FRONTIER PATHOLOGY NHS PARTNERSHIP

SERVICESINFORMATION

HANDBOOKSASH

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Frontier Pathology NHS Partnership (known as Frontier Pathology) offers some fresh thinking in the provision of pathology services across large networks of users and their patients. Frontier Pathology partnerships is located on four sites, one in the main building at the Princess Royal Hospital (PRH), Haywards Heath, one in Crawley Hospital, one in East Surrey Hospital and the other adjacent to level six of the Thomas Kemp Tower at the Royal Sussex County Hospital (RSCH), Brighton. Frontier Pathology provides a wide range of acute and complex services for SASH NHS Trust at the East Surrey Hospital in Redhill as well as a range of outpatient, diagnostic and less complex planned services at Caterham Dene Hospital and Oxted Health Centre, in Surrey, and at Crawley Hospital and Horsham in West Sussex for SASH. Frequent GP courier runs for the collection of samples, and electronic transmission of results, enables the provision of effective pathology services for upwards of 500 primary care physicians and their patients. These are delivered in East Surrey, north-east West Sussex, and South Croydon, including the major towns of Crawley, Horsham, Reigate and Redhill and cover a population in excess of 1 000 000.

Should you have any comment on the content in the services handbook to help us improve on the information provided please email w.donnelly@nhs.net

                 

                   

ABOUT US

This handbook is intended to assist the reader in making the best use of our service.  The handbook contains sections relating to each department in the laboratory, and gives information about contact details, turnaround times, request forms and specimen requirements. The web links will take you to more detailed information about specific tests and sample requirements,

The Pathology Department adheres to the Data Protection Act this ensures all personal and sensitive data is protected and not shared with anyone outside the patient’s clinical team. The Surrey and Sussex Healthcare NHS Trust Policy on Compliance with Data Protection and Confidentiality can be viewed on the intranet.

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HOW TO FIND US

The Pathology department for Surrey and Sussex Healthcare NHS Trust is located on two sites East Surrey Hospital and Crawley Hospital. On the East Surrey Hospital site are the Blood Sciences Department and Cellular Pathology Department. The Microbiology Department is located on the Crawley site.

The East Surrey Hospital Pathology department is located on two floors midway along the main corridor. Pathology reception, Blood transfusion, Chemical Pathology, Haematology, Phlebotomy and the Mortuary are located on the ground floor with Histopathology, Cytology and Andrology directly above on the first floor.

The Microbiology Laboratory and a second Phlebotomy department are situated on the ground floor of Crawley Hospital. 

Further details regarding opening hours and contact numbers can be found under each department.

The Pathology department address is:-

Frontier Pathology East Surrey HospitalCanada AvenueRedhill Surrey RH1 5RH

Complaints Procedure:

If you have any complaints regarding the service you have received by the pathology department please contact us:

Director of Service and QualityFrontier Pathology,East Surrey Hospital,REDHILLRH1 5RH01737 768511 x 1894

Quality Officers:

Sheri Akutu Cellular Pathology Quality Officer ESH 6466sheri.akutu@nhs.net

Liza Faustino Frontier Pathology - Microbiology Compliance Specialist

CRW 3109 liza.faustino@nhs.net

Samia Babiker Integrated Blood SciencesQuality officer

ESH 1819samia.babiker@nhs.net

CONTENTS

TEST REQUESTING AND TRANSPORT OF SAMPLES..........................................6

TRANSPORT OF SAMPLES..........................................................................................8

QUALITY POLICY............................................................................................................9

PATHOLOGY CONSULTANT STAFF........................................................................11

PHLEBOTOMY (Blood collection)................................................................................12

INTEGRATED BLOOD SCIENCES (BLOOD TRANSFUSION, CHEMICAL PATHOLOGY AND HAEMATOLOGY)........................................................................14

INTEGRATED BLOOD SCIENCES RECEPTION....................................................14

HAEMATOLOGY............................................................................................................15

IMMUNOLOGY................................................................................................................22

BLOOD TRANSFUSION................................................................................................23

CHEMICAL PATHOLOGY.............................................................................................28

MICROBIOLOGY............................................................................................................29

DEPARTMENT OF CELLULAR PATHOLOGY.........................................................31

MORTUARY....................................................................................................................37

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TEST REQUESTING AND TRANSPORT OF SAMPLES

Requests for pathology tests will only be accepted from recognised practitioners. All pathology orders must be made with a request form (electronic or paper). Service users with access to BT Cerner (Hospital Users) or Sunquest ICE (GPs) should use electronic ordering to order pathology tests. If electronic ordering is not available, conventional paper request forms may be used.Throughout this document, ‘request form’ refers to a paper request form or electronic equivalent.

Electronic ordering Hospital:

Electronic ordering relies on the presence of a valid, readable barcodeon the sample container. Use BT Cerner to access the patient’s electronic record. Use the correct encounter when ordering pathology tests. When adding an order, complete all mandatory data fields. NOTE:

relevant clinical information is essential to ensure appropriate processing of samples.

Print barcoded sample labels. Barcoded sample labels should contain all of the following information:

Minimum of two patient identification details (full name plus date of birth and/or SASH hospital or NHS number) are required. Without this information, the sample will NOT be processed.

Specimen type.

Date of specimen and initial of phlebotomist/sample collector

When collecting samples, use positive verbal identification whenever possible.

Do not collect samples until any patient identifier discrepancies have been resolved.

