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​News and Updates

​We send out news and updates relevant to GPs via the Dorset CCG's weekly email bulletin, but you can also find the information issued here.

We have also started sending a regular e-bulletin with a supporting video to GP practices directly. If you don't receive these and would like to be added to our distribution list please email communications@dchft.nhs.uk​

DCH Diagnostic Imaging Referrer Survey

The Dorset County Hospital Diagnostic Imaging department would like feedback from referrers to the department.

Please could you find time to complete this short survey online, your comments and answers will be invaluable in helping us to develop the service: https://www.surveymonkey.co.uk/r/J3JMQKR​​

Linda Chappell
Operational Superintendent Radiographer
01305 255128
linda.chappell@dchft.nhs.uk​​

 

Vitamin D, TFTs, A1c and ESR

1)    There has been considerable increase in requests for vitamin D a significant proportion of which are not appropriate and this is impacting adversely on the service.

I recognise the plausible expansive role of vitamin D in general health and wellbeing but the real evidence is in bone health and those with CKD. There is  no recommendation from any guidelines for routine vitamin D testing in asymptomatic individuals and requests for Vitamin D should be limited to the small cohort of patients.

Vitamin D deficiency is common and could affect as much as 40% of the population. One could then argue that giving supplementation to those at risk is a more pragmatic approach which should abolish the need for routine/repetitive testing. 

In the same vein, even in the high risk cohorts, indiscriminate repeated frequent testing is also not in line with best practice and it should be avoided.

2)    We are also experiencing indiscriminate requests for TFTs which currently comprise of both TSH and FT4. As you know, symptoms of thyroid disease are incredibly non -specific and it is therefore no surprises that in the vast majority, TFT results are unremarkable.

In the main, TSH remains the best and in the vast majority, the only biochemical test for screening those with suspected thyroid disease. Also, for the purpose of monitoring those on thyroxine replacement, again TSH remains the most robust test for assessment of adequate replacement or, the need for dose adjustment. Measurement of FT4 is paradoxically unnecessary and rarely add any additional clinical value. Overall there is therefore no need to request for more than TSH in most clinical settings. The laboratory will add FT4 as a reflex test if necessary.

In the odd patients, for example, those with pituitary disease with possibly secondary hypothyroidism, we will suggest initial discussion with the endocrinologists who may then consider further specialist investigations.

The only exception is pregnant patients with either known or suspected thyroid disease where both TSH and FT4 would be indicated and should still be requested but this cohort would ideally be under the care of the endocrinologists.

3)    We have also reviewed requests for A1c in the last year. I acknowledge that A1c has been endorsed a screening test for diabetes in view of some of the advantages. However, there are significant issues with sensitivity which requesting clinicians need to be aware of. In order to put this into some perspectives, only about 45% of patients with diabetes would be detected through A1c testing at the recommended diagnostic threshold of > 48 mmol/mol. This is obviously a concern and therefore, where ever possible, traditional testing with fasting plasma glucose remains the superior screening test for diabetes. A1c still remains the test for monitoring diabetic patients in the vast majority.

All these changes will come into effect from 1 October 2018 but please do not hesitate to contact me if you have any questions.

Dr Rasaq Olufadi
Consultant Chemical Pathologist
rasaq.olufadi@dchft.nhs.uk


 

DCH Pathology New Style Sample Bags

The Pathology Department is going to be changing the style of sample bags they will be supplying to users.

The current two part bag will be replaced by one that is intended to be attached directly to the request form. The request form will no longer have a separate part of the bag. The use of red bags will be discontinued.

The bag comes with instructions. When the current stock of old style bags expires you will be supplied with the new style. Blood Transfusion will continue using their current bags because of the labelling requirements for these samples.

Histopathology / Non-Gynae Cytology Specimens: Histopathology will provide two types of specimen bag; a large white bag for specimens transported within white formalin buckets and a smaller clear bag for the orange/white-topped prefilled formalin pots.

Please follow packaging instructions noted on the specimen bags, affixing addressograph labels to both the request form and specimen pot.  The large white bag will require the request form to be placed into a clear bag and placed inside with the specimen pot, whereas the clear specimen bag provides a pocket for the specimen request form.  Please ensure specimen bags are sealed to avoid the request form and pot becoming separated.  Should a specimen bucket be too large for the white specimen bag, please place the specimen request form into a clear bag and fix to the top of the labelled specimen bucket for transport.  

