11
Bucks Healthcare NHS Trust April 2018 Volume 1, Issue 1 Pan-Pathology Press Editors Stephanie Hill & Farah Mohammed
Bucks Healthcare NHS Trust
April 2018 Volume 1, Issue 1
Pan-Pathology Press
Editors
Stephanie Hill & Farah Mohammed
When I first started at BHT I
didn’t really know what to expect.
I recall driving from home in West
London on my first day
(15/5/2017) and halfway into the
journey thinking, ‘This is really
far’, ‘What have you done?’
My Plan: I had a plan to make
sure that I spent a fair amount of
time in each department getting to
know the staff and the processes
in place. I spent the first few days
meeting people attending
meetings and dealing with issues.
As the days became weeks, and
the weeks became months, I found
that I was constantly attending
meetings and not spending the
time I had hoped I would in the
various Pathology departments. I
had to revise my plan (aka re-plan
my plan) and work with the
Team Heads/Leads to get to know
the departments.
BHT Pathology Hurdles: It was
about the second month into the
job that a private consulting
company came in to look at Pa-
thology. One of their sug-
gestions was outsourcing Pa-
thology. Having worked in Trusts
where this was done and having
seen first-hand the de-benefit this
had produced to the Trusts, staff,
the service and in some cases pa-
tients, I decided to work towards
keeping the Pathology Service in
the Trust and making the service
as efficient and cost effective as
possible, ensuring that our patients
are provided with a safe service
An Honest Look into my First Year as the Pathology Service
Manager at BHT
Page 2
Pan-Pathology Press
and staff, a good working envi-
ronment with good staffing struc-
tures (right skill mix) in place (in
progress).
My Initial Hurdle: I found trying to get
information from people difficult when I
first started. I would get a phone call or
email from someone outside of
Pathology queering something and I
would run around trying to get the
answers. I spent so much time trying to
work things out and found this
frustrating. I heard it said so many times
that my predecessor did everything and I
think he did a really good job. However
my role is different from his in that I
have to participate in Silver Command
On-Call and I am also the Lead
Healthcare Scientist for the Trust.
Both these roles take me away from the
department and mean that the Pathology
Team Heads and Team Leads are respon-
sible for managing their own depart-
ments. One way I overcame my frus-
trations was by creating TTTRP (Talk To
The Right Person). I find we waste so
much time trying to find answers to ques-
tions. Wasted time that can be avoided if
the right person is asked the question in
the first place. I started directing ques-
tions to the right person instead of wast-
ing my time trying to find the answers
and have found things a lot more condu-
cive and less frustrating (note: TTTRP is
now a patented product )
My thoughts on BHT Pathology thus
far: I have worked in a number of
Pathology Services (NHS Trusts and
Private Labs) for more than two decades
and I think that Pathology at BHT is a
very strong SDU. Pathology staff in Cell
Path, Blood Sciences, Microbiology, the
Mortuary and Phlebotomy (alphabetical
order), have gone through so many
changes recently and have remained
hardworking, loyal and very resilient.
Future Thoughts: In order to make
Pathology at BHT competitive we have
to ensure that we are providing the best
service, our Turn Around Times (TATs)
have to meet National Standards, we
have to be Accredited, and we have to
be just as good as the other Pathology
services out there. There are a number
of things that we need in order to
make our service a lot more efficient
but sadly there is a lack of investment
in BHT Pathology. This is something
that I hope we can change. I want to
open Pathology up so people see the
great work staff do. Having Pathology
Open Days where Staff in the Trust,
Patients and GPs can visit Pathology
and learn more about what we do, is a
way we can make our service more
visible and relevant.
Staff recruitment is essential for our
growth and we also need to improve
staff retention and career progression
– changes are taking place. Finally,
BHT Pathology is working with the
new Pathology Network (South 4) and
there are a number of beneficial im-
provement initiatives available to us
in areas like Procurement, Training,
R&D and IT, which will bring about
financial growth in the Department.
