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 most recent 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 email@example.com
Electronic Histology Requests
To all clinicians / personnel submitting specimen to the Histology / Non-Gynae Cytology Department at Dorset County Hospital.
When auditing the process of histology specimen requesting, the department of Histology have concluded that electronic requesting should be used consistently by all service users. Improving efficiency and accuracy of any clinical process is vital and as such processes should be in place to ensure such standards are met.
Therefore, with the support of our Lead Consultant Professor Satti, we ask that the move to ICE requesting for Histology is actioned at all departments across the Trust, with the printed ICE request sent to the lab with the specimen. Some justification behind this request is explained below:
Hand written request forms cause a multitude of issues within histology and have a variety of risks associated with them due to their very nature.
· They are often incomplete and illegible, causing specimens to be delayed when they are required to be sent back for corrections and possibly misinterpreted within the laboratory as a result.
· These forms require a substantially greater amount of time for the Histology department to process than electronic requests, therefore negatively impacting the result turnaround times and general efficiency of processing of your patients specimens. The Histology secretarial staff have to spend long periods of time hand transcribing lengthy clinical details and specimen descriptions from the hand written forms into the patient report, not to mention creating a significantly greater risk of error through the copy typing process as often they are difficult to read and therefore have an element of individual interpretation associated with them.
In contrast, ICE requesting poses none of these risks. All information is input into ICE by the originating clinician/clinical staff, this is then linked to a unique order number, which when entered into the Histology reporting system automatically populates all associated information into the report, circumnavigating any need for secretarial/laboratory input. Due to the automated nature of this process, the likelihood of errors is decreased and the severity of potential risks is greatly diminished.
Many departments already use this method of requesting very successfully, please do contact the department of Histology if you have any questions or concerns.
The IT department are also available if assistance with ICE training is required.
Acting Laboratory Manager / Head Biomedical Scientist
Histopathology, Dorset County Hospital, Dorchester
Phase 3 Cardiac Rehab in Blandford
Due to unforeseen circumstances, we will temporarily be unable to provide phase 3 Cardiac Rehabilitation in Blandford. I will be reviewing this monthly and update you accordingly when we are able to resume the service.
The Cardiac Rehabilitation team will continue to provide all of the alternative platforms and of course offer Blandford patients the option to attend other phase 3 groups where we provide a service in the surrounding area.
It is only phase 3 that is affected and the Cardiac Rehabilitation nurses will continue to provide all of the current follow up services.
Please do not hesitate to contact me if you have any concerns.
Dorset County Hospital
We are experiencing significant increases in requests for faecal calprotectin a significant proportion of which are inappropriate. A recent laboratory audit over a 2 year period showed that 40% of requests especially from primary care were deemed inappropriate and also at significant cost.
I acknowledge that calprotectin is a robust non -invasive stool test and in the main help to discriminate between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). The negative predictive value is quite high at 98% and a normal faecal calprotectin in symptomatic patients would suggest that inflammatory bowel disease (IBD) would be an unlikely diagnosis.
For investigative purposes, I must reiterate that faecal calprotectin has no place in those with known irritable bowel syndrome and clinical utility is therefore mainly where there is diagnostic uncertainty or as a way of assessing disease activity in patients with known IBD. Additionally the prevalence of IBD in primary care is generally low at around 3% and as a guide previously undiagnosed IBD is uncommon in the older cohort.
Therefore the utility of faecal calprotectin as a screening tool in those >50 years is questionable especially if we take into account the low pre-test probability for IBD in this cohort. Specifically faecal calprotectin would add little diagnostic value in this cohort and one could argue that those with persistent/recurrent lower gastrointestinal symptoms i.e. more than 6 weeks but with no red flag would be expected to be referred through the non-urgent route to the gastroenterologists for further assessment.
The pathway from the Dorset CCG is also clear that faecal calprotectin is largely indicated in those who are <45 years of age with persistent unexplained lower GI symptoms but with no red flags or suspicion of malignancy. These include anaemia, rectal bleeding, rectal or abdominal mass, unintentional weight loss and those with family history of bowel or ovarian cancer in which case they should be referred through the 2 week fast track route to the Colorectal Surgeons.
Therefore taken these factors into account and, with effect from 1 February 2020, the laboratory in Dorchester would no longer offer routinely faecal calprotectin as a diagnostic/screening test in those who are 50 years or older. I have discussed this with the gastroenterologists and they are also supportive of this change
Please do not hesitate to contact me if you have any questions in the meantime.
Dr Rasaq Olufadi
Consultant Chemical Pathologist
Pathology Users Survey Results
Thank you to all that responded, 25 in total, not only from the community GPs and Practice Managers but also the Nurse Practitioners. However the response was disappointing with only 13/60 surgeries participating. However some surgeries submitted responses from more than one staff member and from differing roles, giving us an insight into service perception from differing needs and requirements. Please click here to view the full results.
What you say can really make a difference to how we develop our service to meet your needs. Don't feel you need to wait for the next user survey to voice a suggestion - we are keen to receive quality improvement suggestions all year round. If you feel we are asking the wrong questions, please also feed this back, so we can improve our approach.
