Laboratory Bulletin
Date: June 4, 2018 To: Medicine Hat and Area: Nursing, Protective Services, Laboratory, Rural Sites, Labor and Delivery, Registration, Calgary Lab Services From: AHS Laboratory Services - Medicine Hat and Area Re: Medicine Hat and Area Autopsy Referral to Calgary Lab Services
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Key Messages: Implement standardized SZ guideline and corresponding documentation to request and refer same day autopsy services to/from Calgary Lab Services (CLS) at Foothills Medical Centre (FMC) and Alberta Children’s Hospital (ACH). To satisfy recommendations from an Alberta Health Services (AHS) and CLS Quality Assurance Review Medicine Hat Regional Hospital (MHRH) does not perform autopsies, all autopsies are performed in Calgary Inclusive of all MHRH and Area autopsies (adult, pediatric and fetal) o Impending death or death with suspected/known metabolic disease, contact Metabolic Disease Service at ACH for specific direction o Medical Examiner case, contact their office for direction o Consult CLS Test Directory and/or SZ Test Directory for all sampling and submission instructions
Why this is important: . To ensure documented notification of autopsy referral to CLS, timely referral and same day autopsy service
Action Required: All MHRH . Requesting physician completes AHS Consent For Autopsy departments . Arrange transportation of the body to the MHRH morgue Adult or . Ensure paperwork and a copy of the chart is sent with the body to the morgue Pediatric death Send completed AHS Consent For Autopsy to the MHRH Laboratory Transcription department 403-502- 8648 Ext: 1144 Rural Sites . Requesting physician completes AHS Consent For Autopsy Adult or . Contact MHRH Transcription Laboratory department 403-502-8648 Ext: 1144 and notify of an autopsy Pediatric death . Working with MHRH Lab Transcription, arrange transportation of the body to MHRH morgue via funeral home . Ensure AHS Consent For Autopsy and copy of the chart is sent with the body Rural Sites . Retain all tissues FRESH . Complete Histology Requisition Stillbirth ≥20 o with stillbirth/placenta label (place on front of requisition) weeks or o and autopsy sticker (place on top right corner of requisition) Live birth or . Requesting physician completes AHS Consent For Autopsy Fetus/fetal o with autopsy sticker (place on top right corner of requisition) tissue <20 . Contact MHRH Laboratory department and MHRH Labor and Delivery and notify of autopsy weeks If…cytogenetic testing requested If…cytogenetic testing requested stillbirth ≥20 weeks or live birth fetus/fetal tissue <20 weeks . Physician completes AHS Requisition for Constitutional . Physician completes AHS Cytogenetic Services Requisition for Constitutional . Contact lab for transport media (RPMI) Cytogenetic Services . Physician samples tissue and places in RPMI . Contact lab for transport media
Laboratory Bulletin
IF…sampling from (RPMI) IF…sampling from placenta fetus . Pathologist samples tissue and . 1 cm segment of umbilical cord places in RPMI . MUST have . If cord is autolyzed, sample placenta parental consent separately. Physician completes second . Place sample in AHS Requisition for Constitutional RPMI Cytogenetic Services for this sample . Arrange transport of placenta and stillbirth/body to MHRH Labor and Delivery via funeral home (contact MHRH for guidance) Send to MHRH Lab:
. AHS Consent for Autopsy Send to MHRH Labor and Delivery: . FRESH fetus/fetal tissue . Placenta and stillbirth/body . Histology Requisition with . AHS Consent for Autopsy stillbirth/placenta label . Histology Requisition with stillbirth/placenta label . Cytogenetics sample (if . Copy of the chart applicable)
. AHS Requisition for Send to MHRH Lab: Constitutional Cytogenetic . Cytogenetics sample (if applicable) Services (if applicable) AHS Requisition for Constitutional Cytogenetic Services (if applicable) Medicine Hat . Receive notification from rural site regarding incoming case Labor and Delivery When case arrives: . Place stillbirth/body in refrigerator Case referral . Document arrival of the case on “Autopsy Referral Log – South Zone” from Rural . Confirm AHS Consent for Autopsy and Histology Requisition are received Site: . Contact MHRH Histology lab, notify of autopsy and that placenta is available for accessioning Stillbirth ≥20 . After placenta is accessioned, arrange referral of case to CLS at ACH weeks . Contact CLS pathology at ACH and notify them of the case: 403-955-7305 gestation or . Notify the date the case will be sent Live birth . Contact funeral home to arrange transportation of the case to CLS on the next business day. . Specify the case is for same day autopsy service and MUST arrive at its destination by: . 1000 (Monday – Thursday) . 1100 (Friday) . Confirm pick up location as MHRH Labor and Delivery . Confirm date of transfer . Confirm destination as ACH . Place CLS Autopsy Referral Sticker on AHS Consent For Autopsy and document: . Date and time of CLS notification . Name of CLS staff notified . Date of case transfer . Destination of case is ACH . Ensure AHS Consent For Autopsy and Histology Requisition accompany the case
Laboratory Bulletin
