Q: What is the best way to get the specimen to the path lab? Is it OK to place the specimen on a 4x4 piece of gauze and moisten the gauze with 0.9% NaCl in a sterile container?
Nancy King, RN
Day Surgery of Grand Junction
Grand Junction, Colo.
A: The specimen is best sent to the laboratory unfixed in a plastic container. Contact with solvents and with other material, including gauze, is best avoided since the substance may alter the specimen. In the case of a biopsy intended for routine sectioning, place the specimen in formalin and avoid contact with gauze and other substances. There are exceptions to this procedure, such as specimens for DIF (direct immunofluorescence), which require special media. Under these circumstances, your laboratory will provide special media upon request.
Q: Is it acceptable to put specimens to be picked up by UPS in a drop box? We sometimes have a problem with UPS pickups at the appropriate times.
Lisa Martin, ORT
Specialty Surgical Center
A: While it's acceptable to place specimens in the UPS drop box, this may not be the best method due to variables that could compromise the specimen, such as temperature extremes or delayed arrival to the laboratory. The recommended approach is to schedule a pickup in advance and allow for a window of time, depending on the UPS driver's schedule. If there's an issue with UPS's punctuality and efficiency, then try other carrier services, such as DHL they have regulated pickup and delivery options. In addition, most laboratories offer private courier services to ensure convenience, personalized service and safekeeping of the specimen.
Q: How long should a facility keep the specimen log sheets after the pathology report is returned?
Deborah Comerford, BSN, CNOR, CASC
A: According to Department of Health and Human Services and federal Clinical Laboratory Improvement Amendments regulations, an ASC should keep specimen log sheets for at least two years. If your ASC has an electronic medical record system in place, then these records are usually saved indefinitely.
Q: What is the most appropriate way to handle a frozen section in the ambulatory surgical center setting?
Patti Barkey, COE, OCS
Eye Surgery Center of North Florida
A: There are several important things to consider when handling a frozen section. Here are four of them:
- Properly schedule the procedure, making sure that the pathologist is aware of the specimen's nature and arrival. The laboratory staff will then ensure that the cryostat is in proper working order and that a technician is available.
- Maintain proper communication between the pathologist and the surgeon via a reliable telephone or intercom system.
- During the procedure itself, the biopsy specimen must be properly identified, kept fresh and kept out of contact with alcohol and other solvents.
- The laboratory should have the proper forms to record the result of the frozen section.
Q: Do your on-site or off-site pathologists prefer clustering a full day of frozen section patients, or just a few frozen sections per day?
Steven D. Williams, MD, FACS
Riverside Ambulatory Surgery Center
A: Clustering is the preferred method of scheduling frozen sections.
Q: Is it the surgical center's responsibility to inform a tumor board of a carcinoma, or is it the surgeon's responsibility?
Tina M. Ferralez, ADN
Las Cruces Surgical Center Las Cruces, N.M.
A: Either the surgeon or the patient's primary caregiver should inform the tumor board of a diagnosis of cancer, since the responsibility of the patient's health lies primarily with them. A tumor board is typically approached under situations where either the treatment or the diagnosis is unclear. Unfortunately, the diagnosis of cancer and the subsequent treatment regimen is often not black-and-white. Each physician may have his own understanding and interpretation of the medical literature. Bringing a case before a tumor board gives a physician the advantage of having physicians of multiple disciplines including surgery, radiology, oncology and pathology all together in one room to review the same case, able to give their opinions on the handling of the case from their expert medical perspectives.
Q: We have been told by the Accreditation Association for Ambulatory Health Care that our surgeons have to sign the path report that goes in the patient's chart. We are attached physically to the surgeons' clinics and send a copy of the path report to each doc for the post-op visit, which they sign. It's then placed in the clinic chart. What would be the best way to get the docs to sign yet another report for the surgical chart?
Kathy Kennison, RN
Central Park Surgery Center
A: Though this doesn't really fall under pathology services, diagnostic laboratories often experience similar situations with their own regulatory agencies.
I suggest issuing a letter or memo to all the surgeons, explaining that the AAAHC requires all doctors to sign a copy of the pathology report for the surgical chart in addition to the one signed for the clinical chart.
The letter's tone should be sympathetic to the inconvenience of the added paperwork, but it should also stress that your facility needs to adhere to these regulations in order to demonstrate that your operation is legitimate and that your staff is committed to providing the best patient care. The doctors should then understand that you're simply following regulations to comply with the AAAHC.
Q: We are now refrigerating all specimens regardless of size. Is this standard practice everywhere?
Marnie Matthews, RN
Mills Memorial Hospital
Terrace, British Columbia, Canada
A: No. If the specimen is placed in formaldehyde, then refrigeration is not necessary.