NB:  Please send specimens for Histopathology separately from Non-gynae Cytology specimens; providing individual request forms for both sample types.

Finally, please note that this change does not alter any of the labelling requirements for both samples and request forms.

If you have any comments or questions please contact me on the details below.​

Paul Davies
Pathology Services Manager and Head of Microbiology
01305 254344
paul.davies@dchft.nhs.uk


 

DCHFT eRS Fracture Clinic​

DCHFT eRS Fracture Clinic RAS will be published on Monday 3 September 2018. For the initial 2 weeks DCHFT will continue to accept and book GP referrals to the fracture clinic that have been made via Fax, but will notify the practice of the availability of the Fracture clinic RAS. From Monday 17 September 2018 referrals received from GPs via Fax will not be accepted and will be returned to the referrer in line with the paper switch off returns process.​

Kirsty Owen
Service Improvement Delivery Manager
Patient Access & Administration​
kirsty.owen@dchft.nhs.uk


 

DCH Rheumatology Department Contact Numbers

Please be advised that some changes have been made to the contact numbers and telephone service provided by the Rheumatology Department at Dorset County Hospital. There will now be two phone lines into the department as below:

Secretarial Team: 01305 253753

Clinical Advice Line: 01305 255864

The clinical advice line is now an answerphone service which will be responded to by the clinical team as soon as possible. The patient will receive a return call or a letter if more appropriate. At this time, we do not have the appropriate staff to answer the calls live. Patients will be informed of the advice line number at their appointment, if appropriate, and be provided with an information leaflet on the service.

We apologise for any difficulties that have occurred in contacting the department over the past few months. We are hopeful that the above changes will resolve this.​

Michelle Taylor
Interim Business Manager - ENT & Rheumatology
01305 254827
Michelle.taylor@dchft.nhs.uk


 

Lyme Serology

The DCH microbiology department is changing its testing algorithms for Lyme disease, to align with recently published NICE guidelines NG95.

As you will know, Dorset is an area with increased prevalence of Lyme disease, and the NICE guidelines are worth a read. They highlight the need for awareness of Lyme disease and tick precautions, when to test, and new guidance on treatment (Recommended treatment duration for early Lyme is 21 days). See https://www.nice.org.uk/guidance/ng95

Of note, NICE do not recommend performing Lyme serology when erythema migrans (EM) is suspected; EM should instead be diagnosed clinically and treated without delay. See attached images for a clinical reminder. The rash is usually visible 1 to 4 weeks after the bite (range 3 days to 3 months). A rash developing within 48h of a bite is unlikely to be EM.

Serology is unhelpful for diagnosing erythema migrans because antibodies can take up to 2 months to develop in Lyme infection, and EM typically occurs early in Lyme disease when antibodies are often negative. Early testing is therefore wasteful and potentially misleading. The microbiology department will no longer perform serology testing in this scenario.

On the other hand, serology is indicated when later stage Lyme disease is suspected, such as focal Lyme disease (eg. suspected neuroborreliosis, Lyme carditis, uveitis or arthritis), or systemic/disseminated Lyme disease. Antibodies are usually positive by this stage in disease. Positive results will be sent to PHE reference laboratory for confirmation by immunoblots. As a reminder, Lyme disease is an uncommon but possible cause of the following symptoms, particularly if several are present:

  • fever and sweats

  • swollen glands

  • malaise

  • fatigue

  • neck pain or stiffness

  • migratory joint or muscle aches and pain

  • cognitive impairment, such as memory problems and difficulty concentrating

  • headache

  • paraesthesia.

Please include clinical details, date of onset of symptoms and date of tick bite/ exposure if known, to ensure we test appropriately.

Dr Cathy Jeppesen
Consultant Microbiologist
Clinical Lead for Microbiology​
01305 254340
catherine.jeppesen@dchft.nhs.uk


 

DCH Critical Care Follow-up Clinic

Critical Care at DCH now runs follow-up clinics for anyone who has been admitted to our Unit for 2 days or more. Research shows that people who survive a critical illness may experience a variety of physical and psychological symptoms as they recover.

