Pathology

Bridging the gap between science and medicine to diagnose, treat and prevent disease.

The Royal Cornwall Pathology service consists of approximately 190 staff and provides a 24 hour, 7 day service to Cornwall, Devon and the Isles of Scilly for both primary and secondary care.

This covers 3 main hospitals (Royal Cornwall Hospital in Truro, West Cornwall Hospital in Penzance and St Michael’s Hospital in Hayle), 9 community hospitals, approximately 80 GP surgeries and a number of mental health and learning disabilities centres.

Courier vans deliver samples to the laboratories daily, times depending on location.
Enquiries should be made to the Courier Manager in Estates, telephone (01872 25) 2985 or 3813.

There is no courier service at weekends. A limited service (collection from local Hospitals) usually operates on Public Holidays.

For more detailed transport needs for DMP please see –
https://www.royalcornwall.nhs.uk/services/pathology/diagnostic-molecular-pathology/

The Pathology budget is £16.6 million and includes approximately £3.8m for blood and blood product and the service itself. We process approximately 1.4 million requests a year and report 3.9 million requestable test groups. The staff across pathology provides 70% of diagnoses based on the pathology results provided by laboratory services.

Our pathology services are fully accredited, regulatory compliant and provide advice, results and clinical input across all the main Pathology specialties from a base at Royal Cornwall Hospital.

Our mission statement is:

To continue to provide and develop quality, cost-effective pathology services and staffing relevant to local clinical practice and within a changing technological, functional and organisational environment

The Pathology Departments
Key Information

Submitting specimens to Pathology

The Pathology service will accept requests from users that have agreements with the RCHT Pathology service. These requests will be analysed, if compliant with the Pathology Specimen Acceptance and Rejection Policy. This policy is strictly adhered to by all departments.

Use of the NHS Number (10 figures) on paper and electronic patient records is now a mandatory requirement included within the NHS Operating Framework 2008/9. Patient data should be used to identify the specimen up to the point where a NHS Number is allocated whereupon this becomes the primary identifier.

The laboratory computer (LIMS) uses the patient’s hospital number or the NHS number as the file accession number. The use of either of these numbers ensures correct patient identification and also speeds up sample processing. However, the NHS number is regarded as a safer means of positive identification as the computer system automatically performs an integrity check.

Handwritten Labels

Poor or illegible handwriting may be misinterpreted and result in report delay. Please help to minimise this by completing all sections of the appropriate request form using a ballpoint pen. Printed patient addressograph labels are preferable to minimise error.

Specimens that do not meet the labelling requirements will NOT be processed unless the errors identified are rectified by the responsible clinician by confirming details via email or by attending the CMB department to correct the error within 24 hours.

Electronic Requesting – MAXIMS

The MAXIMS ordercomms system is the Trust’s preferred method of requesting Pathology tests. Emergency paper forms are available in clinical areas in case of system failure. All requests should normally be made electronically.

The MAXIMS system allows clinical requests to be made from all RCHT locations, offering tracking from the point of request through to the result issue and acknowledgment by a responsible clinician.

The electronic requesting software is accessed when a patient requires a Pathology test; the requesting clinician launches MAXIMS and selects the investigation that is required.
Once the order has been completed, an order message is sent to the laboratory computer system. At the same time a request form is printed within the ward/clinic or theatre. The sample is then collected and sent to Clinical Microbiology with the request form using the ATTS (pod).

When the sample arrives in Pathology, it is booked onto the laboratory computer system using a bar code reader. This then populates the laboratory computer system with the information provided in Maxims. The sample is then ready to be processed.

Once the result data has been entered onto the laboratory computer system and authorised, the data is ready to be transferred back to the responsible clinician.

  • This system allows complete and accurate order entry by reducing the risk of transcription errors.
  • Request tracking from point of request through to results reporting, as well as incoming request monitoring and a full audit trail.
  • Reduction in the need to telephone the laboratory with enquiries either caused by data entry errors or to query the progress of a sample, as each order will contain status updates.

