Pathology

Overview

Laboratory Medicine (also known as Pathology) is at the heart of modern medicine, it is estimated that 70% of clinical decisions rely to some degree on pathology.

As an average there are about 14 pathology tests per person per year in the UK (obviously some people will have none and others will have very high number indeed).

Last year the Pathology Department here received more than 1,000,000 specimens from the Trust and GPs. Each specimen request has on average five tests, giving an annual total of more than 5,000,000 tests.

Presently there are over 80 members of the Pathology Department including: Medical Laboratory Assistants, Assistant Practitioners, Mortuary Technicians, Biomedical Scientists, Clinical Scientists, and Consultant Pathologists.

Laboratory Medicine (Pathology) is based in a purpose designed building on Fountain Street roughly opposite the Ladysmith Building; the Mortuary is situated immediately adjacent

The following services are provided on site: Biochemistry, Haematology, Blood Transfusion, Point of Care Testing, Mortuary and Bereavement Services.

Microbiology is provided by Central Manchester University Hospitals NHS Foundation Trust, their website is: http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-partnership

Cellular Pathology is provided by University Hospital of South Manchester NHS Foundation Trust, their website is: https://www.uhsm.nhs.uk/services/pathology/#cellular-pathology

What would medicine be like without pathology?

Medicine would look very different without pathology; a lot of what we take for granted would not be possible.

There would be no blood transfusions, this would make surgery and childbirth very dangerous, some operations would not be possible and the mortality rate in childbirth would approach that of under-developed countries

Heart attack? This could only be diagnosed symptomatically, the current best methods for detecting heart attacks (after the event) use the detection of minute amounts of substances in your blood stream.

Leukaemia could not be diagnosed, people would just be unwell and then potentially die without any treatment.

Diabetes would be almost untreatable as we wouldn’t be able to measure blood sugar levels accurately and would certainly be unable to track glycosylated haemoglobin (HbA1c) which is used to track control of blood sugar over a longer period.

Got an infection? No way to discover what the organism is and what antibiotics it is sensitive to would lead to doctors guessing what antibiotic to give leading to antibiotic resistance being present in the majority of bacteria, people would die as a result of minor injuries or infections. Surgery would be undertaken only as a last resort.

Got a strange lump somewhere? Without histology it would be impossible to diagnose precisely what cancer it is and how best to treat it.

In many ways, without pathology, medicine would be back to the middle ages!

Provision of Results

We do not provide the results of investigations directly to patients. This is for a number of reasons:

  1. It is counter to professional best practice - https://www.ibms.org/resources/documents/giving-results-over-the-telephone/
  2. We cannot positively identify that we are speaking to the patient or another person. This would constitute a breach of confidentiality and of data protection legislation
  3. Patients do not necessarily have the knowledge to interpret results
  4. Results may need to be explained to patients, particularly if the testing is complex, we cannot do this as we do not have the full clinical history of the patient
  5. We need to phone urgent results for seriously ill in-patients to Intensive Care, Neonatal Intensive Care etc. We can’t do this if our lines are tied up with calls that we should not be receiving

If you are concerned about a result, please contact your GP or the consultant who requested the test to be done.

Some general practitioners do allow patients to access their own results, this is not something that the pathology department have any control over; you will need to speak to your GP.

Turnaround Times for tests to be done

Most routine tests will usually be done on the same day with the results being transmitted electronically to either the GP Practice or the hospital Electronic Patient Record where it can be seen by the clinicians involved in your care

More specialised tests can take considerably longer as they may have to be referred to another hospital and may be very complex to carry out. We provide a list of turnaround times in our lab handbook which is available to clinicians and also in our Documents section.

Cellular Pathology (histology and cytology) takes longer than routine biochemistry and haematology because the process has many manual steps and the individual processes take more time. As a general guide, most cellular pathology reporting will take a minimum of one week.

Microbiology reports also take longer than routine biochemistry and haematology because of the time required to grow, select and test the bacteria that may (or may not) be present in the sample. In general 90% of the work sent to microbiology is reported within six days, some tests can take significantly longer though.

I’d like to know more about the test(s) I’ve just had?

The best site that we know of is:

Lab Tests Online – Accurate, independent, unbiased, patient centred information generated by professionals for the public.