Each morning it can take over an
hour to get in on a good traffic day,
and longer to get home, and I keep
coming in. Why? Because I believe in
the service we provide and the
excellent staff who provide the
service.
The annual influenza season
usually runs from mid-late
autumn to late spring. SMHs
Flu season started to peak in
January. Most influenza
infections are uncomplicated
illnesses lasting 2-5 days.
Patients visiting A&E may
be at risk of complications,
such as viral pneumonia.
Rapid diagnosis is of the
utmost importance so that
antiviral therapy can be giv-
en to those most in need. On
the wards, the increase in
patient numbers makes care
and management a constant
struggle, critical at times.
There are numerous meth-
ods for Flu testing on the
market, PCR being the most
sensitive. When EIAs are
used at POC it is recom-
mended that PCR be used to
confirm negativity.
During this period last year
pathology tested about 400
flu samples, by PCR. Dur-
ing the first three months of
2018 1013 samples have
been tested and we’re still
testing.
The Cepheid GeneXpert is
quoted as a “Game-
Changer” and Microbiology
have kindly been loaned a 4
module unit which allows
for, you’ve guessed it, 4
specimens to be tested at a
time. The PCR itself hap-
pens inside patented self-
contained cartridges that
require inoculating and load-
ing. This process can happen
continually throughout the
day as and when needed.
Not sounding special yet?
Let’s compare it to last year.
reduction has allowed for
sooner treatment commence-
ment and better patient man-
agement.
The Cepheid GeneXpert
lives up to its claim of being
a “Game-Changer” especial-
ly as it could also help with
rapid testing of Norovirus as
From a laboratory prospec-
tive the minimal hands on
time allows for ease of train-
ing and more staff being
able to participate in testing
procedure, therefore making
it easier to run the process
throughout the day. For the
hospital, Infection Control
and Bed Managers, TAT
and when winter-vomiting
strikes.
Stoke Mandeville Hospital, Microbiology and the Cepheid
GeneXpert Flu Experience
Page 3
Pan-Pathology Press
The Game-Changer
GeneXpert
2017 2018
System Progenie Molecular Cepheid GeneXpert
Preparation (hands-on) time 1hr per batch 2 minute per sample
Test run time to result 1 hr 30 min for negative
20-30 min for positive
Number of tests in batch 12 4 at a time
Number of batches in a day 1-2 during week day depending on
demand
Not applicable as continual loading
throughout day
Times for sample receipt Between 9 am and 3 pm, 6 days a
week during peak
Week day 8am to 7pm
Weekend 8am to 6pm (peak)
8am to 3pm (current)
Reviewed sample dates 15-28/2/17 15-28/2/18
Number of samples 24 187
Turnaround time range 1-5 days <1-16 hours
Average turnaround time 1.5 days <5 hours
Flu Testing Results BHT - 01/03/2018 – 31/03/2018
Page 4
Pan-Pathology Press
The Histology department at
Wycombe Hospital has re-
cently taken ownership of
the next generation of OS-
NA (one step nucleic acid
amplification) analyser.
This is used to test sentinel
lymph nodes from breast
cancer patients intra-
operatively in order to give
an accurate diagnosis of
tumour burden and provides
reliable information to stage
the disease and to aid thera-
py decisions. This new ana-
lyser has a larger capacity
than the original and so is
now to be used for non-
urgent sample analysis too,
enabling more patients to
benefit. Wycombe hospital was the first
laboratory in the country to go
“live” with this technology.
Please use ICE for Cellular Pathology requests!
Laboratory Handbook on ICE
Page 5
Volume 1, Issue 1
OSNA RD210
Osna RD210
Only about 7% of the Trust is
making use of ICE for Cellular
Pathology requests.
Benefits of ICE requesting
include:
The pathology request details to
be recorded on the patient rec-
ord.