ICE

ICE is the Primary care order-comms Pathology requesting system. Users access the system via the patient record in the surgery computer system to place an electronic request for Pathology testing. The system will automatically record the request in the patient record and print a label for the sample. Individual users are set up with ICE accounts via CITS who manage all user account enquiries

Urgent Requests

If results are required to assist with urgent clinical decisions, the laboratory must be notified by telephone, even during normal working hours, and the request form marked as ‘URGENT’. Without such notification, the specimen will not be prioritised and will be processed routinely even if the request form is marked as ‘URGENT’. Please note that writing “urgent” on the request form will not guarantee that the specimen will be handled as an emergency.

Results

It is our aim to issue results in a timely manner. Winpath results are available via Maxims, Winpath Ward Enquiry and ICE. Reports will be issued back to users in line with the RCHT Pathology turnaround time expectations and guidelines as detailed specific agreements.

Please contact CITS on 01209 88 1717 to gain access to these systems.
All results are typed into the Laboratory Information Management System (LIMS) (Winpath) and made available for all individuals registered with CITS to view in Maxims or ICE, once the report has been authorised and released.

Results by Telephone (Blood sciences only)

It is the responsibility of the requesting clinician to promptly review and act on the results of every investigation they request. The laboratory phoning policy acts as a safety net for the highlighting of ‘critically significant’ findings, as defined by the laboratory. Other results (not part of the laboratory telephone policy) are reviewed by the Clinical Biochemists and phoned at their discretion. The laboratory cannot guarantee, or be held responsible, for telephoning all clinically significant results.

If results are requested by phone, it is important to only use extension 2540 or 2548. Direct dial is available by prefixing these numbers with 01872 25.

Results which are markedly abnormal will always be telephoned. Most standard GP test results are available on the next working day. Certain tests are done in weekly batches and others are referred to other centres and will therefore take longer to report (see Pathology repertoire table).

Inpatient results for standard tests (e.g. FBC & Coagulation) will usually be available within two hours of laboratory receipt.

INR results are reported to GPs via GP link by 1830 on the day of receipt provided the request is received by 1630.

As a safeguard all INRs over 5 are automatically telephoned and verbally communicated by laboratory staff to the relevant surgery or NHS Kernow Health as appropriate. Telephone requests for results should be avoided whenever possible. Surgeries are asked to check their IT systems before telephoning the lab.

Where an urgent telephone request for an essential individual result is received from a source without computer access to results, the INR will be communicated on the basis of patient identification using three points of reference (Name, Date of Birth, and Address) after verification of the patient’s NHS number.

Telephone requests for multiple results will be advised to await transmission of results by GP link as the risk of a transcription error is raised. A delay in notification to the patient in most cases of 1 – 2 days is satisfactory (British Society for Haematology – BSH guidelines)

We appreciate that there may be a need to telephone for results but would ask that this is kept to a minimum using the Pathology Joint Reception number (01872 25) 2548 or 2540. Please try to telephone in the morning whenever possible.

Specimen collection and storage

Date and time the specimen was taken must be clearly recorded on the specimen container and the request form/ordercomms. This information is essential to know the age of the sample due to the instability of some analytes and for the interpretation of results.

It is highly recommended that Primary Care locations centrifuge there samples, as delay can affect some results. Please deliver unspun samples to the laboratory asap. If storage is required overnight do not store in the fridge, instead store at room temperature (but cool). However, please note the delay in centrifugation as well as analysis will lead to some tests being rejected by the laboratory.

To obtain advice and information on suitable centrifuges or on any aspect of centrifuging samples please contact the Pathology optimisation team on ext 4619. Angle head centrifuges are not ideal and may produce poor quality separation resulting in rejection of the sample.