Label sample container with barcoded sample label.

IT IS ESSENTIAL THAT THE CORRECT SAMPLE LABEL IS APPLIED TO THE CORRECT SAMPLE CONTAINER.

Apply request labels at the patient’s side IMMEDIATELY after obtaining the sample. NEVER apply labels away from the patient.

Once collected, place the specimen into a plastic specimen bag and seal.

Electronic Ordering GPs:Electronic ordering relies on the presence of a valid, readable barcode on the sample container and/or requisition form.Specimens labelled with inadequate patient identification details or withmismatching details will NOT routinely be processed.

Use Sunquest ICE to order pathology tests. Print barcoded requisition form. If the sample is not collected immediately, provide the patient with the

requisition form, a plastic sealable specimen bag, the correct specimen container (where applicable) and guidance on collecting the sample (where applicable).

Samples must be clearly labelled with the patient's full name, date of birth, date of collection, hospital number, source (to return results to) and signature (initials).

Once collected, place the specimen into a plastic specimen bag

Manual Orders: Request forms MUST be adequately and legibly completed, with full patient details (including hospital number), clinical details, date of and reason for request and tests required. Specimens or forms which have not been clearly identified may be rejected or returned.

Forms:Haematology, Chemistry – Purple formImmunology – Green formBlood Transfusion – Pink formMicrobiology – Blue formSerology – Blue formCytology – Yellow card for diagnostic cytology, cervical cytology use form from Open Exeter or form HMR101 Histopathology –Yellow card

Printable Pathology paper request form (for use during Cerner downtime or if order not available on Cerner)

Pathology supplies email address: sash.pathstores@nhs.net

 Addressograph label may be used on the request forms provided that a label is on every copy of the request form.

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All samples must be sent to the laboratory in a sealed plastic bag, and be clearly labelled with the patient's full name, date of birth, date of collection, hospital number, source (to return results to) and signature (initials).

Unlabelled or leaking samples will be discarded and the relevant medical officer or surgery will be informed. All blood samples from Hepatitis B patients and from suspected HIV positive (including high risk groups) should be labelled DANGER OF INFECTION.

PRIVATE PATIENTS

Private patient forms should be clearly marked with a tick in the box designated for private patients.  All samples must be clearly labelled as PRIVATE.  The patients address must be given on the request form for billing. 

SPECIMEN TRANSPORTWhere appropriate use the pneumatic tube system to deliver the sample to Central Pathology reception at ESH (see Trust Policy for Transport of Pathology Specimens).

Where sample cannot be placed in pneumatic tube (see below) or system not available, arrange for delivery to Central Pathology reception. A portering service for the regular collection of routine samples from wards at the East Surrey hospital is in-place. These samples must be transported to the laboratory via the transport boxes.

Arrangements are in-place for samples to be collected from the GP surgeries and other units by the hospital transport services. To assist with the delivery of samples to the laboratory, Microbiology samples should be placed in the blue plastic bags, and all other samples should be placed in the red plastic bags. 

Pneumatic Tube System

For detailed use of the Pneumatic Tube System, please see SASH Trust Policy for Transport of Pathology Samples.

The pneumatic tube system must NOT be used to transport the following sample types:              

1. BLOOD GASES. 2. CLINICAL WASTE, USED TRANSFUSION BAGS, PLASMA BOTTLES

AND RADIOACTIVE WASTE. 3. TISSUE SAMPLES FOR MICROBIOLOGY INVESTIGATIONS. 4. SAMPLES OF CEREBRO – SPINAL FLUID (CSF). 5. TISSUE FOR FROZEN SECTION 6. CYTOTOXIC DRUGS 7. TISSUE SAMPLES IN FORMALIN

The above items MUST NOT be sent in the Chute system, instead please ensure delivery of these items to Pathology Reception directly.

Please remember to label all samples correctly and ensure that all lids are secured before sealing the sample bag ready for transportation.

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Frontier Pathology NHS Partnership, FPNP‘Is a contractual joint venture of the pathology laboratories Surrey and Sussex Healthcare and Brighton and Sussex University Hospitals NHS Trusts who are the legal entities’

QUALITY POLICYforThe Blood Sciences Departments whose scope is Clinical Biochemistry and Immunology, Haematology and Blood Transfusion.The Departments of Cellular Pathology whose scope is Histopathology, Cytopathology (Non-Gynae and Andrology) and Mortuary services.The Gynaecological Cytology Screening Service, whose scope is Gynaecological Cytology Screening.The Microbiology Departments whose scope is Bacteriology, Parasitology, Mycology and Virology.The Information Technology Team, whose scope is information technology delivery.Business and Support Services whose scope is Stores, Reception and Phlebotomy.

According to the reporting and governance structures of their employing trust staff strive to provide high quality services meeting user and patient needs and will;

Ensure that staff are familiar with and understand their Quality Manual, this Quality Policy and all procedures relevant to their work to satisfactorily meet the needs and requirements of users and their patients for the delivery of quality-based services.

Operate a quality system to integrate the managerial and technical requirements of a quality-based service.

Set such quality objectives and plans as are necessary to implement and develop this Quality Policy and achieve continual quality improvement.

Ensure the health, safety, respect and welfare of all staff and visitors whilst on site. Commit to comply with all relevant environmental legislation for the protection of

patients, staff and the general public. Commit to professional values,practice and conduct at all times.

