North Bristol NHS Trust, Pathology Sciences Department of Cellular
Contents
1. Q Pulse ID CP N CPA 037 Title Cellular Pathology Handbook of Services doc Version 5 0 Page 1 of 10 North Bristol NHS Trust Department of Cellular Pathology Author Elwyn Rees Authorised AR Heryet North Bristol NHS Trust Pathology Sciences Department of Cellular Pathology User Guide to Services EDITION No ORIGINAL DATE OF ISSUE 14 March 2010 REVIEW INTERVAL 24 months AUTHORISED BY AR Heryet AUTHOR COPY ee LOCATION OF COPIES 1 NBT Intranet website 2 NBT Internet website Document review history Review date Reviewed by Comments 2 0 19 July 2010 AR Heryet Contact information 3 0 7 March 2011 Elwyn Rees CPA compliance 4 0 21June2012 Elwyn Rees General updates and CPA compliance 5 0 21 July 2014 Elwyn Rees Procedural and departmental changes Standards CPA E1 1 amp E1 2 ISO 15189 2012 4 5 4 7 amp 5 4 Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 2 of 10 0 Introduction Pathology Sciences North Bristol NHS Trust provides a Cellular Pathology service from a single laboratory based in the Lime Walk Building Southmead Hospital The Department provides2. Occasionally routine histology reporting times may be complicated by the need for extensive histological histochemical or immunohistochemical techniques f If immunofluorescence studies are required Michel s transport medium can be supplied Please telephone department to discuss g All histology is reported or personally supervised by consultants Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 6 of 10 h The department aims to be able to issue at least a preliminary report on all cases within 7 days This does however depend upon the exact nature of the specimen and the requirement for additional processing testing or opinion i Urgent specimens may be able to be processed if of a suitable size within the day it is taken Specimens must be in the department before 12 30 pm Please contact the department to discuss Material for rapid diagnosis should be placed in neutral buffered formalin and promptly sent to the laboratory marked URGENT and accompanied by a request form bearing appropriate details j Frozen Sections Samples for frozen section diagnosis at Southmead Hospital will be accepted at any time during working hours 9 00 am to 4 30 pm Service outside th
3. a wide ranging and comprehensive diagnostic Histopathology diagnostic Cytopathology and Cervical screening service Services offered include consultation with clinical colleagues to assist in the interpretation of reports and provide advice about the collection handling fixation and submissions of specimens for investigation The department also manages the mortuary facility at each site Since April 2009 when the Bristol City Council Coroner s mortuary opened at Flax Bourton the service is limited to storage and management of the deceased and the facilitation of viewings 1 Working Hours The Department is open for service and opinion Monday Friday 08 30 17 00 hrs Outside of these hours contact with on call Consultant staff can be made via switchboard 2 Specimen Identification All samples are to be accompanied by a Request Form It is essential that request forms and specimen containers not the lid be appropriately labelled in accordance with NBT Clinical Governance Policy CG45 Policy for Request Form and Specimen Labelling Specimens should bear e Patient s Surname and Forename e Patient s Date of Birth AND NHS Number if known e Specimen type and site Failure to provide this information may delay or prevent the processing of a specimen In addition to the above Request forms should bear the following information Patient address with postcode Requestor and Consultant name and location Date and t
4. amp Results 0117 323 5623 4 0117 323 8476 Cytopathology General Enquiries 0117 323 5643 0117 323 0087 Cytopathology Report Enquiries 0117 323 5623 0117 323 5624 a es Consultant Pathologist Dr Mary Brett 0117 323 5646 Consultant Pathologist Dr Caroline Calder 0117 323 5645 Consultant Pathologist Dr Anastasios Chatzitolios 0117 323 2807 a Consultant Pathologist Eeee ee Consultant Pathologist er ees Consultant Pathologist aeie S Consultant Pathologist P a Consultant Pathologist Dr Behrang Mozayani 0117 323 2602 Consultant Pathologist Dr Jon Oxley 0117 323 2601 Consultant Pathologist emer Ver Consultant Pathologist Dr Nick Rooney 0117 323 4224 Consultant Pathologist Dr Chandan Sen 0117 323 2608 Consultant Pathologist Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 5 of 10 er a ees Consultant Pathologist ea e SSS Consultant Pathologist Dr Penny Tidbury 0117 323 2702 Director of SW Regional Cytology Training amp Hospital Based Program Coordinator Mr Elwyn Rees 0117 323 8343 Quality Manager Z GP Access a GP enquiries are welcomed and can be made by telephoning during normal working hours 0830 1700 hrs b
5. degenerating 10 Cytopathology Cervical Screening a As the department has converted to Liquid based Cytology for cervical screening all samples must be collected into ThinPrep pots containing fluid to facilitate processing Vials and brooms may be ordered directly from the department on proformas issued and prepared for this purpose b Cervical screening results are usually available within 14 working days of a smear being taken 11 Mortuary The mortuary is staffed Monday to Friday 08 30 to 17 00 hrs A member of staff is available on standby Monday to Friday 17 00 to 21 00 hrs Saturday Sunday amp Public Holidays 09 00 to 17 00 hrs a Requests for viewings of deceased by relatives and friends should be directed to the mortuary i e 0117 414 1700 or 414 1701 Requests for viewings during stand by periods should be directed to the on call technician on 07900 494523 b Note that no Post Mortem examinations are carried out on Trust premises All adult PMs both those reported to coroner and also consented PMs will be transferred to the facility at Flax Bourton Neonatal deaths that are consented for PM will be transferred to the mortuary at St Michael s Hospital Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Au