Please contact myself, the Pathology Quality Manager at firstname.lastname@example.org Tel: 01305 254326 or any member of the Pathology Management Team, see website for details http://www.dchft.nhs.uk/gps/pathology-services/Pages/default.aspx
Pathology Quality Manager
DCH Clinical Haematology Paper/Email Referrals
Firstly I would just like to say thank you for your help and understanding regarding our capacity issues (we appreciate the acknowledgement in many of your letters).
Again while working through our pathway we have noted that we still receive, weekly, between 10-20 paper/email referral letters to the Haematology Service which is outside of the agreed referral process for the Trust and also causes delays for the patients (especially if the letter is posted) and extra work for yourselves as the referrals are returned to you by central referrals for you to resubmit electronically.
What we ask of you:
- When referring a patient please send through agreed routes not as a paper referral.
- When using advice and guidance use ERS to make the referral once you have seen the response from the consultant advising you to refer.
- Please note a paper referral will not get a patient see quicker, if anything it has the potential to delay them getting seen.
Please be assured that the Team are continuing to do everything they can to reduce the waiting times and get patients into the system quicker.
Cancer Lead Manager
Service Manager – Integrated and Holistic Care Cancer, Haematology, Respiratory and End of Life
DCH Rheumatology Service on E-referrals
As of Friday 30 August 2019 the following services are no longer available on E-referrals as they have been unpublished:
Rheumatology Service – Blandford – Dorset County Hospital, including the service for Non Dorset Referrals
Rheumatology Service – Bridport – Dorset County Hospital, including the service for Non Dorset Referrals
Rheumatology Service – Yeatman – Dorset County Hospital, including the service for Non Dorset Referrals
These services have been unpublished as there is no longer a relevant outpatient clinic running at the community hospital locations.
Please continue to refer all non-red flag patients for Rheumatology via the MSK triage pathway.
Patient Access and Performance Directorate
Specimen Transportation to DCH
In August during a hot spell, we monitored the temperature within the specimen bags, from 2 of the outlying surgeries. It is snapshot but I believe we would have seen similar traces for most surgeries during that week, with the interior of the bags reaching temperatures between 28°C and 30°C.
Unlike the transportation of pharmaceuticals, there are no guidelines or scientific papers / literature establishing criteria /ranges for sample transportation. Fresh samples will start at 30°C - 37°C and then cool to the ambient temperature of the surroundings, which varies unless climate controlled.
Microbiology specimens not transported in preservative during periods of elevated temperature have the potential of the integrity being significantly altered giving false results, especially if combined with time delay.
Histopathology specimens are usually transported in fixative and therefore the integrity is maintained, however if not , during periods of elevated temperature have the potential of the integrity being significantly altered giving false results.
The integrity of Blood Science specimens maybe significantly altered in extremes of temperature especially if combined with time delay.
Specific instructions are given for cold agglutinins and andrology specimens which need to be kept at body temperature as for critical specimens which require transportation on ice. Details of which can be found on the Trust Website:
It is important that users are mindful of the effects of heat on samples, when interpreting results, of specimens collected, stored and transported in hot weather.
The following interventions maybe considered to minimise the effect on specimens:
- Improved storage conditions at the requestor site, refrigeration and controlled ambient temperature as appropriate to specimen type.
- Encouragement of centrifugation at requestor site (GP practices/community hospitals) in order to stabilise samples with gel separators.
- Lean pre-analytical processing and centrifugation at laboratory reception
- Ensure stabilisation of samples that require to be left overnight for analysis next day
- Temperature controlled holds in transport vans
- Improvements in sample transport – transport time and frequency of pick up
- Procurement of new insulated pathology medical bags, which in addition to compliance with packing instruction P650, maintain temperature for up to 6 hours by the requestor.
The most of the above is out of the control of Pathology; and we are regularly auditing and reviewing our processes to reduce risk to the sample integrity and factors which impact on the quality accuracy of the results.
The sample transportation provided by the Trust Transport department is commissioned by the CCG and the responsibility for the integrity of the samples until they reach the laboratory lies with the requestor. As does the responsibility for the safe transportation under the packing instruction P650 and the provision of transportation bags, unless stated otherwise in a service level agreement or contract.
I will be doing a similar snapshot audit in the autumn and also in the winter to get a feel for the norm and extremes.
Please can you share with your staff and ask them to be mindful of specimen storage and transportation conditions, especially when interpreting results, when experiencing extremes in weather conditions.
Pathology Quality Manager
Dorset County Hospital
Dorset County Hospital Gynaecology E-referrals Change
As of Friday 9 August 2019 the following service is no longer available on E-referrals as it has been unpublished:
Gynaecology General - Bridport - Dorset County Hospital
This service has been unpublished as there are currently no appointments available for General Gynaecology patients at Bridport Community Hospital. This will be reviewed in three months and an update provided.
The following services are still available to refer to via E-referrals for General Gynaecology:
Gynaecology General - Dorset County Hospital
Gynaecology General – Weymouth - Dorset County Hospital
Patient Access and Performance Directorate
Dorset County Hospital
DCH Private Patient Services
For information in case it is useful for your patients, Greenwood Private Patient Service at Dorset County Hospital is adding three new services for people wishing to use their private health care insurance or self-fund their treatment. These are 4D baby scans, varicose vein removal and a Sports Cardiology Clinic led by Dr Edwards, Consultant Cardiologist. Patients should contact our private patient team on 01305 254138 for more information.
Private Patient Office