We are committed to compliance with the ISO 15189 : 2012 and 17025:2005 International Standards, the Blood Safety & Quality Regulations 2005, as Amended, the Human Tissue Act 2004, the Care Quality Commission (CQC) standards and Health and Safety Executive regulations through:

The use of diagnostic examinations that are fit for use. Effective staff recruitment, training, development and retention. The proper procurement and maintenance of external services, equipment, reagents

and consumables for the provision of the service. Coordinated specimen receipt and diagnostic examinations to ensure the highest

achievable test quality as well as the reporting and dissemination of examination results so they are timely, confidential, accurate and clinically useful.

The implementation of a quality management system using audit, external quality assessment, user satisfaction, complaints and error management and to achieve continual quality improvement of the service.

KEY GENERAL PATHOLOGY PERSONNELEAST SURREY HOSPITAL (ESH) 01737 768511

CRAWLEY HOSPITAL (CRW) 01293 600300BRIGHTON & SUSSEX NHS TRUST (BSUH) 01273 696955

NAME POSITION EXTDr Bruce Stewart Consultant Medical Microbiologist,

Surrey & Sussex Healthcare NHS Trust andClinical Director of Frontier Pathology NHS Partnership

ESH1904

Frontier Pathology Services & Quality Director

ESH 1894

Jimmy Mathew SASH Pathology Computer Manager ESH 6467

Wendy Donnelly Pathology Administrator ESH 2775w.donnelly@nhs.net

John McBride Frontier Pathology Quality Manager BSUH 3678

Elizabeth Berry Frontier Pathology Head of Service - Cellular Pathology

ESH 2774

Carl Wassell Lead Biomedical Scientist, Cellular Pathology

ESH 1851

Sheri Akutu Cellular Pathology Quality Officer ESH 6466sheri.akutu@nhs.net

Clare Reynolds Frontier Pathology Head of Service - Microbiology

CRW 3079

Jackie Longbone Frontier PathologyDeputy Head – Microbiology

CRW 3079

Komal Vaghela Site Manager/ Lead Biomedical Scientist - Microbiology

CRW 3079

Clare McKoen Site Manager/ Lead Biomedical Scientist - Microbiology

CRW 3079

Liza Faustino Frontier Pathology - Microbiology Compliance Specialist

CRW 3109 liza.faustino@nhs.net

Ms Jackie Armitage Frontier Pathology Head of Service – Integrated Blood Sciences

ESH 2192

Ms Sarah Bastow Frontier PathologyActing Head of Service – Integrated Blood Sciences

ESH 2192

Mr Eddie Onipede Lead Biomedical Scientist, Haematology

ESH 2192

Mrs Rashmi Rook Lead Biomedical Scientist, Blood Transfusion

ESH 6461

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Mr Imran Ahmed Lead Biomedical Scientist, Chemical Pathology

ESH 1819

Samia Babiker Integrated Blood SciencesQuality officer

ESH 1819samia.babiker@nhs.net

Mrs Kerri Campbell-Bowler

Phlebotomy Manager ESH 6585CRW 3082

PATHOLOGY CONSULTANT STAFFNAME POSITION BASE EXT

Dr A Alhakim Consultant Histopathologist ESH 1699

Dr M Siddique Consultant Histopathologist ESH 6463

Dr H Birch Consultant Histopathologist ESH 2770

Dr L Fulford Consultant Histopathologist ESH 6480

Dr S Sandhu Consultant Histopathologist ESH 6464

Dr N Heatley Consultant Histopathologist ESH 2779

Dr M Jones Consultant Histopathologist ESH 2771

Dr N Maghsoodi Consultant Chemical Pathologist ESH 1426

Dr K Knox Consultant Microbiologist ESH 2963

Dr S Smith Consultant Microbiologist ESH 2964

Dr P Kaczmarek Consultant Haematologist ESH 2085

Dr E O'Donovan Consultant Haematologist ESH 2918

Dr B Jackson Consultant Haematologist ESH 1692

Dr G Ivanov Consultant Haematologist ESH 6472

Dr C Dragan Consultant Haematologist ESH 2562

PHLEBOTOMY (Blood collection)NAME POSITION BASE EXT

 Kerri Campbell-Bowler

Phlebotomy Services Manager

ESH

Crawley

6585

4081

Nikki Tapal East Surrey Phlebotomy Supervisor

ESH 6444

bleep 423Crawley and Horsham Phlebotomy Supervisor

Crawley

3082

bleep 226

Patient Preparation for blood sampling:

If fasting has been requested for specific tests, please ensure the patient has fasted overnight for Glucose testing and for 14 hours for Lipid Profile.

For any other patient preparation requirements, please contact the Laboratory directly.

 In Patient / Ward Service

At East Surrey and Crawley the Phlebotomy Departments provide a service to in patients on designated wards between 07.00 and 13.00, Monday to Friday.  All requests must be in the allocated areas on each ward and available to phlebotomists before 07.00.

A limited phlebotomy service is offered to inpatients at East Surrey on Weekends and Bank Holidays between 07.00 and 11.00. Requests MUST be restricted to URGENT or NON- ROUTINE SAMPLES only.

In patients MUST NOT be sent to the Out Patients Department.

The request forms for the patients requiring phlebotomy must be ready for the phlebotomy staff and in the designated area on the ward by 7.00am each day. The phlebotomist cannot and will not accept extra requests during their ward rounds as this can have a significant impact on the service to other areas. A phlebotomist will visit the ward between 7.00am and 1pm. There is no set

time for each ward, as it is difficult to determine the workload in advance.