If you have a patient who might benefit, please:

  • Tell them that they are welcome to attend

  • Give them our telephone number and ask them to ring, or ring us yourself, or ask any of your colleagues to ring – our number is 

01305 255596 and ask for Julia Terry

  • Ring this number yourself if you would like more information

  • Reassure your patient that they are not alone – many people believe that they are not 'trying hard enough to recover' and should just 'pull themselves together'. We encourage people to talk about their experience, in a safe setting, with clinical staff who understand the impact of critical illness. Most people will bring with them a family member or friend – keeping watch at a bedside can be more traumatic than being a patient.

Critical Care Bereavement Service
Sadly, many people do not survive a critical illness. If you have a family who are struggling to deal with the death of someone in Critical Care at DCH please contact us in exactly the same way. We will get in touch with the family and arrange an appointment at a time that suits them.

Julia Terry
Ward Clerk
DCH Critical Care Unit
01305 255596​


 

New DCH One Stop Emergency Surgical Ambulatory Care Service - ESAC

From 1 July 2018 the Surgical Assessment Unit and Hot Clinic services at Dorset County Hospital are merging to become a new, one stop Emergency Surgical Ambulatory care service, named ESAC.

Currently, our SAU service is managed by existing staff and our Hot Clinic service is managed by our ward clerk. We need to merge the services to take back some control of how the service is utilised by the various specialities.

Referrals will still be made in the same way at present, directly to the on call Registrar via switchboard. We ask you to use your clinical judgement at the point of referral, to decide whether the patient requires assessment on the same day, or if they can be booked in to be seen within the next 48 hours.

We currently cover General Surgery, Gynaecology, ENT and Urology specialities and our service runs from 10am to 6pm, Monday to Friday. We ask that any patients that require a same day assessment are made aware that they need to attend ESAC on Abbotsbury Ward within 2 hours of referral, ideally 1 hour, to avoid delays. We currently do not take same day referrals after 3pm as there is not enough time resource to assess and treat the patient.  Outside of these hours, the usual referral process is to be followed for emergencies via ED.

When considering a patient for ESAC bear in mind that we carry the slogan "fit to sit". If you believe the patient is at high risk of rapid deterioration, then ESAC is not the appropriate place for these patients.  These patients should be directed to the emergency department. The ESAC area will consist of 4 assessment chairs and a minor procedure room.

Patients will have a one stop service that will aim to diagnose, plan, treat and follow up, which in turn avoids admission to hospital, and will improve patient experience.

Please note this will not affect our current vascular service.

If you would like to know more, please contact Matron for Surgery Miles Tompkins on 01305 255414 or Nurse Lead for ESAC Stacey Smith on 01305 254123.​


 

Breathlessness Groups for Cancer Patients

Macmillan therapy team are running weekly breathlessness groups. The first session is one and a half hours to educate the patients on pacing, pursed lip breathing, positions of ease and the calming hand. They are then followed up a week later with a telephone call to answer any questions or give further advice if needed. All patients are welcome provided they have a diagnosis of cancer and breathlessness limits their daily function. It does not matter where in the cancer journey the patient is.

The group runs each Wednesday from 11am to 12.30pm in the West Annex meeting room, West Annex building, Damers Road (former Damers School site next to main hospital).

Please send details of the patients to macmillantherapies@dchft.nhs.uk Any queries call 07880474393.​

DCH Paediatric Rapid Access Referrals

A reminder that if you would like a child to be seen within Dorset County Hospital's rapid access clinic (within 2 weeks) you must discuss this with the on-call registrar or consultant before sending the request through in case the child needs to be seen that day. You can contact the on-call team on 01305 251150, Bleep 523. All other clinic requests will be arranged in the usual way through central appointments.​

Atrial Fibrillation Clinic Referrals

Dorset County Hospital moved over to ICE referrals for the Atrial Fibrillation Clinic last year.  With this system the ECGs need to be emailed through to the arrhythmia nurse email:  ArrhythmiaNurseSpeci@dchft.nhs.uk or faxed over to 01305 254457 and there is a box on the electronic form to confirm that this has been done. Please ensure that the ECG is sent at the same time as the ICE referral into the AF clinic is made to avoid any delays in scheduling patient appointments.​

Kay Elliott
Arrhythmia Nurse Specialist
Dorset County Hospital
01305 254920
kay.elliott@dchft.nhs.uk


Blood Specimens

We are receiving an increase in blood specimens being sent to pathology at Dorset County Hospital with collection needles in the specimen bags. This poses the risk of needle stick injury to our staff and the transport drivers.