The pathology request and/or
specimen details to be updated
after they have been sent.
Immediate access to patient
results.
The ability to view outstanding
pathology requests.
There is an improvement in data quali-
ty as the patient record is more up-to-
date, presenting the Clinician with the
patient’s full diagnostic pathology
history for review if required.
It provides context-based diagnostic
advice and prompts the GP to provide
pertinent clinical information that may
affect the interpretation or selection of
Diagnostic Tests.
ICE supports the efficient management
of patients with long term conditions
requiring repeated diagnostic monitor-
ing into the future.
It significantly reduces the time taken
to register a diagnostic request onto
the Laboratory Information System
There is no longer a need to re-key/
write out demographic data for each
test request thereby avoiding the old
transcriptional /legibility issues asso-
ciated with paper request forms.
There is a reduction/cessation of
ordering duplicate test requests.
A reduction in errors and mismatch-
es when the result is received in the
clinical system.
It reduces the need to chase results
from the laboratory.
Biochemistry Handbook
Biochemistry
Haematology
Immunology
The cytology department has seen
an increase in Cervical Screening
workload since the beginning of
the year which has impacted on
Cervical Screening turn around
times.
An increase in numbers is always
seen in the first 3 months of any
year but this year, possibly due to
the national promotion to
encourage women who have
defaulted form having their sam-
ples taken over the years, to
come forward and take part in the
cervical screening programme
again.
This number of incoming samples
is beginning to drop again but
sample takers are encouraged to try
to ensure women to take part in
screening when invitation letters are
sent to the from the Screening
Programme.
Page 6
Volume 1, Issue 1
Cervical Screening
Osna RD210
Page 7
Volume 1, Issue 1
Extract from: The Biomedical Scientist
As a consequence the
waiting time for a patient
to have blood taken has
increased significantly
due to space and staffing
pressures.
There has been a signifi-
cant increase in the num-
ber of GP patients attend-
ing the Phlebotomy Clin-
ics at Amersham, Stoke
Mandeville and Wycombe
Hospitals in the past
year, with an average of
30 extra patients being
bled a day per site in
2018 compared to 2017.
Osna RD210
Page 8
Volume 1, Issue 1
Phlebotomy Services
New analyser for Catecholamines
New analyser for Catecholamines
Measurements of catecholamines are used
in the diagnosis of neuroendocrine tumours.
These include pheochromocytomas, para-
gangliomas and neuroblastomas.
The Blood Sciences department has recently
upgraded their HPLC system for urine Cate-
cholamine analysis. This will provide im-
proved performance and reliability of the
analysis. We are in the process of setting up
and verifying the performance. Results will be
available from this system in May 2018.
From a laboratory perspective the modern equip-
ment is easier to use, enabling more of the Bio-
medical Scientist to be trained in this analytical
procedure. We will also be able to develop the
system to measure Metanephrines.
Orders can still be telephoned
through and left on the answer
machine 01296 315 333
The office is open 11:30-13:00
Monday to Friday
Orders will be dispatched with-
in 48 hrs of receipt.
There is now a new improved
way of ordering your pathology
consumables from Stoke
Mandeville Hospital.
The current system is to fax
your orders but this is now an
outdated/unsecure method.
Could all order forms now be
sent via email to :
Osna RD210
Page 9
Volume 1, Issue 1
Pathology Consumables Ordering from SMH
Major Haemorrhage Bleep
SMH
BLEEP
784
WYC
BLEEP
3702
Please use the below bleeps for the correct hospital when there is a major haemorrhage. The department will then
contact you for more information
N.K. a Phlebotomist in SMH has re-
ceived an accolade for “Reassuring,
calm, pleasant, and able to handle a
prolonged telephone query from a
consultant without impatience,
cleared matter up whilst knowing
there were nearly 30 patients waiting.
