MEMO
From: Biochemistry Department, St James’s Hospital, Dublin 8
To: All primary care and other external users of Biochemistry diagnostic service
Subject:Changes affecting clinical diagnostic support service form 12th June 2012
Dear Doctor / service user
The Biochemistry Department is instituting some changes to the diagnostic support service which will be operationalfrom Tuesday 12th June 2012. The nature and extent of these changes is outlined below.
- Plasma Glucose reports: In line with recent guidelines concerning disorders of glucose homeostasis (both from HSE and from international organisations e.g. ADA, WHO)the department, in conjunction with our consultant diabetologist colleagues, has updated its reporting of plasma glucose results.
Firstly, samples should always be clearly designated as fasting, random, or post-prandial/post oral glucose load,whichever is considered appropriate. Any sample that is not designated as either fasting or post-prandial/post oral glucose load will be automatically labelled as RANDOM.
Secondly, please note that there is no effective reference range for Random plasma glucose. Therefore any random sample will automatically be flagged as abnormal so that any potentially abnormal results are highlighted for the benefit of the service user. All glucose reports will be issued with a specific GUIDE TO INTEPRETATION, which is informed by recent national and international guidelines.
Finally, it must always be borne in mind by those who have responsibility for interpreting diagnostic test results that in some instances, due to limitations of the laboratory IT system and the lack of clear clinical information, a reference range cannot be applied to a specific test result. This means that an abnormal test may not be “Flagged” as such.For example endocrine tests such as FSH, LH, and Oestradiolcan vary significantly during the menstrual cycle. Thus interpretation will depend on the stage in the cycle when samples wereobtained. There are many other examples where similar limitations apply. Therefore, in all circumstances it is the responsibility of the requesting doctor to review all results issued by the laboratory and to interpret these results in accordance with the clinical circumstances that prevail.
- Serum CRP analyses will now be performed in the Biochemistry Department from June 12th2012 onwards. Any queries regarding this assay should be directed to the Biochemistry Department, St James’s Hospital.
- The Biochemistry service has updated the critical phone limits for abnormal results generated during sample analysis. The details may be viewed on the St James’s Hospital website . If abnormal results cannot be phoned to service users during routine office hours then only those results that meet the criteria for critical phoning as determined by the joint Royal College of Pathologist/RCGP guidelines,issued in November 2010, will be considered for further action, particularly outside of routine working hours. I cannot overstress the importance of ensuring that the laboratory has the direct contact details for all service users, including mobile phone numbers. These will only be used for urgently contacting service users, as appropriate. If you have not already supplied these details to the laboratory then I would urge you to do so as soon as possible.