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The phlebotomist will not be able to return to the ward if not required at the time they arrive or if the routine bloods have been already been collected.

Out Patients Service

The Phlebotomy clinics at East Surrey and Crawley are open between 08.00 and 16:45, for GP patients and out- patients requiring a blood test. The request forms should be legible and complete with the relevant patient details and given to the patient who will present it to the phlebotomist. 

 We are currently using the Vacuette blood collection system, it is important that the system is used correctly to obtain good quality results therefore for further information or to book phlebotomy training / update please contact Kerri Campbell-Bowler on extension 6444 / 4081.

INTEGRATED BLOOD SCIENCES

(BLOOD TRANSFUSION, CHEMICAL PATHOLOGY AND HAEMATOLOGY)

The Integrated Blood Science Laboratory provides a 24-hour service for Blood Transfusion, Chemical Pathology and Haematology. Outside routine weekday and Saturday morning hours the duty Haematologist and Chemist can be contacted on;

Haematology BMS Bleep Number 554Chemical Pathology BMS Bleep Number 553

Clinical advice and interpretation is available at all times. The switchboard should be asked to bleep/air call the relevant clinician.

INTEGRATED BLOOD SCIENCES RECEPTIONName Position Base Ext

Mrs C Moon Central Reception Manager ESH 1690Central Reception Results and Enquiries ESH 1691/1690

PATHOLOGY SPECIMEN RECEPTION OPENING TIMES

8.00 AM UNTIL 8.00PM MONDAY – FRIDAY

THE RECEPTION AREA IS OPEN FOR RECEIPT OF ALL PATHOLOGY SAMPLES DURING THIS TIME.

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The Pathology Specimen Reception at East Surrey Hospital is responsible for the receipt of samples from East Surrey, Crawley, Horsham, Caterham Dene and Dorking Hospitals and also from the GP surgeries and other associated agencies in these areas. Pathology Services are also provided to North Downs and Gatwick Park Hospitals.

The samples are sorted, prioritised and all necessary pre analytical work is carried out in the Department, prior to testing. Samples that are not tested on this site will be prepared and despatched to the relevant Departments or Hospitals for testing.

HAEMATOLOGYNAME POSITION BASE EXT

Dr E O'Donovan Consultant Haematologist ESH 2918

Dr P Kaczmarek Consultant Haematologist ESH 2085

Dr B Jackson Consultant Haematologist ESH 1692

Dr G Ivanov Consultant Haematologist ESH 6472

Dr C Dragan Consultant Haematologist ESH 2562

Mr E Onipede Lead Biomedical Scientist ESH 2192

Haematology Clinic Appointments

Haematology Secretary ESH 6473

Haematology Clinic Appointments

Haematology Secretary Crawley 3070

Validity of Results

Quality assurance programmes are in operation to ensure a high degree of accuracy and precision of all tests.  However, if you doubt the validity of a result please let us know at once.  Most samples are kept for 2—3 days and during this time it is usually possible to check any result.

Turnaround times

The department prioritises all work received from A/E, ITU, SCBU and other critical care units, together with any other emergency samples. The department aims to ensure the results of the investigations for the immediate management of the patient will be available on the pathology computer system within 1 hour of receiving the samples.

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All other inpatient samples together with GP and out-patient work identified as urgent are prioritised. The department aims to ensure the routine investigations will be available on the pathology computer system within 2 hours of receiving the samples. Samples received from GP surgeries and out-patient clinics samples will be processed on the day of receipt.  All authorised surgery results are transmitted via the GP links at regular intervals.  Please indicate a telephone number on the request form in order that the laboratory may phone a result out of hours if required.

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TESTSSPECIMEN

BOTTLE

MIN

VOL

RESULTS

AVAILABLE

COMMENTS AND FACTORS

AFFECTING RESULTS

REFERENCE

RANGESAPTT Blue Topped

citrate Vacuette

3.5ml See Turnaround Times

Accurate filling of specimen bottle is essential to obtain a valid result. Coagulation samples must be processed on the day the sample is taken, preferably within 4 hours.

Adult range

26.5 – 37.5 secs.

EstablishedIn-house

BLEEDING TIME Please contact the Consultant Haematologist to arrange. The patient must not have taken aspirin for one week beforehand

Interpretation will be quoted with the result.

CHROMOSOME STUDIES

Green topped lithium heparin

6ml 2 weeks Samples are referred to St Georges. Special arrangement with laboratory is necessary.

n/a

CLOTTING SCREEN Blue Topped citrate Vacuette

3.5ml See Turnaround Times

Screen comprises PT and APTT. See APTT

Refer to APTT, PT,INR

FIBRINOGEN Blue Topped citrate Vacuette

3.5mlSee Turnaround Times

Accurate filling of specimen bottle is essential to obtain a valid result. Coagulation samples must be processed on the day the sample is taken, preferably within 4 hours.

1.8-4.0g/L

EstablishedIn-house

FACTOR ASSAYS

II,V,VII,VIIIc,FIX,X,XI,XII

Blue Topped citrate Vacuette 2x3.5m

l2-3 Weeks

Accurate filling of specimen bottle is essential to obtain a valid result. Coagulation samples must be processed on the day the sample is taken, preferably within 4 hours.

