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Wellington SCL Newsletter
16th December 2019

(Please forward on to your clinical staff) 

Please find the latest information from your laboratory provider Wellington SCL.  In this newsletter we cover:

  • Changes to the processing of mycology samples
  • Feedback from our recent annual customer survey 
  • Laboratory results sent to named requestors only 
  • Key Performance Indicators, May - October 2019 
  • Collection Centre hours during the holiday period 

Changes to the processing of mycology samples  

The mycology protocols at Wellington SCL have recently been reviewed. Fluorescent microscopic examination is more sensitive and provides a faster result than fungal culture for detecting dermatophyte infections. Therefore, our current process of routinely providing both microscopy and fungal culture is unnecessary for the majority of patient samples submitted for analysis of superficial mycoses.

A positive or negative microscopy result, in combination with clinical features, allows a clinician to confidently make treatment decisions for most superficial fungal infections. The majority of the time the culture has no bearing on the recommended treatment, which is largely based on the clinical features and site of infection.

From the 30th of January 2020, nail and skin scrapes submitted for fungal analysis will continue to have microscopy performed but will no longer routinely be cultured unless the infection is likely to be caused by fungi other than dermatophytes, has failed treatment or is from an intertriginous skin lesion.

Fungal infections of toenails are almost exclusively caused by the dermatophytes. The first line recommended treatment for dermatophyte onychomycosis is terbinafine, which also has activity against the most common non-dermatophyte mould infections.

Similarly, fungal infections of trunk, limbs, interdigital spaces, or the face (non-intertriginous skin sites) are largely caused by dermatophytes, or Malassezia yeasts associated with pityriasis versicolor. Topical antifungals are the recommended first-line treatment. The microscopic appearance of Malassezia, which cannot be cultured by routine methods, is characteristic.

In contrast, fungal infections of intertriginous skin sites (groin, perineum, axilla, breast folds, abdominal apron), and occasionally fingernails, may be caused by Candida. Fungal culture of specimens from these sites may have a diagnostic role in order to determine appropriate treatment.

All specimens for fungal analysis will continue to undergo microscopy. Culture will also be performed if any of the following conditions are met, as determined by the clinical details on the request form:
  • Skin scrapings from the scalp or an intertriginous site (groin, perineum, axilla, breast folds, abdominal apron)
  • Fingernails; when microscopy is positive and/or clinical details suggest a yeast infection.
  • Any specimen with clinical details of:
    • treatment failure with oral terbinafine or intraconazole
    • recent residence in or return from tropical region (possible Scytalidium spp infection which is resistant to terbinafine)
    • immunocompromised
As always, please ensure that relevant clinical details are provided to enable correct processing of the sample. The on-call clinical microbiologist is available to discuss any severe or atypical cases of suspected fungal infection, as well as in assisting in result interpretation.

Dr Juliet Elvy                                                   Leo McKnight
juliet.elvy@medlabsouth.co.nz                       leo.mcknight@wellingtonscl.co.nz                                               
Clinical Microbiologist                                 Technical Specialist Mycology and TB

Feedback following annual customer survey 

Thank you to all those referrers who responded in the recent Wellington SCL customer survey.  The survey is an annual opportunity for Wellington SCL to confirm what we are doing well and to identify areas for improvement.  The feedback was overwhelmingly positive; 99.5% responses gave WSCL an overall service rating of either satisfied or very satisfied. 

There were however, some themes where improvements could be made.  Broadly the themes & our responses are below:
  • Éclair community electronic ordering system slowness & too many clicks.
Our IT team and Sysmex (the e-order system vendor and designers) are looking at speed and usability improvements to the e-order form.  Recent MedTech slowness and error message issues for both laboratory and radiology e-ordering have been referred back to MedTech for investigation. Indici and MyPractice PMS users are unaffected by this issues.
  • Electronic visibility of serial requests would be helpful.
This is on the medium term plan for our IT team.
  • When a patient presents for phlebotomy with multiple e-orders pending not all requests are processed.
A software change went live on 11 December to address this issue. This change will show our phlebotomists all pending electronic test requests on a patient within the previous 6 months.
  • More late afternoon courier pick ups please.
Courier collection frequency is based on DHB contractual requirements, sample numbers, and urgency.  Although our courier pick up times from surgeries are monitored and periodically reviewed, there are no immediate plans to change current scheduled pick up times.  
  • Histology results turn around times are sometimes too long.
New initiatives will be introduced from January 2020 to assist with histology turn around times.  We continue to carefully monitor our turnaround times.  
  • Microbiology results are delayed and frequently have to be chased up
Most microbiology results take 24-48 hours because of the need to grow pathogens and carry out antibiotic susceptibility testing.
  • It is becoming more frequent for requested tests not to be completed without discussing it with the referrer.
Often tests are declined due to a lack of clinical details or the test does not fit with the clinical setting described.  The reasons for why the tests have been declined are included within the report, and referrers can always discuss directly with the department or pathologist.  
 
Congratulations to Dr Alister Rhodes from Upper Hutt Health Centre and Dr Rose Dodd from Peninsula Medical Centre whose responses were selected in the prize draw to receive ether a morning tea for the practice or a medical magazine subscription.  

Laboratory results sent to named requestors only 

Prior to the Wellington SCL contract, Wairarapa Laboratory was asked to always copy in the GP when a patient had a test request from the Wairarapa Hospital Emergency Department.
 
Recent privacy issues have raised concerns about this historical practice.  Furthermore, GP information on the hospital patient sticker is sometimes incorrect.  

Since the introduction of the Éclair CDR results repository, all results are available to GP’s.
 
From 1st of January 2020, Wellington SCL will report to the requesting clinician only - unless a copy to the patients GP is specifically stated on the laboratory request form.

Key Performance Indicators, May - October 2019

Wellington SCL's key performance indicators for the period May - October 2019 can be found here.

Collection Centre hours during the holiday period

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Level 5, CSB 
Riddiford Street 
Newtown
Wellington






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