Contact us

Postal address

Department of Laboratory Medicine Tameside General Hospital Fountain Street Ashton under Lyne OL6 9RW

Telephone

If calling from outside the hospital dial (0161) 922 followed by the extension number:

 

Extension

Laboratory Reception / Enquiries

6393

Bereavement Office

5192

Please remember that we will not give results directly to patients under any circumstances. You must contact your GP or consultant (via their secretary) for this information

 Departments within Laboratory Medicine

Biochemistry

Biochemistry is concerned with the measurement of chemicals in the blood, this may be the U&E you hear about on TV; we do about 130000 U&E a year (356 a day(, most are done in under an hour from us receiving them, to very specific measurements of hormones and medicines used to treat certain conditions.

The department runs a number of analysers to process all the work that is done all our critical machines are duplicated so that we can run without interruption to our service even when a machine is down for cleaning and servicing or has failed, much of the time though all our machines are in use to get through the work.

Biochemistry is a 24/7/365 service, it never closes, there is always a Biomedical Scientist qualified in Biochemistry on-site.

Blood Transfusion

Blood Transfusion are concerned with testing blood in cases where a transfusion is or may be required and the provision of blood components such as red cells, plasma and platelets. It is critical for some of these components that they exactly match with the recipient to avoid the possibility of transfusion reactions.

The operation of the transfusion department is governed by the ‘Blood Safety and Quality Regulations 2005’ which places very strict controls on how it operates.

Blood Transfusion is a 24/7/365 service, it never closes, there is always a qualified Biomedical Scientist on-site

Haematology

Haematology is mainly concerned with the cellular components of blood and the clotting of blood. The basic test is the Full Blood Count (FBC); these are done on a pair of automated analysers; we do about 261,000 FBCs a year (about 700 a day) we also provide anticoagulant clinics in the community for patients who are on Warfarin or similar medicines to ensure that their treatment is safe and effective.

Point of Care testing

The laboratory leads the Point of Care Testing service (POCT) within the Trust, these includes instruments for near patient testing for blood glucose, blood pH and Oxygen levels and urine testing.

What is Point of Care Testing (POCT)?

Very simply it is testing done at the bedside or in the ward, not in the laboratory

Why isn’t everything done as POCT?

There are a number of reasons:

  • Price, a POCT test costs significantly more to do than the same test in the lab.
  • Speed, our big analysers in the lab can handle thousands of tests per hour
  • Accuracy, the analysers in the laboratory are very accurately calibrated and quality controls are run every few hours to ensure the accuracy of your result
  • Capability, no POCT system can handle all the different things a laboratory based analyser can

If all the above is true, why do we have POCT?

Sometimes results are needed very quickly to make a difference to the care given to patients and the time taken to get the sample to the lab and analysed would be too long.

 

Mortuary and Bereavement

The mortuary provides a comprehensive service to the Trust and to Tameside district and surrounding areas. It is the public mortuary for the local area and carries out post-mortem examinations on behalf of the coroner; We do not perform hospital post-mortems at this Trust. The mortuary is licensed by the Human Tissue Authority the scope of the license can be viewed here: https://www.hta.gov.uk/establishments/tameside-general-hospital-12067

The Bereavement Office provide support to the mortuary and the families of the deceased by liaising with the doctors who cared for the deceased, the Coroner and others to ensure that death certificates are signed off as quickly as possible to allow for the burial or cremation of the deceased to take place.

Quality Management

The Blood Sciences department is accredited to the standards set down by Clinical Pathology Accreditation UK and is moving to ISO 15189:2012 – Medical laboratories – Requirements for quality and competence

The Mortuary is licensed by the Human Tissue Authority according to its standards.

The Quality Manager provides the lead on our Quality Management System and provides advice and support to all areas of the department of laboratory medicine in maintaining their Quality Management Systems and to continuously improving the quality of the service that they provide.

Externally provided services

 

Microbiology

The Microbiology service was transferred to Central Manchester University Hospitals NHS Foundation Trust at the end of 2016. Medical staff were not part of the transfer and remain on site to advise their colleagues on treatment of infectious disease, antibiotic prescribing and infection control.

