Requests for Additional Examinations
Requests for additional examinations must be made as soon as possible, following the laboratory’s receipt of the specimen. These requests must be made by telephone to the reporting pathologist. Depending on the nature of the specimen, and the request made, be aware that it may not be possible to accommodate your request although every effort will be made to do so, if clinically relevant.
Clinical Advice and Interpretation
Clinical advice and interpretation is available via the multidisciplinary team meetings (MDTs), and from the reporting pathologist. If this pathologist is not available, other pathologists from the same specialty will provide this service.
Uncertainty of Results
Generally, no measurement or test is perfect and the imperfections give rise to errors of measurement which may subsequently affect the result. Consequently, the result of a measurement is only an approximation to the value of the measurand (thing that’s being measured) and is only complete when accompanied by a statement of the uncertainty of that approximation.
Measurement of Uncertainty is a parameter associated with the result of a measurement that characterises the dispersion of the values that could reasonably be attributed to the measurand. This allows the lab to estimate confidence in the results.
The majority of diagnostic services provided by Cellular Pathology are not numeric and therefore reports cannot be traced back or related to national or international standards of measurement.
Whilst we cannot always entirely quantify uncertainty, we should ensure we evaluate risks posed to patient and staff by carefully addressing all uncertainties where possible. We must demonstrate that actions are taken to reduce to a minimum, eliminate or take into account any uncertainty of measurement when interpreting results. The below sections summarises possible sources of uncertainties and mitigating actions to reduce the level of uncertainty and to ensure accuracy and precision of results.
Summarising areas where uncertainty of measurement could affect examination and results
Pre Examination
Patient preparation
Sample collection technique
Sample transport
Poor sample preparation
Sample storage
Examination
Calibration
Environmental conditions
Sample size
Reagents
Cross reactions
Combination with other results
Calculations
Poor External Quality Assurance (EQA) and Internal Quality Control (IQC) results
Post Examination
Calculations / Algorithms
Reference ranges
Interpretation
Mitigating Actions
- Complying with specimen acceptance criteria
- Maintenance and calibration of equipment in line with current ISO standards
- Robust training and on-going assessment of competence
- Full compliance with standard operating procedures
- Verification and validation of procedures
- Implementing IQC
- Robust EQA procedures
- Control of non-conformities
- Audit of pre, post and exam processes
- Equipment / reagents sourced from reputable suppliers
- Compliance with acceptance procedures for reagents and equipment including after breakdown, repair and calibration
- Pathologists / screeners / BMS staff seeking a second opinion
- Discussion of results at multidisciplinary team meetings
- Reference to published descriptions of pathology
- Dual reporting for some specimen types including HER2
Results of Tests
Results are available electronically on the Leeds Teaching Hospitals NHS Trust results server as soon as they are validated.
The Results Server website is available to authorised users.