Essential Desirable Essential for all DMP specimens
Specimen
  • NHS number or CR number*
  • Patient’s FULL name or unique coded identifier (e.g. GU number)
  • Date of Birth
  • Date and time of specimen
  • Nature of specimen e.g. site of biopsy
  • Surname, Forename or coded identifier
  • NHS / Hospital number or Date of birth
  • Signature of the requester
  • Date of collection
  • Time specimen taken
  • Sample type
  • Site and side
  • Description of Biopsy
  • Consultant or patient’s GP
  • Patient location or address
  • Report destination
Request Form
  • NHS number or CR number*
  • Patient’s FULL name or unique coded identifier (e.g. GU number)
    (Blood Transfusion – names on request forms must be correctly spelt and forms must be signed and dated by the person making the request and must also state date/time of any blood products required and all clinical details)
  • Date of Birth
  • Patients location and destination for report
  • Patients consultant, GP or name of requesting practitioner
  • Investigations required
  • Clinical information including relevant medication (this is sometimes essential)
  • Date and time when specimen is collected (this is sometimes essential)
  • Patients home address including postcode
  • Practitioners contact number (bleep or extension)
  • Gender
  • Surname, Forename or coded identifier
  • NHS / Hospital number or Date of birth
  • Signature of the requester
  • Date of collection
  • Time specimen taken
  • Sample type
  • Site and side
  • Description of Biopsy
  • Consultant or patient’s GP
  • Patient location or address
  • Report destination
  • Diagnostic Cytology – Label frosted slide end (Full Name and Hospital No or NHS number or DOB and Sample type and Site / side)

*For DMP Specimens that do not meet the labelling requirements as detailed in the table above, the specimen will not be processed until the errors identified are rectified by the responsible clinician. For Hospital requests the clinician is contacted directly and requested to rectify the error, this may be by confirming details via email or by attending the Histology department to correct the error, depending on the nature of the error. For GP requests the specimen is returned to the GP practice for correction.

Referral Laboratories

All departments refer some specimens for primary or secondary testing to reference facilities.

If you require a list of the laboratories we refer specimens to or information on a for a particular test or referral laboratory, please contact the laboratory directly. This is due to the information changing as we constantly review referral testing to ensure; the referral laboratories we use are providing a good & timely service, expanding our repertoire of referred tests to allow us to offer our users the most update-to-date tests available, and when appropriate bring testing in-house.

Complaints procedure

Complaints can be made by an existing or former patient, someone else with the consent of the patient (the patient’s consent must be in writing), or someone such as a close relative if the patient cannot complain or consent, for example if they are very ill or have died. There is a 12-month time limit for making a complaint. There is, however, some flexibility, so if your complaint is outside the time limits; it may still be investigated, especially if there is a good reason why you did not complain earlier.

Comments about, or experience of problems with the service should be addressed to the Lead Biomedical Scientist (LBMS), Consultant Head of Department (HOD), or to the Specialty Director (SD).

Key Pathology Contacts & Roles

Key Pathology Contacts

Pathology Specialty Director

Dr James Garvican (Consultant Histopathologist)
01872 252665
j.garvican@nhs.net

Pathology Service Manager and Head Biomedical Scientist Diagnostic and Molecular Pathology

Stephen Davison
01872 25 2798
sdavison1@nhs.net

Head Biomedical Scientist for Blood Transfusion, Haematology and Clinical Chemistry

Alain Rolli
01872 252554
alain.rolli@nhs.net

Pathology Services Optimisation Manager

Dr Nigel Oakes
01872 25 4619
nigeloakes@nhs.net

Pathology Optimisation Projects Lead

Jo Walsh
01872 254619
jowalsh@nhs.net

Lead Scientist for Clinical Microbiology

Dr Gemma Vanstone
01872 254900
Gemma.vanstone@nhs.net

Pathology Quality, Governance Manager and H&S Lead Business Continuity Lead

Sarah Pointon
01872 252582
sarahpointon@nhs.net

Pathology Quality Improvement and Assessment Specialist

Lynne Bedford
01872 252582
lynne.bedford1@nhs.net

Pathology Information Technology Manager

Steve Sprague
01872 254619
steven.sprague@nhs.net

Key Pathology Roles

The Pathology team is both highly specialised and incredibly varied. We have a mix of scientific, medical and support staff who all work together to process and analyse millions of samples each year. In each of our departments you’ll find:

Medical Laboratory Assistants / Medical Laboratory Support Workers
Our medical lab assistants and support workers keep our labs running smoothly. They receive and unpack all of our samples and make sure they end up in the right place. They also help prepare specimens for analysis as well as equipment maintenance, filing, audits, preparing chemicals for analysis and providing results.

Biomedical Scientists
Our Biomedical Scientists process samples using a range of specialised techniques so that they can make a diagnosis, identify causes of disease and monitor the effectiveness of treatments.