6. Reports are dispatched by hospital postal service the majority GP practices have direct access to results via computer 8 Histopathology specimens a Routine specimens should be placed in at least 10 times their volume of fixative neutral buffered formalin in an appropriate container Specimen containers and fixative can be supplied on request All samples are to be accompanied by a Request Form Delayed or inadequate fixation will have a detrimental affect on the initial diagnosis and may invalidate subsequent tests such as immunohistochemistry Formalin is a hazardous substance and care should be taken when handling The lids of all specimen containers must be securely applied to prevent leakage b Small specimen pots should be placed into the sealed plastic specimen bags with the request form placed in the front envelope of the bag This is to ensure the request forms are kept clean and avoid being ruined by potential formalin leaks c Large operative specimens collected during working hours should be sent in a sealed box or specimen bucket unfixed to the laboratory with a porter After 16 30 hrs unless prior specific arrangements have been made place specimen into fixative and transport to the laboratory as usual d All Inoculation Risk specimens must be fixed in formal saline and labelled appropriately e Most routine biopsies will be available on the ward computer within three working days of receipt to the laboratory
7. ally be an aliquot of the whole output although a midstream sample is acceptable An early morning sample is not appropriate Please indicate on the request form if specimen is a catheter or cystoscopy sample No alcohol can lead to the degeneration of the cellular content and to bacterial overgrowth and can affect diagnosis Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 8 of 10 Sputum Collect into dry sterile sputum pots The specimen should be collected before any food is eaten and before teeth are cleaned and should be a deep cough early morning specimen taken with the assistance of a physiotherapist if needed Saliva is not adequate Available by contacting Cytology Southmead Hospital on ext 35643 ii Neuropathology Specimen type Requirements Cerebrospinal fluid Contact Neuropathology who provide this service CSF in support of Neurosciences and the Burden Centre All samples need to be sent to the laboratory as soon as possible and arrive at the laboratory during routine opening hours If this is not possible store in the fridge and send in on the next working day Any delay can lead to the cellular content
8. ese hours or at Frenchay Hospital by prior arrangement only 24 hours notice is required Please telephone the department with details ext 35623 4 9 Diagnostic Cytopathology specimens a All samples specimen pots or slides must be clearly labelled and include relevant clinical details including any treatment that the patient is receiving Requests for breast aspiration cytology should state if the patient is pregnant or on contraceptives b All specimens that may be an inoculation risk should be labelled as such Please see 3 Health and Safety above c The department aims to be able to issue at least a preliminary report on all cases within 5 days This does however depend upon the exact nature of the specimen and the requirement for additional processing testing or opinion If a rapid result is required specimens should be promptly sent to the laboratory marked URGENT and accompanied by a request form bearing appropriate details d The department aims to report One Stop Breast samples within 1 hr of receipt The lab should be told in advance that samples are expected then they must be transported immediately to the Lime Walk Specimen Reception e Please note that Cerebrospinal fluids CSF samples are handled by Neuropathology see details below f Specimen Collection i Cellular Pathology Specimen type Requirements Quality Measures Serous Fluids Serous fluids are collected into plain universals pleu
9. ime specimen was taken Biopsy site This is particularly important if multiple samples are to be sent relevant clinical details including LMP as appropriate details of any previous biopsies Patient category NHS Private Other Failure to provide the information may result in delays in producing a report Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 3 of 10 3 Health and Safety a Any patient with or suspected any of the following are considered to be an Inoculation Risk HIV Hepatitis B Hepatitis C Creutzfeld Jakob Tuberculosis VVVVV b For the safety of staff please ensure that investigations are kept to a minimum c Forms must be clearly labelled with a Biohazard Risk or Inoculation Risk sticker although for issues of confidentiality the nature of the risk must not be given on the request form d If a patient having an Inoculation Risk is admitted to a trust hospital the Consultant Microbiologist should be advised as soon as possible 4 Transport City Sprint under contract to Pathology Sciences NBT provides a routine service to local hospitals and GP surgeries For emergency transport contact the Trust Transport Depart