She was working alone without any
assistance and managed to have a
kindly greeting for all.” - nominated
by patient
H.B. in Mortuary has received an
accolade.
Certificate of Merit awarded to K.C
and C.S. by Aspire for the huge
amount of work they did during the
SI investigation and compilation of
information.
S.H. andA.D. received thanks from
the Trust’s Information of Govern-
ance Department for the huge amount
of work they have done on the
Pathology Audit.
F.P,. assisted the coagulation nurses
with research ‘collecting patient sam-
ples for an APML drug trial’ and has
received a commendation.
Osna RD210
Page 10
Volume 1, Issue 1
GP Survey
Accolades
Excellence reporting
Serology and Microbiology team no longer have to input data manually, nor do they have to produce paper re-ports.”
Many thanks to all who completed
the GP survey. The results have
been published .
One of the comments that kept
arising regarded staff unaware of
where to find the handbooks, please
see a screen shot on page 5 of this
newsletter.
We are always looking at ways in
which we can improve our service
so the more of you that complete
these surveys the better for patient
care.
Please see embedded a copy of
the GP survey results. If you can-
not view these please contact the
Microbiology secretaries on SMH
5322 or email them on:
Pathology Department Contact Details
Bucks Healthcare NHS Trust
Lead Clinician for Pathology Dr Steve Corrigan - 01494 42 5202 Pathology Service Manager Gladys Lawson - 01296 31 5346 Blood Science Department Dr Surreshni DeFonseka, Consultant Clinical Biochemist - 01296 31 5353 Ian Heins, Head Biomedical Scientist - 01296 31 5355 General Biochemistry Laboratory Enquiries - 01296 31 5354 Biochemistry Secretaries - 01296 31 5357 Haematology & Blood Transfusion Department Dr Helen Eagleton, Lead Consultant Haematology- 01296 31 5512 Estelle Cawley, Operations Manager, Clinical Haematology - 01296 31 5195 Katy Cotton, Lead Biomedical Scientist, Haematology & Blood Transfusion - 01296 31 5627 Donna Beckford-Smith, Transfusion Practitioner, CCHU - 01296 31 5359/5513 General Haematology Laboratory Enquires - 01296 31 5452 Haematology Secretaries - 01296 31 6053 Microbiology & Serology Department Dave Pritchard, Head BMS, Microbiology - 01296 31 6392 General Microbiology Laboratory Enquires - 01296 31 31 5321 Microbiology Secretaries - 01296 31 5322 General Serology Laboratory Enquires - 01296 31 31 5232 Cellular Pathology Department Dr Steve Corrigan, Lead Consultant Histopathology - 01494 42 5202 Gail Bell, Head BMS Cellular Pathology/Cytology - 01494 42 6054 Fiona Hogg, Lead BMS, Cellular Pathology - 01494 42 5106 Cytology Laboratory Enquires - 01494 42 6405 Cytology Secretaries - 01494 425 399 Histology Laboratory Enquires - 01494 42 5106 Histology Secretaries - 01494 42 5105 Pathology IT Manager Dave Green, Pathology systems Manager - 01296 31 5013 Pathology Quality Contact Claire Stinchcombe, Senior BMS Quality Manager - 01296 31 5355 Specimen Reception - 01296 31 5591 Pathology Supplies/Consumables SMH - 01296 31 5333 WYC - 01494 42 5248 Mortuary SMH - 01296 31 5381
Laboratory Opening Times
Cellular Pathology - Routine Hours 09:00 - 17:00
Blood Science - Routine Hours 08:00 - 18: 00.
Microbiology - Routine Hours 09800 - 20:00
Pathology IT - 09:00 - 17:00
Mortuary/Bereavement - Routine Hours 08:30 - 16:00
Outside of these times there is an on-call service in
operation for Biochemistry, Haematology, Mortuary and
Microbiology departments. Contact them on-call staff via
BHT Switchboard on ext. 0 (or 01296 315000 externally)