50-150 u/dL

Established by manufacturer

AT IIIBlue Topped citrate Vacuette

3.5ml 2-3 Weeks

Accurate filling of specimen bottle is essential to obtain a valid result. Coagulation samples must be processed on the day the sample is taken,

82/128 u/dL

Established by manufacturer

PYRUVATE KINASE Purple topped EDTA

2ml 3 days Screening test for the deficiency, which is autosomally inherited. Quantitation studies performed at reference centre.

Screening test reported as normal or deficient.

RETICULOCYTES Purple topped EDTA

2ml See Turnaround Times

Reticulocytes reflect the rate of red cell production. In states of bleeding, haemolysis, and recovery from marrow suppression. The EDTA sample must be processed on the day of venesection

Adult range

20 – 100 x 109/l

Established by:B.Bain

Note: age dependent, refer to individual report for range

 

Reference:Bain. B, Bates. I, Laffan. M, Lewis M; (2011); Dacie & Lewis, Practical Haematology; 11th Edition, London, Churchill Livingstone Elsevier.

Bain. B, (1995); Blood Cells, A practical Guide; 2nd Edition, London, Blackwell Science.Orkin. S, Fisher. E, Thomas Look. A, Lux. E, Ginsburg. D, Nathan. D, (2008); Nathan and Oski's Hematology of Infancy and Childhood, 7th Edition, Saunders.

REFERRAL LABORATORIES:

The Haematology Department send a number of tests to specialised centres, please contact laboratory for sample requirements and test centre information.

IMMUNOLOGY

The Immunology service is now delivered from The Royal Sussex County Hospital, Brighton. There is a separate Immunology form which requires completion for all Immunology requests.

Most test results are available within 14 days of receipt of the specimen. If a test is urgent, please contact the laboratory at Brighton directly.

Contact telephone number

Telephone:   01723 696955, extension 4593 

Clinical Advice Consultant: Dr M. Tarzi

The Royal Sussex County Hospital, Clinical Biochemistry and ImmunologyRoyal Sussex County Hospital,Eastern Road,Brighton  

Clinical staff will be happy to discuss cases and provide advice, including choice of test(s) & interpretation of results or visit the website

All current reference ranges are available with the results either on the Apex computer system or on the paper report.

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BLOOD TRANSFUSIONNAME POSITION BASE EXT

Dr E O'Donovan Consultant Lead Blood Transfusion

ESH 2198

Mrs R Rook Lead Biomedical Scientist ESH 6461

Elizabeth Tatum Specialist Practitioner in Transfusion

ESH 6489

Requests for Blood Products and Results

Laboratory ESH 6460/6459

SPECIMEN BOTTLE:

Pink top 6ml EDTA venous blood for following tests:

Group & Screen.CrossmatchingAntenatal group, screening and antibody quantitation/ titres Kleihauer testHLA typingHFEG typing

SAMPLE LABELLING

All specimen tubes MUST be handwritten with 4 key identifiers:

First name

Surname

DOB

Hospital Medical Record Number and / or NHS number

Date and time written on sample

Samples must have printed initials of staff taking the sample

Do not use pre-printed labels on samples for G&S and cross-matching

Incorrectly labelled samples cannot be accepted.

REQUEST FORMS

Blood bank specific request forms must be used for requesting tests.

Forms must be fully completed including the requesting area, clinician, contact details, and signature.

Clinical details / surgical procedure must be provided

Any special blood requirements must be provided and the lab informed by telephone.

Cross MatchingIf you wish to convert a group and screen to a cross match, please phone the laboratory on ext 6459 during core hours (09:00- 20:00hrs Mon-Fri). Outside of these hours please bleep 554.

Allow one clear working day for elective cross-matching. Cross-matched blood is routinely returned to stock at 08:00hrs two days after the date required.

Group & screen samples are kept for 7 days from date of collection, however the issue of red cells against a G&S sample is dependent on recent transfusion history (see table 1 below).

Table 1 Sample timings for transfusion of blood.

Patient Whole blood (EDTA) sample stored 2-8°C

Transfused or pregnant in last 3 months

Up to 3 days *

NOT transfused or pregnant in last 3 months

Up to 7 days

* time between sample being taken and subsequent transfusion

Unconscious patient in Emergency Dept.

Request and specimen bottle must have an NHS or MRN number along with the gender, and approximate age of the patient.

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OTHER BLOOD PRODUCTS :

Blood Product Comments

FRESH FROZEN PLASMA (FFP)

Blood group specific

Allow 30 min for FFP to be defrosted in laboratory.

FFP should never be used in the treatment of hypovolaemia or nutritional support.

FFP may be used to correct a disturbance in haemostasis having first identified it by performing laboratory coagulation investigations (for example in DIC, massive transfusion, liver disease etc) . A request for FFP should be discussed with the blood bank or consultant haematologist to assure appropriate use

CRYOPRECIPITATE Allow 30 min for defrosting.

Cryoprecipitate is used primarily to restore greatly reduced fibrinogen levels

PLATELETS Routine orders during the day should be telephoned to the laboratory x 6459 by 10:00 am for delivery that day.

In an emergency platelets are usually available within 3 hours.

This product is not stocked on site.

Platelets are stored between 22 to 24oC and must NOT be placed into a fridge as this destroys platelet activity.

