Phone: 03000 265 556

• Email: co-office@durham.gov.uk or: HMCoroner@durham.gov.uk

As a general guideline deaths listed below should be referred to the Coroner (the list is not comprehensive and if there is any doubt contact the Coroner's Office for advice).

1. All deaths in which the doctor has not attended in the last illness or within 14 days of the death.  This usually refers to deaths in the community.
2. Sudden Unexpected Death - When a sudden death occurs in an in-patient, which was NOT to be expected from the nature of his illness.  Persons brought in dead, who die during admission or shortly after admission to the wards, where insufficient clinical history, examination or investigations are available to justify a firm opinion as to the cause of death (the underlying cause of death, NOT the MODE of death).
3. Accidents and injuries OF ANY DATE which are considered to have contributed to the cause of death.
4. Anaesthetics, Surgical Operations and Therapeutic Procedures:-Deaths during or before complete recovery from anaesthetic are reportable, as are deaths during, or as a consequence of any operation or therapeutic procedure (such as cardiac catheterisation, endoscopy, angiography or any other radiological diagnostic procedure).The common misapprehension that only deaths occurring within twenty-four hours of operation are reportable should be discarded - no time limit exists, if any caused connection is thought to exist, e.g. pulmonary embolism within the first fortnight.  Where the procedure was performed as a consequence of any injury, the death is always reportable.
5. Deaths due to crime or suspected crime.
6. Deaths due to Industrial Disease (or in which industrial disease was possibly contributory), see Appendix 1. Of particular importance are miners with pneumoconiosis and any suspected mesothelioma.
7. Deaths due to starvation or neglect (including hypothermia).
8. Deaths in which the deceased was in receipt of an industrial or war disability pension.
9. Infant deaths which are unexplained (S.I.D.S.).
10. Persons dying in legal custody.
11. Deaths due to poisoning of any cause (includes food poisoning as well as more obvious causes).
12. Traumatic deaths (e.g. R.T.A., domestic injuries).
13. Suicide/suspected suicide.
14. Unidentified bodies.
15. Circumstances in which a relative or similar expresses dissatisfaction or outright criticism of the standard of medical or nursing care (best discussed with the Pathologist in the first instance).
16. Alcoholism - where acute intoxication but not the effects of chronic alcoholism is suspected as the cause of or contributing to death.
17. Death related to the use of recreational drugs.
18. Deaths related to abortion where any cause other than natural is suspected.

Turnaround time

All post-mortems are performed as soon as possible depending upon the circumstances of each particular case.

Clinicians are encouraged to attend and prior notice will be given as regards the time of the autopsy wherever possible.

Summary findings (issued as a cause of death) will be sent to the deceased's GP within several hours of completion of the autopsy in most cases (a notable exception being Coroner's autopsies which will proceed to an inquest).

High risk cases (infectious disease)

Please note that all such bodies submitted to the mortuary (for post-mortem or not) must clearly be identified as a high risk and all appropriate staff (nursing, portering, mortuary) must be informed.  Appropriate body bags and labels must be used.  (See Infection Control Manual, Chapter 9).

In general known high risk cases will not be autopsied unless this is vital.  The request form must clearly identify infectious risk and its nature.  The cases must be discussed with the relevant pathologist.  Cases of HIV and Hepatitis B (or similar infections) will be performed as a 'high Risk procedure.   CJD and other category 4 infections will not be performed.  If an autopsy is required on these cases the pathologist will liaise with other hospitals.

Disposal of Foetal tissue 

For any queries as regards disposal of foetal tissue, kindly refer to the unit policy (available in the department of Obstetrics and Gynaecology).

For viewing of bodies

Please liaise with mortuary technical staff prior to directing relatives to the mortuary for body viewing (extension UHND 32300, or DMH 43594).  Unbooked attendance for relative viewing can lead to unnecessary conflict, delays and distress for relatives of their expectation for viewing cannot be accommodated.

Consent & the Hospital Post Mortem:

• Can be performed with the prior consent of the deceased.
• Deceased's nominated representative
• Person in a qualifying relationship

Nominated Representative

• Adults may appoint one or more persons
• Where deceased persons wishes are not known, the nominated representative must give consent.
• Must verify the NR's authority to act on behalf of the deceased person

Appointment of a Nominated Representative:

• May be general, or limited to consent in relation to one or more activities
• May be made orally (in the presence of at least two witnesses)
• May be made in writing:

Signed in the presence of at least one witness who attests the signature, or

Signed at the direction of the person making the appointment, in their presence & that of at least one witness who attests the signature, or

Contained in the deceased person's will

Qualifying Relationships (ranking in highest priority first)

• Spouse or partner (including civil or same sex partner)
• Parent or child
• Brother or sister
• Grandparent or grandchild
• Niece or nephew
• Stepfather or stepmother
• Half-brother or half-sister
• Friend of long standing

Discuss the Post mortem examination with the deceased person's relatives or nominee. They need to be given:

• Honest, clear, objective information
• Opportunity to talk to someone they can trust & ask questions
• Reasonable time to reach decisions
• Support if needed (bereavement, psychological etc)

Those seeking consent should be sufficiently senior & well informed, with a thorough knowledge of the procedure.

Ideally they should be trained in the management of bereavement & in the purpose & procedures of post mortem examinations.

Usually the responsibility of the deceased persons clinician

This responsibility should not be delegated  to untrained or inexperienced staff

Responsible clinician should contact the pathologist who will perform the PM, before discussion with relatives so that:

•        Accurate guidance can be given on which, if any, organs or tissues are likely to be taken.

