Dr Piyush Tailor

[A]For outdoor patients

1)First of all the patient comes at registration window with case paper & request form with desired investigations and registered at the registration desk and accordingly request forms are given filled with details of registration and desired investigations.

2) Registration includes name, age, sex, opd referred from, MRD number, investigations desired along with the unique lab ID number. This unique ID number is noted on patient’s case paper for future reference.

3) Simultaneously patient is registered on HMIS (software) and info.diagnostica software.

4) Then patient is guided towards next window which is of Rogi Kalyan Samiti. Patient is required to deposit Rs.25/- here. Some patients are exempted from this fee according to the set protocols.

5) Patients are then given labelled vacuettainer according to the desired investigations written on the request form and are registered separately for the biochemistry section.

6) Patients are then guided towards the entrance door of laboratory for the waiting sitting area.

7) According to the sequence and availability of the empty cabin the patients are taken inside for the phlebotomy in the blood collection room.

8) The vacuettes are appropriately filled and slides are prepared from the sample in the collection cabin itself. Slides are labeled with lab ID no. and patient’s name. If desired investigation includes bleeding time ,clotting time then it’s done in the cabin itself. Patient is given Acknowledgement slip and asks to come with this slip to collect report.

9) The labeled filled vacutte and slides with the respective request forms are then transferred to the processing room after 3-4 collections.

10) In the processing room the vacutte are sorted out according to the categories of investigations desired e.g. Haematology,biochemistry, microbiology and blood bank. Coagulation samples are send for processing in indoor section. Biochemistry, microbiology and blood bank are transported to respected department.

11) The samples are first run on the cell counter and then transferred for further investigations like ESR, AEC. The cell counter’s slip is attached to the respective forms.

12) The slides are stained dried and kept over their respective forms and transferred to the reporting room for microscopic examination. Slides are screened by resident doctors and reported by authorized signatory.

13) The results are noted in the report forms itself and then send for the report entry to the data operator. Malaria forms records are entered in register by technicians.

14) Finally the Printed reports are aligned ID number wise and are kept at the dispatch window.

15) When patient comes and shows the Acknowledgement slip on which unique ID lab number is written the reports are searched for. On getting respective reports they are given to the patient and the lab number that is written on his/her main form is striked through to indicate that the report has been dispatched to the patient. Records of dispatched reports are written on the respective request forms.

[B]For Indoor patients

1) First of all the samples and request forms are received at the reception counter. They are checked for appropriate information and patient details along with the adequacy and appropriate vacuttainer for the desired investigations. Provided request form is matched for patient details and other desired data. If sample rejected according to the written criteria it is mentioned in rejection format along with reason for rejection and action taken.

2) samples are registered in infodiagnostica softwer at the reception. Accordingly unique id is generated. out of 2 sticker ,one sticker with unique id and barcode number is being sticked on the vacuttee and sticker which contain only unique id is being sticked on the request form of patient.

3) Registration includes name, age, sex, ward, MRD number, investigations desired along with the unique lab ID number. The request form is provided with a counter slip attached to its lower part.A sticker with unique ID is sticked on the counterfoil and given back to the servant or the patient relative, who brought the sample to the lab, for further reference.

4) Then samples are aligned sequentially according to the specific investigations desired.

5) The labeled filled vacutte with the respective request forms are then transferred to the processing room within appropriate time.

6) In the processing room the vacutte are processed for the desired investigations e.g. for coagulation profile they are centrifuged and for peripheral smear examination slides are made along with running of the sample on cell counter.

In case of an urgent test request, samples are segregated for immediate processing and report is issued as per the T.A.T. of urgent investigation.

7) The samples are first run on the cell counter and then transferred for further investigations like ESR, AEC if other investigations are desired from the same sample. The cell counter’s slip is attached to the respective report forms.

8) The slides are stained dried and kept over their respective forms and transferred to the reporting room for microscopic examination. Slides are screened by resident doctors and reported by authorized signatory.

9) Other investigations if demanded (like PT, APTT or others) samples run on respective instruments and results are noted on request forms and verified by authorized person.

10) All results are entered in info.diagnostica software and release by authorized person. The results are easily accessed by clinicians. After release of reports printed reports are dispatched by opd servants at ward side.

11) In case of misplacement of reports, patient /servant comes and shows the counterfoil given at the reception of the sample on which unique ID lab number is written the reports are searched for. On getting respective reports they are given to the patient /servant and this counterfoil is kept with us.

Workflow in sickle cell laboratory, Haematology section

For indoor patients:

-The patients' relative/sample collection boy come at receiving area in sickle cell laboratory with blood samples and request forms. All the samples and request forms are checked for patient details along with adequacy and appropriate Vaccuutainer for the desired investigations.If sample is rejected as mentioned in rejection SOP ,reason is mentioned in sample rejection register and sample with request form is send back to clinicians.

-Details of patients are noted down in sample receiving register and Lab ID is given.

-Details include name,age,sex,ward,MRD no,investigations desired along with the unique ID no. The request form is provided with a acknowledgement slip attached to its lower part. The unique ID no.is given on acknowledgement slip and given back to patient's relation/sample collection boy and asked to come with this slip to collect report.

-Then samples are aligned sequentially according to the Lab ID.

-The labelled vacuutte are then transferred into processing room and respective request forms are kept in request form file.

-in the processing room, the vacuuttee are processed for desired investigations.(For solubility test-procedures are followed as mention in SOP for solubility test)

-The solubility test is performed by technician, screened by resident doctor and reported by authorized signatory.

-all the solubility positive samples are run on cell counter and CBC data are noted down in CBC register.

-Solubility positive results are then noted down and finally the results are entered in reporting form.The reporting forms are kept aligned for dispatch in receiving area.

-when the patient's relative/sample collection boy come to take reports, they are asked for acknowledgement slip, details are verified and report are then handled them.

-All positive and gray area result of solubility test are stored at 2-8 c for further confirmation by HPLC.

-the HPLC test is performed on the same day or within 7 days of collection. The samples are proceed for HPLC according to Lab ID.

-After generation of HPLC reports, they are kept in HPLC dispatch file. when the patient's relative/sample collection boy come to take reports, they are asked for solubility report, details are verified and report are then handled them and asked for family study whenever required.

-The patients details and results of solubility and HPLC are then entered into the microsoft excel sheet during routine hours.

For outdoor patients:

The procedure is same for outdoor patients as mentioned in workflow for outdoor patients in haematology. After collection, the samples are segregated and transported to sickle lab by servant. The receiving, rejection and processing of sample and dispatch procedure are similar to that of indoor patients.

For PHC and CHC patients:-

-The lab technician of different PHC and CHC of surat district do solubility test and send positive and gray zone samples by counsellor to sickle cell ,NCHCS for further confirmation by HPLC.

-The counselor come with samples with 2 copy of request forms.

-all the samples and request forms are checked as per receiving and rejection criteria. once the criteria are fulfilled ,a unique ID is given on both request forms and one copy is given back to counsellor and asked to come with this copy to take out the reports.

-The samples are stored at 2-8 and HPLC test performed maximum within 7 days from the date of collection.

-The generated reports are kept in PHC/CHC patients HPLC dispatch file. When counsellor come with signed copy of request form with unique lab ID,the HPLC reports are searched for and given to the counsellor and asked for family study whenever required.

-The patients details and HPLC results are then entered into Microsoft excel sheet during routine hours.