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Formulating the Microbiology content of the National Laboratory Medicine Catalogue (NLMC) in England, UK

Dr Julian K Sutton Consultant in Infectious & University Hospital Southampton NHS Foundation Trust, Southampton, UK.

Results Background This system is currently being used to standardise microbiology test The National Laboratory Medicine Catalogue (NLMC) is a collaboration request names for inclusion in the NLMC. between the Royal College of Pathologists, the Department of Health and NHS Connecting for Health. The goal of the NLMC project is to create a Each request is comprised of a series of discrete information (data) comprehensive standard for test requests and results reporting. The elements that, when combined as part of a relational database, benefits will include: defines the test being requested. The information elements defining all pathology tests, including those in Microbiology are: • standardised common terminology for test names - requestables • Test request name • standardised common formats for test results - reportables • Collected specimen type • Collection method This will facilitate: • Topography (anatomical location) • appropriate test selection and standardisation of coding • Laterality (may be mandatory, dependent on topography) • Morphology (optional term, e.g. ‘cyst’ or ‘abscess’) • safer test interpretation at a national level, regardless of test source, thus contributing to patient safety In local implementation of the Catalogue, there should be the facility to enter additional clinical and/or test-specific information to enable appropriate and safe test requesting and sample processing and Scope results interpretation in the laboratory. The aim is that all providers of clinical diagnostic pathology services in Microbiology, Biochemistry, Haematology, Histopathology, Immunology and

Genetics in the NHS will be required to implement and use the NLMC. Challenges The NLMC project has presented considerable challenges, some of which

arise from the use of existing elements in historical databases as the start Individual local providers of pathology services will be free to determine which point for formulating and editing catalogue content. tests from the catalogue are made directly available to clinicians, to place requests. The delivery of Diagnostic and Public Health Microbiology services is complex and encompasses bacteriology, virology, mycology and Project Governance parasitology and there are wide local variations, for example in diagnostic The governance process for assuring the quality of NLMC content is hosted by methodology and reporting algorithms. the Royal College of Pathologists on behalf of the NHS. The Department of Health owns the NLMC and its content. The challenge is to create a ‘future-proof’ database or ‘list’ of tests and report formats that will ultimately help to standardise Microbiology The individual NLMC Clinical Specialty Leads (CSLs) are accountable to the requesting and reporting in the NHS. National Lead, who sits on the NLMC Governance Board, chaired by the President of the Royal College of Pathologists. Conclusions and Key Messages The National Laboratory Medicine Catalogue (NLMC) is a unique data NLMC Microbiology test naming structure set which will standardise the way that pathology tests are requested

Single permitted test display name or examples of permitted test display Purpose of Test Test type Naming convention structure and reported electronically in the NHS. names Culture for bacterial and fungal pathogens with or Bacterial and Bacterial and fungal MCS without microscopy, identification and/or susceptibility fungal MCS testing Culture for fungal pathogens only with or without Fungal MCS Fungal MCS microscopy, identification and/or susceptibility testing The Catalogue is a set of uniquely defined pathology test requests and Culture for specific pathogen genus or species (bacteria, Named pathogen Examples: Neisseria spp. MCS; Bordatella spp. MCS; MRSA MCS; fungus, virus or parasite) with or without microscopy, MCS Actinomyces spp. MCS; Mycobacterium spp. MCS; Cryptococcus neoformans associated report items that have been validated for use within the NHS. identification to species level and/or susceptibility testing MCS: Trichophyton spp. MCS; Influenza MCS; Leishmania spp. MCS Microscopy for gastrointestinal parasites (ova, cysts and Microscopy OCP Microscopy OCP parasites) Microscopy of or fluid without specifying a pathogen Microscopy for < for cells/organisms> Microscopy for cells/organisms. and without culture or susceptibility testing. cells/organisms (This test would encompass microscopy of an endocervical swab for clue cells. Going forward, the NLMC will require prospective (initially quarterly) Note this test category is for microscopy alone, without culture). Microscopy for specific pathogen genus or species Named pathogen Examples: Plasmodium spp. microscopy; Trypanosoma spp. microscopy (bacteria, fungus, virus or parasite) without culture or microscopy review, and updating; stakeholders will be invited to help refine and susceptibility testing. Screen for the presence of bacterial pathogens by detection Bacterial rRNA Bacterial rRNA gene detect improve its content. A feedback form is included with the Catalogue for of bacterial ribosomal RNA genes gene detection (Bacterial 16S rDNA by NADA) Screen for the presence of fungal pathogens by detection of Fungal rRNA gene Fungal rRNA gene detect the submission of any questions or suggestions about any aspect of the fungal ribosomal RNA genes detection (Fungal 18S rDNA by NADA) NLMC. Screen for the presence of specific pathogen genus or Named pathogen < DNA> OR Examples: Chlamydia spp. DNA; MRSA DNA; Tropheryma whippelii DNA; species (bacteria, fungus, virus or parasite) by nucleic acid NADA . Bacillus anthracis DNA; Rickettsia spp. DNA; Mycobacterium spp. DNA; detection assay (NADA) Aspergillus spp. DNA; Influenza RNA; HSV DNA; Toxoplasma gondii DNA; Option to add to specify a separate Trypanosoma spp. DNA; CMV DNA; CMV DNA level. quantitative test name for limited designated tests. Specific pathogen genus or species (bacteria, fungus, virus Named pathogen

Identification of arthropod of medical importance Arthropod Arthropod identification identification http://nlmc.x-labsystems.co.uk http://www.connectingforhealth.nhs.uk/systemsandservices/pathology/ Methods modernising/projects/nlmc As the NLMC Specialty Lead for Microbiology, I have consulted with a range of colleagues to construct a simple, comprehensive and robust system for the Acknowledgments naming of diagnostic microbiology tests. I thank those who have provided their professional opinions and contributed to this work, in particular: Guidelines to enable a consistent approach to the naming of tests and use of Dr Matthew Laundy, Consultant Medical Microbiologist, St George’s Hospital, London, terminology within the Catalogue are set out in the NLMC’s Editorial Principles. Tony Oliver, Advanced Practitioner, Virology, Barts & The London NHS Trust, Dr Mohammad Raza, Consultant Virologist, Sheffield Teaching Hospitals NHS Trust The Catalogue is web based and the method for editing, adding or deleting tests Dr Liz Johnson Director, and Michael Palmer, Clinical Scientist, HPA Mycology from the Catalogue, is via a web-based editing tool. Reference Laboratory, Bristol, Richard Barton Principal Clinical Scientist, Mycology Reference Centre, Leeds General Infirmary. The initial release of the Catalogue is now available for wider peer review and can be accessed via the NHS Connecting for Health website: I also thank Dr Paul Collinson, NLMC, National Clinical Lead, and http://www.connectingforhealth.nhs.uk/ Howard Beswick, Maxine Chappell and Gifford Batstone, NHS Connecting for Health and my fellow NLMC Clinical Specialty Leads in the other Pathology disciplines.