Medicine Hat . Retain all tissues FRESH Labor and . Complete Histology Requisition Delivery o with stillbirth/placenta label (place on front of requisition) o and pink autopsy sticker (place on top right corner of requisition) . Requesting physician completes AHS Consent For Autopsy Stillbirth ≥20 o with pink autopsy sticker (place on top right corner of requisition) weeks . Contact MHRH lab 403-502-8648 Ext: 1144 and notify of autopsy gestation or If cytogenetic testing requested Live birth or If cytogenetic testing requested stillbirth ≥20 weeks OR live birth fetus/fetal tissue <20 weeks Fetus/ fetal tissue <20 . Physician completes AHS Requisition for Constitutional Cytogenetic weeks Services gestation . Contact lab for transport media (RPMI) . Physician completes AHS . Physician samples tissue and places in RPMI Requisition for Constitutional IF…sampling from Cytogenetic Services IF…sampling from placenta fetus . Contact lab for transport media (RPMI) . 1 cm segment of umbilical cord . MUST have . Pathologist samples tissue . If cord is autolyzed, sample placenta parental consent and places in RPMI separately. Physician must complete a . Place sample in second AHS Requisition for Constitutional RPMI Cytogenetic Services for this sample
. Contact MHRH Histology lab, notify of autopsy and that placenta is available for accessioning . After placenta is accessioned, arrange referral of case to CLS at ACH . Contact CLS pathology at ACH and notify them of the case: 403-955-7305 . Notify the date the case will be sent . Contact funeral home to arrange transportation of the case to CLS Send to Lab: on the next business day. . AHS Consent For Autopsy . Specify the case is for same day autopsy service and MUST . FRESH placenta and arrive at its destination by: fetus/fetal tissue 1000 (Monday – Thursday) . Histology Requisition with 1100 (Friday) stillbirth/placenta label . Confirm pick up location as MHRH Labor and Delivery . Cytogenetics sample . Confirm date of transfer . AHS Requisition for . Confirm destination as ACH Constitutional Cytogenetic . Place CLS Autopsy Referral Sticker on AHS Consent For Autopsy Services and document: . Date and time of CLS notification . Name of CLS staff notified . Date of case transfer . Destination of case is ACH . Ensure AHS Consent For Autopsy and Histology Requisition accompany the case
Laboratory Bulletin
Protective Adult or pediatric Stillbirth or Live birth Services Rural MHRH Rural site to MHRH Labor and Delivery Site to MHRH morgue to floor to MHRH LDR to CLS Transfer… MHRH CLS morgue morgue . Funeral home arrives . Escort case . Funeral home arrives to to transport body transfer to Labor transport case . Obtain AHS Consent and Delivery . Obtain AHS Consent For . Escort body transfer For Autopsy from . Document Autopsy and Histology to morgue Registration arrival in Requisition from Labor . Complete Morgue . Escort funeral home to “Autopsy and Delivery and send Log Book morgue for release of Referral Log – with case . Give AHS Consent body South Zone” . Retrieve vital stats For Autopsy to . Send AHS Consent For . Give AHS paperwork from Registration Autopsy with the body Consent For registration . Complete Morgue Log Autopsy to . Ensure Funeral Home Book Registration signs paperwork with
Registration
If adult or pediatric MHRH . Receive completed AHS Consent For Autopsy Laboratory . Contact funeral home to arrange transportation of the body to CLS on the next business day. Transcription . Specify the body is for same day autopsy service and MUST arrive at its destination by: Department . 1000 (Monday – Thursday) . 1100 (Friday) . Confirm pick up location (AHS Site) . Confirm date of transfer . Confirm destination of body (ACH or FMC) If pediatric If adult . Contact CLS pathology at ACH and notify . Contact FMC vital stats department and notify them of them of the case: 403-955-7305 the case: 403-944-1689 . Notify the date the case will be sent . Notify the date the case will be sent . Place CLS Autopsy Referral Sticker on AHS Consent For Autopsy and document: . Date and time of CLS notification . Name of CLS staff notified . Date of body transfer . Destination of body (ACH or FMC) . When funeral home arrives to transfer the body, give protective services the AHS Consent For Autopsy Calgary Lab If stillbirth ≥20 weeks or live birth or If adult or pediatric Services fetus/fetal tissue < 20 weeks . Receive notification from MHRH Labor and . Receive notification from MHRH Registration of Delivery of autopsy referral autopsy referral . Provided with date the case will be sent . Provided with date the case will be sent . Body/case and paperwork (including AHS Consent For Autopsy) arrives at ACH or FMC for autopsy . CLS performs autopsy . When autopsy complete, release body to funeral home Laboratory Bulletin
Related Documents: AHS Consent For Autopsy Form #160012 (On the external web: http://www.albertahealthservices.ca/frm-160012.pdf ) AHS Requisition for Constitutional Cytogenetic Services–Karyotype, FISH and RAD Form #101667 (On the external web: https://www.albertahealthservices.ca/frm-101667.pdf) Histology Requisition Stillbirth/placenta label for Histology Requisition (SZ requirement, provided by MHRH lab, contact for supply) Morgue Log Book – Formal documentation for intake and outtake of deceased from a morgue (site specific document) CLS Test Directory - https://www.calgarylabservices.com/lab-services-guide/lab-tests/ CLS Autopsy Referral Sticker “Autopsy Referral Log – South Zone”
Contacts: Medicine Hat Regional Hospital Laboratory (MHRH): Business hours Monday – Friday 7:00 am to 5:00 pm: Transcription 403-502-8648 Ext: 1144 Histology 403-502-8648 Ext. 1556 Off hours: 403-502-8648 Ext. 1540
Metabolic Disease Service at CLS: 403-955-7211 Medical Examiner’s Office: 403-297-8123 CLS at ACH: 403-955-7305 Vital Stats at FMS: 403-944-1689
For additional questions contact: David Bisimwa, Pathology Scientist MHRH, Lab: 403-502-8648 ext 1517 Renee Tatro, Technologist III, MHRH Lab, 403-502-8648 ext 1541
This bulletin has been reviewed and approved by: Dr Julio Silva, AHS Zone Clinical Department Head (Co-Lead) Laboratory Medicine, South Zone Tamara Trotter, Director, Laboratory Services, South Zone