HUMAN ALBUMIN SOLUTIONS

(HAS)

20% 100ml solution available for named patients

4.5% 500ml solution available for named patients

Anti-D IMMUNOGLOBULIN Following doses stocked: 250IU , 500IU and

1500IU

1500IU used for 28 week RAADP clinics

See BCSH guidelines for recommended dose and testing requirements prior to administration

BERIPLEX Only Stroke or Haematology Consultants can approve Beriplex.

For mixing product see details: Administering Beriplex

Always give Beriplex as a bolus infusion, give at rate 2½-3 minutes per 500IU (10ml)

NOVOSEVEN Only available via Haematology Consultant Approval

TESTS:

TESTSpecimen

bottle/ sample

Min VolResults

Available (TAT)

Comments & Factors affecting results

Group & screen Pink top 6ml EDTA

6ml 4hrs Samples may take longer to process if antibody investigation is required

Routine Cross-match

Pink top 6ml EDTA

6ml 4hrs If patient has special blood requirements this may take up to 3 days.

Group compatible, un-crossmatched blood

Pink top 6ml EDTA

6ml 20 minutes

Antenatal G&S Pink top 6ml EDTA

6ml 24hrs Blood grouping and antibody screening should be undertaken on all pregnant women at booking and again at 28 weeks gestation.

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If a hospital number is not available provide first line of patients address on both the Request Form and Sample

HLA typing disease association (ie B27, HFEG)

Pink top 6ml EDTA

6ml Referred test : 21 days

Referred testing, performed by the NHSBT

HLA Typing for Transplantation

Pink top 6ml EDTA

Referred test : 21 days

Referred testing, performed by the NHSBT

Platelet & Granulocyte serology

Contact lab Contact lab

Referred test:

14 days

Referred testing, performed by the NHSBT. Please consult with the Blood Transfusion Dept./Haematology Consultant before submission

Kleihauer Test Pink top 6ml EDTA

5ml 24hrs

Baby Group & DAT

Pink top 2ml EDTA

1ml 4hrs

DAT Pink top 6ml EDTA

2ml 6hrs

IF IN DOUBT PLEASE LIAISE WITH THE BLOOD BANK STAFF WHO ARE VERY WILLING TO HELP AND ADVISE.

CHEMICAL PATHOLOGY

NAME POSITION BASE EXTDr N Magshoodi Consultant Chemical

PathologistESH 1426

Mr I Ahmed Lead Biomedical Scientist ESH 1819

FOR COMPREHENSIVE DETAILS ON EACH TEST PLEASE REFER TO THE 

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MICROBIOLOGYThe Microbiology laboratory assists in the diagnosis and management of infectious diseases. It offers diagnostic bacteriology, parasitology, mycology, mycobacteriology and virology service.

The Microbiology Laboratory for the Surrey and Sussex Healthcare NHS Trust site of Frontier Pathology NHS Partnership is based at Crawley Hospital.

For detailed information regarding our service please refer to our Microbiology Laboratory User Manual on our Pathology department page.

The laboratory is open throughout the week during core hours with an on-call system for urgent specimens operating at all other times. 

Laboratory Opening Hours

Monday 09:00 - 17:15

Tuesday 09:00 - 17:15

Wednesday 09:00 - 17:15

Thursday 09:00 - 17:15

Friday 09:00 - 17:15

Saturday 09:00 - 13:00

Sunday & Bank Holidays 09:00 - 13:00

Departmental Contact Numbers

Laboratory enquiries

Crawley Hospital ext 3079

Out of hours: Urgent samples only (contact via switchboard)

Clinical adviceEast Surrey Hospital ext 2778Out of hours: Urgent advice only (contact via switchboard)

For urgent, out of hours clinical advice please contact the Consultant Microbiologist on duty via switchboard.

Name Position Qualifications Lead Direct lineDr Bruce Stewart

Consultant Microbiologist

MB ChB, MSc,MRCP, FRCPath

Clinical Director of Frontier Pathology NHS Partnership

ESH ext 1904

Antimicrobial Stewardship Lead

Dr Karen Knox Consultant Microbiologist

MB ChB, MSc, MRCP, FRCPath

Infection Control ESH ext 2963

Dr Stephanie Smith

Consultant Microbiologist

MB ChB, DTM&H, Msc FRCPath

Laboratory ESH ext 2964

Infection Control for SASH NHS Trust is managed by the Infection Prevention, Control and Antimicrobial Stewardship (IPCAS) Team.

 Useful links

SASH Infection Prevention, Control and Antimicrobial Stewardship (IPCAS)

Notification of Infectious Diseases

Printable Pathology paper request form (for use during Cerner downtime or if order not available on Cerner)

Pathology supplies email address: sash.pathstores@nhs.net

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DEPARTMENT OF CELLULAR PATHOLOGYCellular Pathology is situated in the first floor at East Surrey Hospital.

Cellular Pathology consists of histopathology, cytopathology, andrology and mortuary services. The Histopathology, Cytology and Andrology service is available from 09:00am to 17:00pm Monday to Friday.  Outside of normal hours please contact switchboard for the on-call Consultant. All urgent requests must be justified clinically.   The mortuary service is described in more detail in the mortuary section.

