Requesting of investigations and specimen acceptance policy

The Division of Laboratory Medicine (DLM) guidelines for specimen acceptance must be followed to ensure that all samples are correctly and unambiguously identified. The policy provides an overarching process to specimen rejection to help balance the requirement to process against the risk to patient safety. Clinical governance issues may arise from errors in specimen identification and/or insufficient clinical information being given with a specimen. To ensure that specimens are linked to the correct patient, adequate identifiers are essential. Due to the difficulty in repeating a tissue specimen, different criteria are used in Adult Histopathology.

All urgent and specimens on a cancer tracking pathway (HSC205) should be clearly labelled as such. The date and time the specimen was taken is important information that should be included on all requests to determine the length of fixation of the tissue specimen.

Specimen Acceptance Policy

All samples sent to Adult Histopathology must comply with our specimen acceptance requirements. All samples taken at an MFT location must be ordered through Hive. A printed request form must be sent to the laboratory with the sample so they can be matched and accepted by the department.

Samples sent from an External source must have an accompanying request card which lists all the essential patient identifiers.

The following mandatory information must be provided for us to accept the specimen:

Essential Patient Identifiers:

• Surname
• Forename
• NHS number
• Date of birth
• Address – for external locations

Essential Clinical Details:

• High risk status – to ensure health and safety of all staff
• Specimen site – must match on specimen pot and request card
• Relevant clinical information – to ensure all necessary investigations are performed, gestation date and LMP for gynaecological specimens
• Lung cancer – For any sample where there is a clinical concern for lung cancer (primary or metastatic), please ensure details of smoking (never/light smoker or current/ex-smoker) and performance status (WHO 0 1 2 3) are recorded on the request form in the clinical details section.
• Consent – fully completed PS1 form and gestation date or LMP for early pregnancy tissue specimens, with clear indication of cremation or burial wishes.
• Date/time taken – essential to ensure proper fixation of high risk specimens

Essential Sender Details:

• Ward/department – required for return of external reports
• Consultant or GP – required for return of external reports and contact in case of any errors/discrepancies
• Contact number/bleep – for frozen sections

Specimens that do not contain the required information or have discrepancies between the request card and specimen pot will not be processed in the laboratory until the necessary information has been obtained. The sender will be contacted via email or instant messaging on Hive (internal MFT only) to rectify any problems. If the discrepancy cannot be rectified by this method or the changes are too substantial the sender will be asked to attend the laboratory to rectify the issue.

The person correcting the patient or specimen details should be of appropriate seniority and able to take responsibility for the labelling of the specimen. This will result in a delay to specimen processing and reporting.

Request Cards

All paper request cards should be completed in full (see above) and all information provided should be clearly legible. Any missing information or errors will result in a delay to specimen processing and reporting.

Correct patient and specimen information is vital for us to provide a quality service to our users. Any specimens deemed to be high risk or potentially high risk should be clearly labelled as such to protect the health and safety of all staff.

As we provide our service to a range of service users, please also state the type of unique patient identification number given, e.g. NHS, Medical Record Number (within MFT). Please also indicate whether the patient is an NHS, private or waiting list initiative patient.

If a patient is part of a research project, this should be clearly labelled on the request card to ensure that the specimen undergoes the correct procedures. Similarly, patients that are part of a screening programme, e.g. BCSP BOSS, should be clearly labelled.

GP ICE Requests

Specimen acceptance criteria for ICE samples sent from GP surgeries are identical to those for samples requested in the conventional manner. Unlike some of the other pathology disciplines, Adult Histopathology still require a request card for all specimens requested on ICE. ICE generates two histology labels for each pot. Both must be used; one label contains patient demographics; the other contains space for the user to add information regarding specimen type. ICE labels must be attached to the specimen container and not to the lid of the container.

Storage of Specimens

Prior to transport to the laboratory, it may be necessary to temporarily store specimens. All specimens that are placed into Formalin should be kept at room temperature until transported to the laboratory. Specimens in Formalin should not be placed into the fridge as this will have a negative impact on fixation and therefore preservation of the tissue.

All dry specimens and specimens in gel transport medium ideally should be transported to the laboratory immediately. Where this is not possible, these specimens should be stored in the fridge. Specimens in Zeus medium should be stored at room temperature. Zeus medium should ideally be stored in the fridge prior to use.

(Last reviewed March 2023)