10. ment on 0117 323 5417 5 Supplies Supplies for use in collection and despatch of Histology and non Gynae cytology samples can be ordered through Pathology Sciences Southmead Tel Fax 0117 323 8338 e mail PathologyConsumables nbt nhs uk Requests can be made using a proforma list and supplies are dispatched by the Trust Transport system within 3 days LBC supplies are available directly from the laboratory request either by phone fax or post using the official forms supplied by the department Please ensure that gt forms are clearly marked with a delivery point gt you don t overstock as the expiry date on some containers is less than six months gt if you have stock that is likely to go beyond expiry date that it is returned whilst still in date Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 4 of 10 6 Key Contacts and Consultant staff For guidance and advice about any aspects of the work of the department please contact an E appropriate member of staff Dr Rob Pitcher 0117 323 2158 Consultant Pathologist Secretary Head of Department 0117 323 5623 Mr Andrew Heryet 0117 323 2706 Laboratory Manager Histopathology Enquiries
11. ne School of Medicine Cardiff University Heath Park Cardiff CF14 4XN Specialist IHC Oxford Radcliffe Hospital Dr lan Roberts Reporting Renal biopsies Oxford Radcliffe Hospital Dr F Pezzello Reporting Second Opinion Haem malignancies Frimley Park Camberley Surrey GU16 7UJ Professor Cook Second Opinion Skin Pathology Gloucestershire Hospitals Prof N Shepherd Second Opinion GI specimens Royal Orthopaedic Hospital Birmingham Professor Kindblom Dr Sumathi Second Opinion Sarcoma Southampton University Hospitals NHS Trust Tracey Mitchell PhD PCR Guy s and St Thomas London Gene Analysis St Thomas s Hospital London Dr Eduardo Calonje Second Opinion Dermatopathology UHB Bristol Dr Joya Pawade Reporting Second Opinion Haem malignancies UHB Bristol Dr Newton Wong GI Pathology including Bowel Cancer Screening UHB Bristol Dr Nidhi Bhatt Respiratory Pathology Institute of Liver Studies Dr Alex Knisely and colleagues Liver biopsies Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016
12. ral ascitic pericardial peritoneal lavage washings Cyst Fluids Collect into dry sterile universals Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 7 of 10 Bronchoalveolar Lavage BAL Collect into dry sterile universals Bronchial Washings Fine Needle Using pencil label up to five clean frosted end If the sample is too Aspiration FNA microscope slides with thick it may not be amp Needle a patient s surname possible to obtain a Washings b patient s forename and diagnosis c patient s DoB or hospital number Place 1 drop of specimen near bottom of each Delay in air drying or slide and spread gently using another clean slide fixation affects cellular Rapidly air dry the slides prior to placing ina preservation and can plastic slide container affect diagnosis NB If squamous cell carcinoma is suspected at least one slide should be spray fixed and labelled Fixed slides must as such immediately be fixed Flush needle into a bottle containing 5ml Cytolyt with Cytospray and send the needle washings together with the cytology fixative to FNA slides do not send the needle prevent air drying Breast Fine Breas
13. t FNAs should be spread thinly onto a clean If the sample is too Needle Aspiration FNA labelled slide see FNA above and air dried rapidly Any needle washings should be placed in a sterile universal containing 5ml Cytolyt available from Cytology x5643 thick it may not be possible to obtain a diagnosis Delay in air drying or fixation affects cellular preservation and can affect diagnosis Brushings bronchial oesophageal biliary gastric A minimum of two slides are required Using pencil label clean frosted end microscope slides with a patient s surname b patient s forename and c patient s DoB or hospital number Transfer material from brush onto slides immediately after collection using a gentle but firm rolling technique One slide is rapidly air dried and the other spray fixed Slides should be allowed to dry labelled with identification fix or dry and placed in a plastic slide container Delay in air drying or fixation affects cellular preservation and can affect diagnosis Fixed slides must immediately be fixed with Cytospray cytology fixative to prevent air drying Synovial Fluid Collect into dry sterile universals Samples must be sent to Cytology department as soon as possible Incorrect storage can lead to the formation of contaminating crystals Urine Urinary Tract Washings Place in bottles containing alcohol Urine sample should ide
14. thor Elwyn Rees Version 5 0 Authorised AR Heryet Page 9 of 10 c Reporting deaths to Coroner For further information contact the Coroner s office d Hospital Post Mortems Written consent must be given for a post mortem examination All necessary documentation is available through the Bereavement office Before asking relatives a death certificate must be completed e General enquiries Contact the mortuary 12 Referral Services Details are provided below of the accredited referral laboratories and services used by the department Created 14 March 2010 Date of revision 11 August 2014 Review date 12 August 2016 North Bristol NHS Trust Q Pulse ID CP N CPA 037 Department of Cellular Pathology Title Cellular Pathology Handbook of Services doc Author Elwyn Rees Version 5 0 Authorised AR Heryet Page 10 of 10 Name and Address of Department Named Consultant Repertoire Scope of Service to be provided Source Bioscience 1 Orchard Place Nottingham NG8 6PX if applicable Reporting of Histology specimens including Breast pathology UCL Advanced Diagnostics 21 University St London WC1E 6JJ Immunohistochemistry Ashford amp St Peters Cervical Screening and QC Dept of Medicine School of Medicine Cardiff University Heath Park Cardiff CF 14 4XN Dr D Griffiths Reporting Renal biopsies Dept of Medici
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