Each of our teams also have a number of specialist roles:

The Haematology, Blood Transfusion & Immunology Team

Transfusion Practitioners oversee blood transfusions. They make sure blood components are safe and used efficiently. They also advise other medical staff who care for patients receiving blood components, and make sure guidelines and protocols are followed.

Clinical Scientists carry out haematology tests including andrology and coagulation services. They hold clinical responsibility and are the main point of contact for GPs, other primary care practitioners and within the Royal Cornwall Hospitals.

Consultant Haematologists interpret test results and act as the bridge between the science of the laboratory and the medicine of the hospital. Hospital doctors and GPs can phone them for advice.

Specific contact information for the Haematology, Blood Transfusion & Immunology team.

The Diagnostic and Molecular Pathology Team

Cytoscreeners evaluate specimens on glass slides using microscopes to see whether the cells are normal or abnormal. Abnormal specimens are referred to a pathologist for final interpretation or medical diagnosis.

Consultant Biomedical Scientist in Cytology is the strategic and clinical lead in cervical cytology covering the south west.

Consultant Pathologists interpret the results from the Cytoscreeners and act as the bridge between the science of the laboratory and the medicine of the hospital. Hospital doctors and GPs can phone them for advice. They diagnose disease and carry out post mortems to investigate cause of death.

Specific contact information for the Diagnostic and Molecular Pathology team

The Mortuary and Bereavement service

Anatomical Technicians assist Pathologists during post mortem examinations. They also look after the day-to-day running of the mortuary service and maintenance of the post mortem room. They conduct viewings in our specially designed quiet rooms, and release the deceased to undertakers in preparation for a funeral.

Bereavement Officers offer advice, practical help and support for bereaved relatives in the period following the death of a loved one.

Specific contact information for the Mortuary and Bereavement team

The Clinical Microbiology Team

Consultant Medical Microbiologists have an incredibly varied role. Microbiologists advise clinicians on the management of infection, do clinical ward rounds, provide advice for community care and review positive laboratory samples. They also work with the infection control team to prevent and control outbreaks of healthcare associated infections. This involves responding to changing microorganisms and emerging diseases, and advising hospital engineers about building new hospital areas. Consultants are also responsible for the clinical governance of the diagnostic laboratory and are involved in introducing new tests and techniques.

Specific contact information for the Clinical Microbiology team

The Clinical Chemistry Team

Clinical Biochemists interpret results, acting as the bridge between the science of the laboratory and the medicine of the hospital. Hospital doctors and GPs can phone them for advice.

Chemical Pathologists are similar to the Clinical Biochemists as they also provide interpretation of results. However, as medics, they have a larger clinical component to their role. For example, they are involved in nutrition ward rounds and providing clinics such as Diabetes, Lipids & Metabolic Medicine.

Specific contact information for the Clinical Chemistry team

The Point of Care Testing (POCT) Team

The Associate Practitioner is available for problem solving, fixing of Point Of Care Testing (POCT) equipment and assisting in training.

Our senior Biomedical Scientist in Clinical Chemistry oversees the day-to-day running of POCT team and ensures Service Level Agreements and policies are disseminated throughout the trust.

Consultant Biochemist is the clinical lead for POCT.

Specific contact information for the Point of Care Testing team

Registrations and Memberships

Our scientific staff are all registered with the Health and Care Professions Council and either members of the Institute of Biomedical Scientists (IBMS) or the Royal College of Pathologists (RCPath). Our medical staff are members of the Royal College of Pathologists (RCPath) or Royal College of Physicians (RCP). Everyone in the Pathology team undergoes Continual Professional Development to ensure their education and training remains up-to-date.

Careers in Pathology

Working in an NHS laboratory means you will play an important part in diagnosing disease and making sure that patients get the treatment they need as soon as possible.

If you’d like to visit our laboratory to find out more about a career in pathology, please contact Martyn Hicks in the Haematology Department on 01872 252502.

Find out more about a career in pathology:

Further sources of information about pathology

Pathology Services Newsletters

Lab Med News

A bimonthly newsletter sent via email to Primary Care. It contains the latest news from Pathology including changes to services, information and guidance on tests, and much more. Lab Med News is compiled by Anna Barton, Principal Clinical Biochemist (Department of Clinical Chemistry).

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