Please would you remind all your staff taking blood to dispose of sharps /collection needles in the appropriate sharps containers at the collection point and not to forward with the blood specimens.

Thank you in advance for your support in this matter.

Sharon Wood
Pathology Quality Manager
Dorset County Hospital
01305 254326
sharon.wood@dchft.nhs.uk


X-ray Requests

We are continuously improving our electronic requesting systems here at Dorset County Hospital and we are hoping to reduce the number of paper requests we process.

We are currently looking at how we book and process general X-Ray requests (not CT, MRI, Fluoroscopy, Nuclear Medicine or Ultrasound).

By reducing the paper processing time (and sending out letters) we can speed up the time it takes to get the patient the imaging test requested.

When an electronic (ICE) request is placed by the referrer it arrives in our Radiology Information System (RIS) within seconds. When the patient arrives in our department the request is already here waiting to be processed. We offer an open access service for general x-ray requests at DCH and Weymouth or alternatively the patient can ring Bridport or Blandford for an appointment and we can access the request.

We are still also receiving a number of paper copies of ICE requests in the post and faxed copies of ICE requests. This is unnecessary. These requests are already available on our system in the X-ray departments.

Because we do not know why the forms are being sent/faxed to us our admin teams are sending letters to the patients asking them to come for an X-ray or to ring a Community Site for an appointment. By the time the form has been posted to us and then we post a letter to the patient a week or more has passed.

To reduce this time:

Please always tell the patient to come for an X-ray (and when if it is for a follow-up in the future). Give them the X-ray form if you wish. If you are unable to give the X-ray form directly to the patient or see the patient directly please do not send the form in to our Appointments Team. Please contact the patient and inform them of where and when they can have the X-ray. They can then turn up or ring to book an Appointment.

This will save postage and potentially a delay of up to a week before getting the imaging test done.

Please do use the ICE system to request all Radiology examinations this is faster and more efficient. If you are not able to request examinations on ICE please do contact us so access can be arranged.

Kate Lewins
Radiology Project Manager – Senior Radiographer
Diagnostic Imaging
Dorset County Hospital NHS Foundation Trust
01305 255221
kate.lewins@dchft.nhs.uk


Walk-in appointments at The Park Centre are changing

Our appointment system at The Park Centre for Sexual Health is changing. 

From 3 April 2018, our walk-in one stop clinics on Monday and Wednesday afternoons will be restricted to under 18 year olds.

Apart from this, no walk-in clinics will be available. Instead, we will be offering a same day appointment service.

Same day appointments can be booked from 08.15 am Monday to Friday, by calling 01305 762 682

Please note: same day appointments will be given on a first come, first serve basis. 

To book an appointment in advance, or to speak to a nurse for advice, call 0300 303 1948 between 09.00 am and 17.00 pm Monday to Friday.

www.sexualhealthdorset.org​​​


CA199 Test

Tumours markers have important roles especially in monitoring and prognostication but we must be aware of the limitations.

There are significant inherent issues with both sensitivity and specificity as levels are raised in a long list of benign as well as malignant conditions hence why it is generally not endorsed as a screening tool.

Specifically, CA199 has no role in asymptomatic or those with non- specific symptoms, a situation that is often encountered in Primary Care.

CA199 as a screening test is therefore not recommended. Even in those with suspicious symptoms, the positive predictive value for pancreatic cancer for raised CA 199 is less than <2%. One challenge is in the jaundiced patients where a raised CA199 is not uncommon and this is regardless of the cause of the jaundice.

There are other implications with false positives, including potential referral to secondary care, further sometime invasive investigations and avoidable patient anxiety. The problem is further compounded by false negative results as this may provide false reassurance; some patients with pancreatic cancer may indeed have a normal CA199.

In broad terms, the best chance of a cure is to identify suspected pancreatic cancer at the earliest or pre-malignant stage, for example, intraductal papillary mucinous neoplasia (IPMN) but CA 199 is almost invariably unremarkable and hence why it unlikely to be a helpful test in this cohort.

There is no validated biological marker yet that can detect pancreatic cancer at the earliest or curative stage when it is localised to the duct (< 2cm) hence the reliance on imaging for the small higher risk cohort of patients.