The website for the service is: http://www.cmft.nhs.uk/info-for-health-professionals/laboratory-medicine/manchester-medical-microbiology-partnership

Cellular Pathology

The Cellular Pathology service was transferred to University Hospital of South Manchester NHS Foundation Trust in August 2014.

The service provided includes Histology, Cytology and Andrology. (Cervical Screening is provided by Central Manchester University Hospitals NHS Foundation Trust).

The website for the service is: https://www.uhsm.nhs.uk/services/pathology/#cellular-pathology

 Staff Types within Pathology

Medical Laboratory Assistants (MLA)

These staff perform a very important role in sorting the incoming work, booking it on to our computer system and assisting more senior staff with their work, these staff are at Agenda for Change Band 2 or 3. A good general education is required but just as important is having the right attitude and aptitude for the job. MLA staff can progress to become an Assistant Practitioner.

Assistant Practitioners (AP)

These staff take on more responsible duties such as the day to day running of the POCT service or line management of MLAs. The educational requirements are very similar to MLAs. At Tameside this role is paid at Agenda for Change Band 4.

Anatomic Pathology Technician

These staff deal not just with the deceased but a significant part is dealing with the families of those who have died at what is often a very difficult time for all concerned. As well as having the skills to assist with post-mortems they help relatives and liaise with the Coroner and Funeral Directors. Pay is at Band 2 and upwards depending on qualifications and experience. A good basic education is required; training is done on the job with some taught modules to gain the Level 3 Diploma from the Royal Society of Public Health in Anatomical Pathology Technology, then the Level 4 Diploma from the Royal Society of Public Health in Anatomical Pathology Technology and finally a Foundation Degree in Mortuary Science.

Biomedical Scientists (BMS)

These staff are the main component of the workforce, they take responsibility for the provision of results, running quality controls, performing internal audits and much more besides.

Career progression as a Biomedical Scientist requires the following steps:

  • Completion of a degree in Biomedical Sciences (this degree needs to be accredited by Institute of Biomedical Sciences otherwise it is very likely that ‘top-up’ modules will need to be completed)
  • Completion of the Registration Portfolio which is a laboratory based training and assessment programme; this take a minimum of one year. At this stage you can legally call yourself a Biomedical Scientist (but only if you are registered with the Health and Care Professions Council). At this stage most hospitals would pay at Agenda for Change Band 5
  • Completion of the Specialist Portfolio/Diploma. This entails more specialist training within a particular discipline such as Haematology or Biochemistry. This generally takes about two years. Once completed this would usually gain promotion to Band 6 on the Agenda for Change pay-scale.
  • After this it is possible to progress by gaining an MSc or by demonstrating capability above and beyond that which is expected at Band 6. This frequently involves taking on managerial duties. Pay is at Band 7 and upwards.

Clinical Scientists

A degree and specific training (NHS Scientist Training Programme). These posts are less laboratory oriented and more clinically oriented than Biomedical Scientist roles.

Consultant Pathologists

Training as per any other doctor with specialist training in e.g. Haematology, Microbiology etc.

Secretarial staff

An important part of the service, these staff arrange clinic appointments for patients, ensure clinical letters etc. go out on time and ensure that patient records are kept accurate and up-to-date.

Useful Links

Lab Tests Online – Accurate, patient centred information generated by professionals for the public

United Kingdom Accreditation Service – Medical Laboratory Accreditation UKAS are the accrediting body for medical laboratories; they assess the laboratory at regular intervals for compliance with the standard ISO 15189:2012 Medical laboratories – Requirements for quality and competence.

Medicines and Healthcare products Regulatory Agency – Blood Transfusion the MHRA regulate medicines and included within their remit is blood transfusion.

Human Tissue Authority – Mortuary licensing

Institute of Biomedical Science – The professional body for Biomedical Scientists

The Health and Care Professions Council – The regulatory body for Biomedical Scientists, Clinical Scientists and many other health and care professions

Royal Society for Public Health – The professional body for Anatomic Pathology Technicians

Royal College of Pathologists – The professional body for Clinical Scientists and Consultant Pathologists

The General Medical Council – The regulatory body for Medical staff

Documents

Pathology User Guide

Pathology Specimen Packaging and Transport

Pathology Specimen Guide

External Links