•        Opportunity for pathologist to be available for any discussion the relatives may wish to have

•        If pathologist certain no organs will be retained then there will be no need to obtain relative consent & this section of the form can be deleted

The Microbiology department examines many different sample types to look for evidence of infection using a variety of different techniques, e.g.:

• Bacterial & fungal culture: specialised growth plates or broths are inoculated with patient specimens and incubated under different conditions and temperature to try and grow and identify bacteria or fungi that may cause infections (pathogens).
• Antimicrobial sensitivity: bacterial pathogens are tested against a range of antimicrobial agents that could be used to treat the infection they have caused. These tests can help to identify the most appropriate treatment for the patient, as well as identifying antimicrobial resistance.
• Molecular tests: these tests are useful when pathogens cannot be grown using traditional culture techniques, or would take a very long time. Molecular tests look for pieces of genetic material that are unique to a specific pathogen.
• Serology / blood tests: these tests are also useful when pathogens cannot be grown using traditional culture techniques, or would take a very long time e.g. viral infections. A range of different tests are used to detect unique parts of a pathogen known as antigens circulating in patient blood. Other tests can detect specific antibodies (part of the natural immune response) to a known pathogen in patient blood. This can be used to detect current or previous infection.

The Microbiology department also works closely with CDDFTs Infection Control team and Public Health England providing testing, screening and epidemiological information relating to infection control. This includes monitoring of communicable diseases and multi-drug resistant pathogens.

Test Repertoire

The Microbiology test repertoire can be found via the test directory and individual handbook pages.

Referred Tests

See the microbiology referral test page for the tests sent via the microbiology department, including details of the referral laboratories and specimen requirements.

Contact Information and Laboratory Opening Hours

Please contact Microbiology by email: cddft.microbiology@nhs.net

Please see the general pathology handbook information pages for further details on contacting Microbiology team.

What are turnaround times?

The local microbiology turnaround time (TAT) for each test is defined as the time of the receipt of the specimen into the pathology laboratories (UHND, BAGH or DMH) to the time when the report is available to the requester (electronically in most cases). TATs are specific to individual tests or specimen types.

How are average turnaround times measured in microbiology?

The average TAT for a test is determined using information from all of the tests performed in the previous year i.e. how long 'on average' they took from receipt to report. This data takes into account all tests, taken at all times, with all combinations of negative and positive results and follow-up work.

TATs can vary greatly depending on a number of factors including the time of receipt, culture or test result and priority of testing so the individual test results within this measured average TAT are usually spread over a wide timeframe.

Defined turnaround times in microbiology

Some microbiology tests have nationally agreed TATs, or are agreed with service users, for example antenatal screening tests and sexual health molecular tests. In these cases our local TAT are measured against these targets.

Why are microbiology turnaround times much longer than for other pathology services?

The majority of microbiology tests are still based on the culture of bacteria which require incubation for days rather than hours. Further confirmatory testing, e.g. antimicrobial sensitivity testing, also relies on the growth of the bacteria for a further period of time.

What about urgent results?

The TAT listed below are from the time of receipt to the finished report being available to the user. Interim reports may also be issued for urgent or partial results e.g. a microscopy result will be available within the same day but the culture result may take a further few days to complete the report.

The consultant microbiologists are informed of results that require notification prior to the completed report and contact the requesting clinician to advise as appropriate.

All urgent requests should be communicated to the laboratory e.g. CSFs, urgent gram stains, etc. See individual handbook pages for further details.

Turnaround Times in Microbiology

* NB urgent gram stain / microscopy <2 hours available on request - see rel

Speed of diagnosis and treatment: POCT testing is very efficient, as the test is performed at the bedside or in close proximity to where the patient is being treated. This means that the treating clinician is able to see the results quickly and make rapid decisions about patient care.

The process is also more efficient for clinicians as, due to the speed of testing, they do not need to re-familiarise themselves with each case when test results come back.

Expanded testing capabilities: POCT means that laboratory testing can be provided in a wide variety of settings in both primary and secondary care.

Specimen stability and ease of handling: POCT reduces the risk of sample deterioration, as the tests are performed rapidly once the sample has been taken.

• Reduced potential for sample deterioration, since most POCT is initiated and performed rapidly once the sample is obtained.
• As POCT sample volumes are 1ml or less, there is less blood loss and potential anaemia for patients requiring frequent testing, as well as being beneficial for neonatal and paediatric samples.

Portable devices: The portable size of POCT devices means that less space is needed for operation and storage. It also means that testing can be carried out in a wide variety of locations that would previously have not been possible. POCT can be flexible to meet the diversity of medical needs.

• Diminished space requirements for operation and storage.
• Flexibility to meet the diversity of medical needs.

Improved patient outcomes and satisfaction: The immediate availability of test results means that patients can be diagnosed more effectively and can be moved through the system faster. This allows more patients to be treated in a shorter timeframe.

Economic and operational outcomes: The use of POCT can result in:

• shorter lengths of stay in emergency departments
• shorter lengths of admission
• efficiency in the use of hospital capacity
• the avoidance of unnecessary admissions
• More effective use of outpatient and rapid access clinics.

What POCT can offer

• Bespoke quality-assured POCT solutions tailored to the specific clinical requirement of your department within the trust and GP practices
• Comprehensive implementation plan including validation and verification, documentation, internal quality control, external quality assurance, reagent management, training and audit.
• On-going training and competency assessment of the operators in conjunction with allocated Link Nurses.
• Technical support and maintenance and servicing of all POCT devices and analysers.
• Contingency and business continuity plans.

Contact us

If you want to find out more about the POCT solutions that our team can offer you, or any queries regarding training, password updates or POCT analysers you can contact:

• Andy Craggs POCT Co-ordinator
• Deborah Grey POCT Associate Practitioner
• Dominic Ramsey POCT Associate Practitioner

Email: cddft.poct@nhs.net or telephone: 01325 380100 or ext: 44172