In this section
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 specimens need to be accompanied by a correctly completed histology / cytology request form.
For test requests ordered on the Hive Electronic Patient Record (EPR) system an order requisition printout must be submitted with the request.
For non-Hive requests or paper requests raised during Hive downtime see sample acceptance criteria below for more information.
The following mandatory information must be provided for us to accept the specimen:
Essential Patient Identifiers:
- Surname
- Forename
- Unique identification number – Medical Record Number (MRN), NHS or external hospital number for external cases
- Date of birth
Address – for GP or external locations
Essential Clinical Details:
In producing a final diagnostic histopathology or cytopathology report the Pathologists are essentially looking to provide guidance and answers to clinical queries. Therefore it is essential that all relevant clinical information is provided on the request form (paper based or electronic) so that the histological and cytological features of the specimen can be interpreted within the clinical context. Rather than simply repeating oneself under each heading give relevant clinical details, procedure details, medical history and the clinically suspected (differential) diagnosis. This should include all previous malignancies, whether in the same or any other organ system. Under Specimen Details, give the precise anatomical site of the specimens sent. If there are multiple specimens, there should be a one-to-one correspondence between the specimens listed on the card and the labelling of the specimen pots. State any markers / sutures / clips, and their significance. Record any features of the specimen that are likely to be difficult to interpret after fixation, particularly for complex resections.
If the relevant, appropriate clinical information is not provided this may lead to a delay in the final report being issued.
- High risk status – to ensure health and safety of all staff
- Specimen site – must match on specimen pot and request card
- Relevant clinical information – see above
- 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 specimen
Essential Sender Details:
- Ward/department – required for return of reports
- Consultant or GP – required for return of reports and contact in case of any errors/discrepancies
- Contact number/bleep – for frozen sections
It is recognised that histology samples are often not repeatable therefore the department has protocols in place to deal with specimens and accompanied request forms that do not meet the specimen acceptance criteria. A final report will not be issued until such details have been corrected. The requesting clinician will be required to attend either the Laboratory at Wythenshawe or Tameside. Samples from General Practitioners will be returned for amendment. All specimen and/or request form amendments will need to have a specimen amendment form completed. If amendments are not addressed within seven calendar days then an incident will be raised in Ulysses.
For some external clinics we will accept corrections to patient detail discrepancies via email, e.g. Tameside.
Any high-risk specimens should be highlighted on the specimen request form and received in formalin. The specimen will be left to fix in formalin for 24 – 48 hours after receipt to ensure safe to handle and therefore there may be a delay in the report being issued.
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, district, MRN. 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.
HIVE requests
Unlike some of the other pathology disciplines, Cellular Pathology (Histology and cytology) still require a request card for all specimens requested on HIVE.
For test requests ordered on the Hive Electronic Patient Record (EPR) system an order requisition printout must be submitted with the request.
HIVE generates specimen labels for both the requisition printout and each sample pot created as part of the order entry. Please ensure the correct label is attached to the correct container. HIVE labels must be attached to the specimen container and not to the lid of the container.
(Last updated April 2023)