Specimen Information

Ordering Information

An order requisition must accompany each specimen or group of specimens. SSM Health St. Mary's Hospital – Madison Laboratory Services provides four types of order requisition, (1) clinical laboratory, (2) surgical pathology, (3) microbiology, and (4) frequently ordered tests that are sent to another reference laboratory. Order requisitions are pre-printed with client name and account number for your convenience. For accuracy in testing, reporting and billing, please print clearly or type all patient information requested. Minimum patient information required for accurate result interpretation includes the patient's full "legal" name (First and Last), date of birth and sex, as reference ranges are age and sex dependent. If a clinic record or patient identification number is necessary for proper distribution of reports in your office, please include it in the patient number or lab number area on the order requisition. Your number will be transferred to the patient's report and will appear on the result copy headers of the report. The originator's copy is provided as a record for you to verify orders and monthly invoices.

SSM Health St. Mary's Laboratory Services participates in the Medicare/Medicaid programs and accepts assignment for patients covered by these programs in accordance with current regulations. When referring tests on patients covered by one of these programs, additional patient information is required to process the bill directly: Patient's address, Medicare or Medicaid number, ICD-9 Code(s), and supplemental insurance information. This information must be supplied at the time the test is ordered. SSM Health St. Mary's Laboratory Services relies on the ordering physician to notify and educate Medicare patients when the tests they are ordering are not covered by Medicare as being medically necessary. The ordering facility is required to obtain a government approved Advanced Beneficiary Notice (ABN), indicating the patient is aware of his/her responsibility to pay for non-covered service. One copy of the signed ABN should be sent with the specimen, one given to the patient and one maintained at the ordering facility.

A miscellaneous area for ordering tests which do not appear on the requisition is provided for additional tests, specimen or patient information.

Multiple Tests

When multiple tests requiring different processing are requested on the same patient, please identify the specimen type on the transport tube. Be as specific as you can be, especially since many different types of plasmas are now tested, i.e.: EDTA plasma (for cardiac marker), citrate plasma (for coagulation) and heparinized plasma for CKMB. If a single sample tube needs multiple tests done on it, please do not freeze unless you first aliquot to separate tubes.

Reference Ranges

As methodology or instrumentation changes in our laboratory, our reference ranges also may change. The ranges listed in this manual reflect adult values for current methodology unless indicated. Age specific reference ranges for neonates, pediatrics and adolescents are included in addendum #5. It is important to refer to the reference range printed on the patient's result copy as this will always reflect the correct normal value for the methodology currently in use, the age, and sex of the patient.

Reporting

Most frequently ordered tests are reported within 24 hours following receipt of the specimen at SSM Health St. Mary's. Those which require a longer processing time will be reported as soon as they are completed. This manual lists the days on which each test is set up as a guide to the expected turnaround time.

SSM Health St. Mary's Laboratory Services' computerized reporting system includes a chart-ready report form with reference ranges for the age and sex of the patient. Abnormal results are identified with an "H", "L", or "P" following the patient value indicating a result higher or lower than the expected reference range, or that the value is a "panic or life threatening" value. A panic laboratory value is a value at such variance with normal that it represents a pathophysiologic state which is life-threatening and requires immediate and appropriate medical action. Our laboratory staff communicates each and every panic value immediately to the client, ordering physician or his/her nurse. If you receive such a call, please forward the information to the physician immediately.

If you need results before your next scheduled printing or delivery, we will be happy to fax your results. Please supply the fax numbers. If results are needed after your usual hours, please provide a phone number where the physician can be reached.

Preliminary results will be reported for tests which require a lengthy time to process, such as cultures; positive cultures will be phoned.

Specimen Identification

Proper identification of samples is the responsibility of the client. Each specimen should be clearly and legibly labeled with the following information (a typed label is preferred):

• Patient’s first and last (legal) name
• Date of birth
• Client name
• Tests ordered
• Collection date and time
• Specimen type (serum or plasma)

Unacceptable Specimens

Some specimens cannot be analyzed because of improper collection, identification or storage. Our laboratory does not accept or test unlabeled or mislabeled specimens for venous blood, stool, or urine. You will be notified of any specimen problem on receipt. Notification of any corrective action taken will be documented for you on the report.

The following is a checklist you should confirm before referring any specimen:

• Patient/specimen identified properly
• Correct specimen type
• Adequate specimen volume
• Appropriate transportation medium or container
• Specimen label is attached and correct
• Lack of hemolysis
• All requested patient information is included
• Medicare information, if applicable
• ICD-9 diagnosis code(s) included

Collection & Storage

To ensure the most accurate and reliable results, it is imperative that all specimens are properly collected, separated and stored at the proper temperature prior to pick up. Specimen requirements and volumes required are included with each procedure, with special handling instructions appearing in bold print. Refrigerate all specimens until pick up unless otherwise indicated.

Frozen Specimens

Frozen specimens will be transported on dry ice. If multiple tests are ordered and one or more are required to be frozen, please aliquot the specimen in the appropriate quantity for each test before freezing.

Fasting Specimens

Certain tests are most accurate if performed when the patient has been fasting. Instruction to the patient should include avoiding intake of all food and beverages except water for 12 hours prior to the time the specimen will be collected.

Vacutainers

The type of specimen and collection code appear with the specimen requirement for each test as indicated below: (When multiple tests are drawn, please draw in the same order listed.)