In suspected symptomatic cases of pancreatic cancer, for example, those with painless/cholestatic jaundice and/or significant weight loss, radiology or imaging is by far the more appropriate investigation. If there are concerns, or a suspicious lesion was to have been identified, then we recommend fast track referral to gastroenterologist/upper GI team.

In the light of these limitations, request for CA199 will no longer be available in Primary Care from 1 February 2018.

Please do not hesitate to contact me if you have any questions.

Dr Rasaq Olufadi
Consultant Chemical Pathologist
Dorset County Hospital NHS Foundation Trust​
rasaq.olufadi@dchft.nhs.uk


GPs and Specialist Practitioners Sought for Service at DCH

Dorset County Hospital in partnership with Dorset HealthCare and South West Ambulance Service will be providing additional urgent primary care bookable appointments at weekends and over bank holidays for patients registered with a Mid Dorset General practitioner.  The service will operate from Dorset County Hospital and will have a group of professionals working together to deliver the service. The Improving Access to General Practice Service is a primary care led service aimed at facilitating:

Improved access to general practice services – both pre-bookable and same day access for urgent care

Technology based access, including e-consultations

Care hub and locality integrated team development

Plans which increase system resilience and deliver care in partnership to improve outcomes for patients

We need bank GPs and specialist practitioners to help deliver the service. For further information or an informal discussion please contact Dr Hay Ming Blunt email: Hay-Ming.Blunt@dorset.nhs.uk  or Barbara Jenkins at Dorset County Hospital:  barbara.jenkins@dchft.nhs.uk  You can also find more information and apply via the DCH pages of NHS Jobs


Pathology Services User Survey Results

The Pathology Department at Dorset County Hospital would like to thank all who responded to our User Survey.

It was fantastic to have such a good response , 52 in total, with over half coming from the community, GPs, Practice Nurses and Practice Managers.

We have proactively reviewed all your comments, complaints, concerns and compliments.

Please click here​ to read the report where we have clarified misunderstandings around service provision and explained what we are in the process of implementing to address your issues and suggestions.  ​

Don't feel you need to wait for the next user survey to voice a concern or make a suggestion; we are keen to receive quality improvement ideas all year round.

Please contact the Pathology Quality Manager: sharon.wood@dchft.nhs.uk , Tel: 01305 254326 or any member of the Pathology Management Team, see our web pages for details: http://www.dchft.nhs.uk/gps/pathology-services/Pages/default.aspx


Electronic Ordering of CT Scans

Diagnostic Imaging at Dorset County Hospital has set up a new exam code that allows GPs to order CT scans electronically following a radiologist recommendation.  This function was requested by Weymouth and Portland locality.  We hope you will find it an improvement.

 

We also need to advise you that the radiologists do not see handwritten information that is added onto electronic requests.  The electronic request pre populates the Radiology Information System with the clinical information and the radiologists do not view the paper copy at all.

For any further information or assistance please do contact Sue Tree Radiology Manager on 01305 254165 or email susan.tree@dchft.nhs.uk.


Neurophysiology Service at DCH

The Neurophysiology service at DCH is supported by a visiting consultant from Poole. Unfortunately this service was temporarily suspended when the previous consultant left. We are now please to let you know Dr Anas Qureshi Consultant Neurophysiologist has joined the team and services are set to resume.

There has been growing demand for the service for some time currently reviewing our referral pathway to see how to our make best use of our resources and help progress patient more efficiently.

DCH is a small department offering a number of clinics, to make the best use of the resources here is a summary of the tests available and how access the service.

Peripheral Neurophysiology
This is a generic referral form, from which the patient will be assigned to a clinic best suited to the clinical question asked in the request. 

Referrals from here will be triaged into clinics for NCS or EMG.

A member of our team will then allocated the referral to the most appropriate clinic or advise you further if you request a test that is not currently offered from this department. Patient will be seen in either a consultant or practitioner clinic. When referring patients; please give details about symptoms, duration of onset and signs, especially wasting or weakness.  Patients with known diabetic neuropathy should be declared, as well as pacemaker patients.

Practitioner Clinics
We continue to offer practitioner led NCS clinic for the grading of CTS these clinics are most useful when considered as an aid to assist in grading severity.   These clinics either evaluate Carpal tunnel median nerve entrapment or Ulnar Nerve entrapment at the elbow.

