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Wellington SCL Newsletter & Clinical Update

8th March 2016  -  Please forward this email to all clinical staff

We thought it would be useful for you to know how we are progressing with some of the concerns raised since Wellington SCL commenced, and provide further updates relevant to community referrers. In this newsletter we also cover:
  • HBA1c testing now included in first Antenatal Screen
  • Skin prick testing to food allergens
  • Zika virus testing
  • Access to the Clinical Data Repository (CDR)
  • Wellington SCL Collection Centres opening hours over the Easter period
  • MedTech screening tool instructions
  • ELab automatic task function
  • Requests for 'U&Es'

HBA1c Now Standard Test In First Antenatal Screen

The Ministry of Health guideline to include HbA1c in the first antenatal blood screening tests (http://www.health.govt.nz/publication/diabetes-pregnancy) has been rolled out in the Wellington & Hutt Valley regions from 1 Feb 2016. HbA1c is considered a reliable method of detecting probable undiagnosed pre-existing diabetes in the first 20 weeks of pregnancy. All women residing in the CCDHB & HVDHB catchment area will have an HbA1c test with their first antenatal blood screening tests. It will not be necessary to specify HbA1c as part of the first Antenatal blood test as this test will be included automatically as part of the first antenatal profile by the laboratory.  Comments on the significance of the result will be included in the report.
Dr Carol Siu, Chemical Pathologist, Wellington SCL

Skin Prick Testing To Food Allergens

Wellington SCL is pleased to announce for the first time in the Wellington Region skin prick testing to common food allergens (egg white, peanut, soy, cow’s milk, codfish, shrimp and wheat) will be available in the community. This will commence from 1 March 2016 at our Courtenay Place rooms. As for environmental allergens, bookings can be made by ringing our call centre.

In most clinical situations skin prick testing should be used in place of rather than as well as specific IgE testing. Skin prick testing to foods should only be ordered when there is a good history of acute reactions to the foods in question or where food is thought to be important in cases of childhood eczema. You should only order the allergens you think are clinically relevant for example if the patient is allergic to egg do not order the rest of the panel.
Accurate clinical details on the request are very important for the pathologists and staff performing the testing. As with all skin prick testing, patients will need to be off antihistamines or drugs with antihistaminic properties.
If you have questions please discuss these with our immunologists.
Dr Richard Steele, Medical Director, Wellington SCL

Zika Virus (Abovirus) Testing

Wellington SCL refers samples for arbovirus testing to ESR. The greatest priority for testing is pregnant women who have been exposed in the first trimester of pregnancy. Exposure to the virus is most likely to occur in Tonga, Samoa and other Pacific Islands. It is possible that arbovirus infection rates will increase in Fiji after the recent cyclone. The best test is PCR of serum and urine within the first 2 to 3 weeks of onset of symptoms. Serology may be performed later but seldom has a useful role in clinical management.
 
Testing of men, non-pregnant women, or concerned but asymptomatic pregnant women should be discussed with a microbiologist before testing. There may be other more important diagnoses to exclude, and Zika is generally a mild illness which needs no special management outside the setting of pregnancy.  Arbovirus infection is notifiable to Regional Public Health, and there is information on the MOH website.
 
Dr Tim Blackmore, Infectious Diseases Consultant & Clinical Microbiologist, Wellington SCL

Easter Collection Centre Operating Hours

The opening hours of our collection centres over the Easter break can be found on our website at www.wellingtonscl.co.nz..
All collection centres will be closed on Friday 25th March (Good Friday) and Monday 28th March (Easter Monday).
Collection centres which normally operate a Saturday service will be open, Saturday 26th March.

All collection centres resume normal operating hours on Tuesday 29th March.
 

Cervical Smear Notifications No Longer Reported


From mid February Wellington SCL no longer reports notifications of cervical smear dispatch.

Clinical Data Repository Access (CDR)


Wellington SCL operates a secure on-line access system to our patient test result database for referrers.  This database holds all the laboratory test results from hospital and community referrers since 1 November 2015.  Wellington SCL is running an information campaign about its Clinical Data Repository (CDR) to community referrers.  If you are interested in accessing the database to look up laboratory results please email contact@wellingtonscl.co.nz

You will be required to complete an IT security access agreement form.  Once we have received your completed form we will be in touch to set up your account.  Access is either via MedTech or web-based (for non-MedTech users).

Non Urgent Queries for Anatomical Pathology test results


We have set up an email address for non-urgent queries for anatomical pathology results.  The email inbox is regularly monitored by our medical secretarial team and will allow us to deal with queries more efficiently and responsively. The email address is medical.secretaries@wellingtonscl.co.nz

Herpes Simplex And Varicella Zoster Virus PCR Results Always Reported Together Even If Only One Test Is Ordered


The Herpes Simplex Virus (HSVP) and Varicella Zoster Virus (VZVP) PCRs us a dual test.  When one test is requested, both PCRS are performed.  It is the nature of the test assay.  Consequently Herpes Simplex and Varicella Zoster Virus PCR results always reported together even if only one test is ordered.

MedTech 32 Screening Inbox Mapping Tool Instructions For Referrers


We are aware the some community referrers missed seeing the communication sent by MedTech to MedTech 32 users regarding the use of the screening inbox mapping tool. A link to these instructions is provided below.
http://www.wellingtonscl.co.nz/medtech-32-screening-inbox-mapping-tool-instructions-referrers
 

Elab Automatic Task Function


We wish to raise awareness of the eLab automatic task function.  This replaced the eLab 'truancy' report for receiving notifications of overdue test results.  The automatic task is set at the laboratory according to the instructions from a practice.  Currently all practices have an automatic task generated for the same tests they had nominated for the truancy report.  If you are concerned that your practice does not have this function in particular for histology and cytology requests or would like to add other tests please contact Fiona James, fiona.james@wellingtonscl.col.nz to discuss.

A Request For 'U&E' Is Not A Valid Request


The laboratory frequently receives handwritten requests for "U&E" when that is not what the requestor actually requires.  Usually the expectation is that creatinine, sodium and potassium will be provided, with the e-GFR.

There is no test set designation "U&E" within the laboratory system, so registration staff have to change the request to what they believe the requestor requires.  We have had a number of occasions when the required test was not anticapted and there has been one reportable event related to this.

We would be grateful if requestors would stop using this anachronistic term.  It relates to clinical practice of more than 30 years ago, when urea was the primary test for renal function.  Similarly, if you request "Electrolytes" you should not have the expectation that you will get creatinine included.

Please request creatinine, sodium/potassium specifically as required.  e-GFR is automatically included with all requests for creatinine, provided that it has not been provided within the previous 24 hours.

There are some limited clincal circumstances when urea may be a useful additional test and in such cases that should be indicated as being a specific request for urea.
Dr Michael Crooke, Chemical Pathologist, Wellington SCL
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