 CONTACT NUMBERS

NAME POSITION BASE EXTDr L Fulford Consultant Pathologist ESH 6480

Dr A Alhakim Consultant Pathologist ESH 1699

Dr S Sandhu Consultant Pathologist ESH 6464

Dr H Birch Consultant Pathologist ESH 2770

Dr M Siddique Consultant Pathologist ESH 6463

Dr N Heatley Consultant Pathologist ESH 2779

Dr M Jones Consultant Pathologist ESH 2771

Mrs E Berry Head of Service Designated Individual for the Human Tissue Authority

ESH 2774

Mr C Wassell Lead Biomedical ScientistHistopathology

ESH 1851

Histopathology Office Histology Secretary ESH 64486475

Andrology Appointments

Histology Secretary ESH 1697

Laboratory ESH 1851

Mr S Rolfe Mortuary Lead Anatomical ESH 1695

PathologyMortuary ESH 1695

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Out Of Hours contact

Mortuary - via switchboard

Operational Manager - via switchboard

GENERAL In order for the Pathologist to write a meaningful report, sufficient specimen and clinical detail, relevant treatment and case history must be given on the request form.  The name of the clinician to whom the finished report is to be sent, must also be given on the request form.

Specimen containers (not the lids) must be adequately and clearly labelled with patient identification data, surname, first name, date of birth, hospital number (if known), specimen type and date of specimen or time of production.  Request forms must be fully, accurately and legibly completed.  Patient details and specimen details should correspond with the information given on the specimen label.  Any discrepancies giving cause for concern, which cannot be rectified by telephone enquiry, will result in the return of the specimen.  If slides are received it is important to label each slide individually not just the slide container.  Unlabelled slides and specimens will be rejected and returned.  This will result in delay.

 SPECIMEN COLLECTIONSpecimens generated from outpatients clinics are transferred to the Central Pathology reception (ground floor pathology) throughout the day by the porters.  On an hourly basis cellular pathology staff go down and collect specimens from the central pathology reception.  Specimens from East Surrey theatres are collected by histology staff at 9.00am and 4.00pm.  Specimens from Redwood Diagnostic Treatment Centre are delivered directly to the histology department by DTC porters at 9.30am and 4.00pm.  Specimens from GP surgeries, outlying clinics, and hospitals are collected by hospital van and brought to the Pathology Reception area.  North Downs Hospital specimens are delivered by a North Downs Hospital van. 

FROZEN SECTIONSWhenever possible, arrangement for frozen section must be made 24 hours in advance by contacting the Histopathology department (ext 1851) or Consultant Pathologist.  The request form accompanying the specimen must show a telephone number to which the result can be telephoned.

URGENT REPORTSTick the urgent box on the request form and enter the date / time the results is required by.  

If possible arrange for a porter to take the specimen directly to Cellular Pathology Department.  For clinically complex cases contact a Consultant Pathologist to discuss the case.

CWT stickers (Cancer Wait Patients)Patients who are being treated under the two week rule the 31 and 62 day cancer wait targets must have a CWT sticker attached to the request form.

CWT stickers are available from the Histology Dept.

HIGH RISK SPECIMENSKnown or suspected High Risk specimens and request forms must be clearly labelled (reference—Control of Infection Procedure file).  High risk specimens are:- suspected or positive HIV, Hepatitis B and C and Tubercle Bacilli.  These specimens must be put into plastic zip lock bags and sealed.  The request form must be put into the separate compartment provided.  High risk specimens are allowed a longer fixation period than normal.  Thorough fixation is necessary to control infection before the specimen is handled.  Please note that frozen sections cannot be carried out on High Risk specimens.

 SAFETY PROCEDURES FOR 10% FORMALIN.The safety warnings concerning formalin on the specimen label should be observed and followed.  10% Formalin is an irritant to the eyes and respiratory system.  It may cause sensitisation by skin contact.  It is toxic by inhalation, in contact with the skin and if swallowed.  Use in a well ventilated area.  Wear suitable protective clothing and gloves.  Eye protection is advisable.  Wash immediately with water if it does contact the skin.  Seek medical advice if in any doubt.

Very small spillages: wearing gloves, should be mopped up with paper towels .

For safe handling information of spillages refer to “Guidance for use of Formalin”

For advice contact the Histology dept. ext. 1851

 HISTOLOGICAL SPECIMEN FIXATIONSpecimen pots and fixative are obtained from the laboratory on request.  All specimens (with the exception of specimens for frozen section,) should be submerged immediately in a volume of formal saline x 10 that of the specimen.  Inadequate fixation is likely to delay reporting, may compromise complicate histological interpretation and can create an infection hazard for laboratory staff.  Larger containers and cork boards for extra large specimens can be obtained on

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request from the laboratory.  In the case of limbs, contact the Histopathology laboratory for advice.

Cracked specimen containers and lids should not be used.  The container must be securely closed to prevent leakage.  Avoid ‘cross threading’ a screw cap.  Specimens should be sent to the laboratory in sealable plastic bags which have a separate compartment for the request form.  Any leakage of fixative should be contained due to the seal and not contaminate the request form.  Exceptions are specimens generated in theatre which are collected daily by laboratory staff.  Contamination of the outside of the container and request form with blood or other body fluid is to be avoided.  If contamination occurs transfer the specimen to a clean container, before sending to the laboratory via unsuspecting staff members on route.

GYNAECOLOGICAL CYTOLOGYThe gynae cytology uses the Cytyo Thin prep system.  Vials and brooms are ordered directly from the cytology department on the re-order form sent out with each batch of supplies.  Request forms (HMR101) are available or pre-printed forms can be generated from the open Exeter system.

Forms and vials must have two items of patient identification; Christian and surname and either date of birth or NHS number. 