When referring patients; please give details about symptoms, duration of onset and signs, especially wasting or weakness.  Patients with known diabetic neuropathy should be declared, as well as pacemaker patients.

Our report will give a simple yes/no answer and where changes are seen a grade is indicated.  If you have a more complex differential diagnosis or patient with known complex history, please complete use Peripheral Neurophysiology tool to submit the referral.

If you feel a patient needs both CTS and Ulnar evaluation it is better to referrer using the Peripheral Neurophysiology pathway and provide full referral details so we can assign the patient to the most appropriate clinic.

Referrals are made through the ICE system.  Referrals that don’t contain enough clinical information will be returned which may result in a delay for the patient. 

If you need advice please contact the department our practitioners are clinically based but will try to help where they can. You can contact us by email neurophysiology@dchft.nhs.uk or phone (01305) 255255. 

Allison Tate
Department Manager/ Highly Specialist Clinical Physiologist (Neurophysiology)
Department of Clinical Neurophysiology
Dorset County Hospital NHS Foundation Trust


PACS Transcription

We have become aware of a transcription issue with volume measurements in the Dorset County Hospital Radiology PACS. There are two issues that we need to alert you to:

1.       Any volumes using the notation format of cm3 are being displayed as cm?

2.       The  notation format for degree is also being displayed as ?

We have stopped using these notations but need to alert you to any previous reports that may contain the error.

Please do contact me if there are any clinical concerns that we can assist with.

Sue Tree
Radiology Manager
01305 254165
susan.tree@dchft.nhs.uk 


New Cardiac Electrophysiology Service at Dorset County Hospital

Dr Julian Boullin has recently started as a Consultant Cardiologist and Electrophysiologist at DCH, and will be providing a new Electrophysiology service.

He will run an arrhythmia clinic at Dorset County Hospital on Wednesday mornings.

Patients can now be listed directly for catheter ablation which Dr Boullin will undertake at The Royal Bournemouth Hospital.

He will also support the existing cardiac device service at Dorset County Hospital implanting pacemakers, defibrillators and CRTs.

Please refer patients with documented arrhythmias directly to Dr Boullin.

Our arrhythmia nurse specialists will continue to run the Rapid Access AF Clinic for patients with persistent AF. Any patients with troublesome symptoms from paroxysmal AF can be referred to Dr Boullin.

Dr Boullin would welcome any requests for arrhythmia related talks.

Dr Julian Boullin
Consultant Cardiologist & Electrophysiologist
Secretary: 01305 255114
Email:  julian.boullin@dchft.nhs.uk


New Access to Specialist Advice Service

Dorset County Hospital is launching a new service that offers specialist advice to primary care staff across the West Dorset Cluster.  The service is called Access to Specialist Advice.  The service is simple to use and will help you get advice quickly about your patients from hospital specialists.

Currently 4 specialities are available; Cardiology, Diabetes & Endocrinology, Paediatrics and Respiratory.  The email addresses to use are; DCH.Cardiology@dchft.nhs.uk, DCH.Diabetes@dchft.nhs.uk, DCH.Paediatrics@dchft.nhs.uk and DCH.Respiratory@dchft.nhs.uk.

Click here for a brief which details the service, how best to use it and also has some local case studies that demonstrate the benefits.

Paul Lewis MBE
Integration & Collaboration Programme Manager
01305 255770
paul.lewis@dchft.nhs.uk


Colorectal Pathway Update

A new pathway is being introduced for patients called the Proctology Service.  This is for any patient who has a benign ano-rectal condition requiring review by a colorectal surgeon e.g. pilonidal sinus, anal fistula, skin tags and non-bleeding fissures etc. 

This will be accessible on e-referrals as follows:-

    • Enter the Speciality called   - GI and Liver (medicine and surgery)

    • Then select clinic type         - Colorectal Surgery               

    • Then click on                      -  Proctology Service 

The Colorectal Telephone Assessment Clinic is unchanged and is for patients with colorectal symptoms or family history of colorectal cancer.  This is for routine and urgent referrals and has a waiting time of 2-3 weeks. 

