14.1 By Hard Copy or Computer link

Hard copy reports are printed directly to Blackrock Clinic wards and delivered daily to external customers.

Results are available to internal wards via an interface with iPMs, the hospital patient management system. The laboratory also has a system in place to communicate electronically with customers by computer via a modem link. This system, known as Medibridge, is “live” at several external sites.  Medilink is also available to Consultants and GPs via their PC.  Access to this service must be arranged through the Blackrock Clinic IT department.  Patient results for all disciplines, including Histology, can be accessed through this link.

If a delay occurs in reporting of results, requesting clinicians are notified as soon as possible.

14.2 Faxing Results

On request results and in some cases by prior agreement results can be faxed to a secure line. Please note all fax numbers must be confirmed and approved prior to use.

14.3 Telephoning Critical Results

Critical results are telephoned to users according to laboratory guidelines approved by the Medical Advisory Committee.  The guidelines are available on Q pulse or by request:

Ref: WI-HAEM-0025 Haematology/Blood Transfusion Abnormal/Critical Results that Require Telephoning

Ref: WI-BIO-0031 Biochemistry Abnormal/Critical Results that Require Telephoning

Results will be phoned if there are no recent similar results available for comparison, if there is no known clinical reason for the result or if results are significantly abnormal - as defined in the documents above. If the abnormal results cannot be communicated to the clinical team by phone, despite two attempts, these results will then be released by hardcopy and softcopy reports. The Siilo messaging application is used by some departments to notify consultants of results.  Further attempts to contact the clinical team may be undertaken but cannot be guaranteed. While the staff in the Laboratory will do their best to adhere to the above guidelines, it is the duty of all doctors to follow up, in a timely fashion, on the results of pathology investigations requested on patients under their care.

Microbiology and Cellular Pathology critical results are telephoned to users by Consultants.

14.4 Turn Around Times

Turnaround times are established with collaboration between senior laboratory staff, departmental consultants and clinical users. TAT's stated refer to time from sample receipt in the Blackrock Clinic Laboratory to the time the final result has been authorized. Significant delays in agreed TAT, for example due to instrument down time, will be communicated to the clinical area or requesting clinician.

In addition to the turnaround times listed in the appendices below the following turnaround times for reporting have been agreed with the users of the pathology service:

14.4.1 Pre-Op Elective Surgical Admissions

In most cases, patients are admitted on the eve of their scheduled procedure, and the results of specified examinations are required before surgery. The following examinations have been agreed to be available upon request, prior to the surgical procedure.

            ·         Full Blood Count (with or without differential)

            ·         ESR

            ·         Coagulation Screen (APTT, PT)

            ·         INR

            ·         Full Biochemistry Profile (Renal, Liver, Bone, Cholesterol, Triglyceride, Uric Acid)

            ·          Glucose

            ·         Cardiac profile and NT proBNP if required

            ·         Lipid Profile if required (Cholesterol, Triglyceride, HDL and LDL Cholesterol)

            ·         Blood Group and Antibody Screen

            ·         Crossmatched Blood if required

            ·         Blood Gas (incl. of electrolytes) available on Point of Care equipment in ICU.

In order to ensure these blood examinations are completed prior to surgery, it is important the nursing staff ensure delivery of these samples to the laboratory as soon as possible after admission and that laboratory staff are aware of these blood examinations.

Some Pre-Op elective surgical examinations often requested on the eve of the scheduled surgery, but which will not be available prior to the surgical procedure are:

• MSU for culture/sensitivity
• Nasal swab for culture/sensitivity
• Throat swab for culture/sensitivity

MSUs are stored in the fridge and processed for examination the next working day. Preliminary results (possibly final) are available the following day (24 hours later), and where a positive culture is established, the final report is normally available within 48 hours.

Note: This arrangement has been agreed with the Cardiac Ward clinical team and meets the needs of their patients.

14.4.2 Special Requirements for Turnaround Times

The following turnaround times have been agreed between laboratory management and clinical/nursing staff on the wards:

        14.4.2.1 Oncology Day Unit

Patients attending for chemotherapy have a Full Biochemistry Profile and Full Blood Count and Differential requested. The following turnaround times have been agreed.

Full Biochemistry Profile to be available within 1 hour of receipt in lab.

Full Blood Count and Differential to be available within 40 minutes.

The reports are printed directly in the Oncology Day Unit.

The forms are labelled with “CHEMO URGENT ODU” stickers to indicate urgency.

        14.4.2.2 ICU

Routine early morning blood examination results (Biochemistry profiles, magnesium, FBC, Coagulation studies) are printed by 10 am each morning, and by 11 am on Saturday/Sunday/Public Holidays.

        14.4.2.3 Outpatients Clinic

Reports are delivered to Consultant suites twice daily, morning and evening.

        14.4.2.4 Urgent and Emergency Examinations

The following blood and body fluid examinations are available as urgent requests and the results will be made available as soon as possible thereafter.  The results of these examinations (except transfusion – see below) will be automatically printed on the ward following authorisation.