Details on the form and vial must match and they must also match the information held on the Open Exeter database to allow the PCSS to send the result to the correct patient.  Any discrepancies will be checked with the surgery and where necessary form and vial will be returned.

Samples will usually be reported within 2 weeks.  All reports will include a management recommendation.  Patients with abnormal smears that require colposcopy will be directly referred by the laboratory.  Results are sent to the PCSS to update the lady’s screening history on the Open Exeter system and to send out result letters.

This has now all moved to The Royal Sussex County Hospital, Brighton

 A fail safe system operates in conjunction with the Open Exeter system.

 NON-GYNAECOLOGICAL CYTOLOGY

FINE NEEDLE ASPIRATESMaterial should be spread thinly and evenly on the slide.  If possible four slides should be prepared.  Two should be air dried and the other two slides should be spray fixed.  All four slides should be sent to the laboratory in a white slide container as soon as possible. All slides must be labelled with patient name, date of birth and hospital no.

 BREAST CYST FLUIDShould be collected into a universal container and sent to the Laboratory as soon

as possible.  In the case of multiple cysts each sample should be collected separately and clearly labelled with the site from which it was obtained.

 JOINT FLUIDSShould be collected into a universal container and sent to the Laboratory as soon as possible after collection. 

 ASCITIC AND PLEURAL FLUIDSFresh fluid is required (not the contents collected over several hours from a drain bottle).  25ml of fluid should be collected into a universal container and sent as soon as possible to the laboratory.  Large quantities of fluid are inappropriate for cytological investigation.  If a specimen has to be kept overnight it should be refrigerated. 

SPUTUM, BRONCHIAL WASHINGS/LAVAGESSputum samples:In line with Royal College guidelines sputum samples for malignant disease are recognised to be of limited or no clinical value, and hence should be rarely received.In cases where patients are unfit for bronchoscopy, three separate sputum samples, collected on different days, should be sent for cytological examination.Nebulised saline may be used to induce sputum production in appropriate clinical circumstances and guidance should be given to the patient on producing a deep cough sample - a salivary sample is inadequate for cytology.Specimens should be taken before breakfast to avoid contamination with food or toothpaste. The whole specimen should be sent in a wide mouthed, screw-capped container or trap and should reach the laboratory the same day

Nasal, pharyngeal swabs, buccal smears and bronchial brushings:Bronchial brushings and swabs/buccal smears should be smeared gently onto frosted end glass slides and fixed immediately with cytology fixative. Allow 10 minutes before putting the slide in the transport box. The slides must be clearly labelled in pencil with the patient’s name and date of birth.

 URINESA complete mid-morning sample on should be supplied or a 25ml aliquot of the complete sample.  Samples should be sent to the laboratory within 4 hours. Samples received in microbiology boric acid container are unsuitable for cytological investigation and a repeat will be requested.

 C.S.FsA separate sample should be sent for cytological investigation.  All CSF’s are treated as URGENT samples and should be sent to the Laboratory as soon as possible. 

REPORTING OF NON-GYNAECOLOGICAL CYTOLOGYSamples received in the Laboratory are normally prepared in batches and

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stained as soon as possible. It is the aim of the laboratory to report all non-gynaecological samples within 24 hours of receipt of the specimen.  There may be a delay in reporting if special investigations are found to be necessary after primary screening.

ANDROLOGY SAMPLESDetails for collection of seminal fluids can be found on the reverse of andrology request form.Samples must be delivered to the East Surrey laboratory within two hours of production.  The male partners name should be given as the person from whom the sample has been obtained.It should state clearly if the sample is for post vasectomy check or infertility investigations.  Reports are usually issued within one week. There is a room available on site for specimen production. This room is located at East Surrey Hospital, directions and the room key can be obtained from Pathology Reception.

 REFERRAL CENTRES

Liquid based cytology vials are processed off site at Royal Surrey County Hospital in Guildford.

 SPECIMEN RETENTION

All specimens are stored in accordance with the Royal College of Pathologists guidelines.  Any unprocessed residual material is retained for the following times:-

Specimen Retention timeHistology 8 weeksGynae thin Prep vials 4 weeksNon-gynae samples 2 weeksAndrology samples Not retained

 

 

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MORTUARY

The mortuary, managed by Surrey and Sussex Healthcare NHS Trust, serves both the Surrey HM Coroner and the West Sussex HM Coroner. The mortuary is located on the ground floor next to pathology in East Surrey Hospital.

The mortuary has an HTA license and provides secure, cold storage for all hospital deaths and community deaths reported to the Coroner and a post mortem service to both the HM Coroners and the hospital.

The mortuary deals with Coroners, consented and forensic post-mortems. Paediatric post-mortems are transferred to St.Georges Hospital, Tooting.

The mortuary works closely alongside the bereavement office which manages issuing Medical Certificate of Cause Death and facilitates the completion of cremation paperwork. The bereavement staff also deals closely with the families returning property and valuables and liaising with the mortuary to arrange viewings where requested of the deceased.

Mortuary Opening times: 8.30 -4.30 Monday –Friday.

Mortuary direct line: 01737 231695At all other times there a Duty Anatomical Pathology Technologist available on call contactable via switchboard 01737 768511

Bereavement Office: 9 – 5 Monday – Friday 01737 768511 x 1718

Coroners OfficeSurrey: 01483 637100Sussex: 01243 520286