This is accessible on e-referrals as follows:-

    • Enter the Speciality called      - GI and Liver (medicine and surgery)

    • Then select clinic type            - Colorectal Surgery

    • Then click on                          - Colorectal Telephone Assessment        

The Rectal Bleed Clinic is unchanged: a single direct access flexible sigmoidoscopy and treatment of haemorrhoids service based in Endoscopy.  The criteria for this have been updated in line with BSG guidance and are for rectal bleeding in patients 18-40 years.  For patients over 40years or those solely with change in bowel habit please referral to Colorectal Telephone Assessment.  There is no direct access to colonoscopy.

This is accessible on e-referrals as follows:-

    • Enter the Speciality called      - GI and Liver (medicine and surgery)

    • Then select clinic type            - Endoscopy  

    • Then click on                          - Rectal Bleed Clinic Service

There is a second referral pathway to the Rectal Bleed Clinic which is rarely used.  This will be closed at the end of the year.  Please follow the pathway above.

If you would like further information please contact Julie Lane, Colorectal Nurse Consultant on 01305 255273 or julie.lane@dchft.nhs.uk


Four Hour Limit for Special Coag Tests

Following Dorset County Hospital’s UKAS visit its lab has changed its policy regarding the maximum time after collection it is willing to accept samples for specialist coagulation testing.

In future all samples for Lupus anticoagulant testing, thrombophilia screening, Von Willibrand screening, anti Xa testing, factor assays, and platelet function tests  will need to be received and processed by the laboratory within 4 hours of collection. This is to comply with ICSH and UKAS recommendations.

This may mean that samples taken outside the hospital could be rejected if the transportation time is too long. It is therefore suggested that anyone considering asking for any of these tests, first contact the laboratory before bleeding the patient, so that arrangements can be made to bleed the patient on site.

Acceptance of non-specialist coagulation tests such as normal clotting screens and INRs is under review, though it is likely that current policy of accepting test up to 12 hours post sampling will continue. Verification of this is ongoing and a decision will be announced later.

If you have any queries, please contact Blood Sciences on 01305 254331


 

Making Best Use of Clinical Neurophysiology at Dorset County Hospital

Email: Neurophysiology@dchft.nhs.uk

Telephone numbers:  01305 255255

Clinical Information:
Please provide as much relevant clinical information as possible.  Patients are prioritised according to clinical need. Please can referrers include a correct bleep or contact number in case the referral requires further discussion. 

Inpatients:
If you require an inpatient study then please requests on ICE as soon as possible and phone the Neurophysiology on 5255 to confirm the referral. Referrals made after 1:00 PM may need to be considered the following day.  Occasionally we may need to cancel and reprioritise for a more urgent case. 

Urgent inpatient cases are prioritised on a daily basis and appointments being issued about an hour before the appointment unless additional planning is required.

Outpatients:
For urgent outpatients please ensure that patient contact numbers are correct so that we can offer these patients short notice appointment or cancellation slot.

Ambulatory EEG is a planned outpatient procedure. The procedure requires both the ambulatory recording equipment and staff availability. Appointments are prioritised on a clinical basis. 

All Nerve Conduction studies and EMG referrals are vetted and allocated by the Consultant Neurophysiologist.  This means all CTS and Ulnar referrals should be made via the Peripheral Neurophysiology option on ICE.

In the event of the clinical picture changing and a referral requiring to be escalated either resubmit an ICE request or email the department via Neurophysiology@dchft.nhs.uk with additional information so that the referral can be reviewed. 

Allison Tate
Department Manager/ Highly Specialist Clinical Physiologist (Neurophysiology)

Department of Clinical Neurophysiology
Dorset County Hospital NHS Foundation Trust
Allison.tate@dchft.nhs.uk                                           
01305 255255  


Diabetes Support Email for Clinicians

The diabetes consultants at Dorset County Hospital offer another line of support for clinicians involved in the care of people with diabetes.

For cases that are not urgent enough to need admission to hospital or a direct phone call there is now an option to use this email address Diabetes.Support@dchft.nhs.uk to obtain advice. The aim is to provide a response within 1 working day. Obviously, we would expect ‘routine’ queries or referrals to use the usual channels.

The diabetes.support email address will be covered by all of the diabetes consultants, on a rota. Consultant specific requests should still be sent to the relevant consultant’s email address.

Dr Andrew Macklin
Secretary: 01305 255738
Office: 01305 254885
Andrew.macklin@dchft.nhs.uk