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HSL Rapid Response Laboratories: Results

All results are recorded on the HSL LIMS (Laboratory Information Management System) Winpath. This is interfaced with the electronic patient record of the local Trust:

  • Barnet/Chase Farm: EFR– RFG
  • Royal Free: EFR– RFG
  • North Middlesex: Careflow
  • UCL Hospitals: EPIC

As soon as results are authorised on Winpath they are transmitted to the Trust systems and are available for viewing by clinical staff.

GPs in all catchment areas can be set up to use the electronic requesting and resulting system T-Quest. Please contact the IT helpdesk on helpdesk@tdlpathology.com.

Providing the GP surgery has been set up to request and receive results via T Quest, results will be electronically downloaded. Requests for missing GP results or requests for copies can be made to the email addresses shown below. These will be re-transmitted electronically or emailed as appropriate.

Each RRL operates a helpdesk for results enquiries:

Royal Free London

UCL Hospitals

Barnet/Chase Farm

North Middlesex

A harmonised service for duty biochemist advice is provided from the Halo Building for all clinical users of the RRLs. Clinical Scientists, Chemical Pathologists and Chemical Pathology Registrars from all sites participate in one rota. The involvement of a larger pool of specialists with a wider expertise, both scientific and medical, provides comprehensive clinical support for Biochemistry.

The contact details for this service are:

Please use the email for non-urgent enquiries; it is monitored and responded to at a frequency of not more than 90 minutes between the hours of 09:00 and 17:00 Monday-Friday. For more urgent issues please use the telephone contact.

Critical/Abnormal results

Results falling outside of predefined limits (set by the Royal College of Pathologists) will be phoned to the requesting clinician, GP surgery or patient location as appropriate. See below.

Outside of normal working hours, GP results will be phoned to the relevant deputising service; hospital results will be phoned to a member of the hospital’s medical team.

Critically abnormal results will be communicated to the requesting clinician at all times where contactable.

Where not contactable, or out of hours:

  • Inpatients – the ward will be contacted
  • Outpatients – will be bleeped to the Medical Registrar
  • GP results will be telephoned to the NHS emergency service 111.

If contact cannot be made, the local on-call Chemical Pathologist will be alerted (via switchboard).

RRL Haematology Phoning Limits

Haemoglobin (g/L)

 <80 >180

WBC

 <1.0 >30.0

Malarial Parasites

Positive Ag Screen, Parasitaemia % for P. falciparum

  

Platelets

≤50

 >600
INR >4.5  

APTT Ratio

   >6.0

Fibrinogen

 <1.0  

Blood Film shows evidence of Blast Cells or diagnosis suggesting of AML/CML/ALL/DIC

 

    
Test Lower Limit Upper limit

North Middlesex University Hospital

Haematology test Result
WBC

> 50 x 109/L

Neutrophils

< 0.5 x 109/L
Hb.

< 60 g/L

Hb. (Males)

> 200 g/L

Hb. (Females)

>180 g/L

Platelets

>1000 x 109/L

Platelets

< 20 x 109/L

Malaria

All Positive results

Any suspected Acute Leukaemia (irrespective of WBC)

All new cases reported to Haem clinical team

Special Haematology

New major Haemoglobinopathy reported to Haem clinical team

Coagulation (non-warfarin patients

PT >40 APTT >50

Coagulation (patients on anticoagulants)

PT >120s / INR > 5. APTT >80s / APTTR > 6

D-Dimer

>550ug / L FEU
Haematology test Result

Clinical Biochemistry

Critically abnormal results that will be communicated to the requesting clinician at all times where contactable.

 

Analyse (Serum/plasma)   Lower action limit Upper action limit Comments

Sodium

mmol/L

 120 155

≤ 130 if < 16yrs

Potassium

mmol/L

 2.5

6.5

7.1 (pre-haemodialysis sample)

Exclude renal patients. Exclude haemolysis, old samples and EDTA contamination.

Urea

mmol/L

   30

≥ 10 if < 16yrs

Creatinine

mmol/L

   350

≥ 120 in < 14 years and ≥ 200 in older children (≥ 14 and < 16)

Glucose

mmol/L

 2.5 25

≥ 15 if < 16yrs

Adjusted Calcium

mmol/L

 1.8 3.0  

Magnesium

mmol/L

 0.4 2.5  

Phosphate

mmol/L

 0.3    

AST

U/L

  

15 x upper limit

of normal (ULN)

10 x ULN if < 16yrs

ALT

U/L

  

15 x ULN

10 x ULN if < 16yrs

Total CK

U/L

   5000

≥ 2000 if < 16yrs

Amylase

U/L

   500  

Triglyceride

mmol/L

   20  

Carbamazepine

mg/L

   25  

Digoxin

ug/L

   2.5

Check timing > 6hrs after dose. If Potassium < 3.0mmol/L, this should be phoned with high digoxin result.

Lithium

mmol/L

   1.5  

Phenobarbitone

mg/L

   70  

Phenytoin

mg/L

   25  

Theophylline

mg/L

   25  

CRP

mg/L

   300

≥ 100 if < 16yrs

Ammonia

umol/L

   100  

Conjugated Bilirubin

umol/L

   25

Neonates only

Bicarbonate

mmol/L

 10    

Cortisol

nmol/L

 50

If 9am Cortisol

Unless part of dexamethasone suppression test

Ethanol

mg/L

 100 4000  

FT4

pmol/L

   40  

TSH

mU/L

   50  

Cyclosporin

ug/L

  

500 (Renal)

600 (BMT)

  

Tacrolimus

ug/L

  

25 (Inpatients)

20 (Outpatients)

  

Bile Acids

umol/L

   20

Ante-natal indications only

Urate

umol/L

   340

Ante-natal indications only
Analyse (Serum/plasma)   Lower action limit Upper action limit Comments

Acute Kidney Injury (Royal Free/Barnet/Chase Farm only)

AKI-1 Only if K > 6.0 mmol/L. Primary Care: If out of hours (OOHs) GP OOHs service or communication next day to GP

AKI-3 All new occurrences

AKI-2 All new occurrences

(AKI) – For patients with previous results AKI-2 triggers to be followed.

 

* Croal B, The Communication of critical and unexpected pathology results. Royal College of Pathologists. Document No. G158. Published: October 2017.