Quality Policy
QUALITY POLICY
Nothing comes before quality. We are acutely aware that our patients and physicians are depending upon us to produce accurate, complete and timely laboratory results. We meet this need because we never forget that each specimen represents a person awaiting a laboratory report that they can trust to help in making important healthcare decisions. Proficiency testing, quality control, document control and quality assurance exercised at the pre-analytical, analytical and post-analytical stages ensure that each specimen receives the best quality testing that laboratory medicine offers.
Our commitment to quality is genuine and strong. Similarly, our commitment to compliance is based upon our belief that each person in our company will do the right thing every time, without compromise. We are pledged to this philosophy of ethical behavior and know that while this encompasses adherence to all applicable regulations and standards, it goes beyond what the law requires. Our commitment to our patients requires no less.
EQAS PROGRAMS
Clinical Biochemistry:
Biochemistry EQAS-CMC Vellore
Clinical Pathology:
NABL-Sysmex
AIIMS, New Delhi
GENERAL INFORMATION
1]Request Forms: The forms should have the following entries – Name, Age & Sex, Unit & Ward, IP/OP Number, Income – Non Paying / Paying Case, Convict/MLC/Non MLC, NGGO/ESI with Numbers, Clinical History, Provisional Diagnosis, Previous Test Results, Signature & Name of Unit Assistant Professor
2] Rights:Lab tests are based on Mechanical & Subjective Observations. All constituent divisions of the CDL have independent Internal and External QC mechanisms. Feed back is welcome for better service. If results do not correlate with the clinical parameters of the patient, call the concerned lab and inform the issue and ask for a repeat test if required.
3]Collections: EDTA Bottles [Red Necked] for CP/Hematology Blood Samples and Yellow Necked Bottles / Plain Bottles for Biochemistry Blood Samples are available at request.
4] Working: The CDL works for 24hours on all days. OPD : On all days 7.30am to 12.30pm. Routine Indoor: All Days7.30am to 5.00pm. Emergency undertaken all 24hours. Samples and Requests to be marked ‘URGENT’
5] Enquiries shall be made to the respective divisional Medical Officers and Technical Supervisors.
Statistics
| Year | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2009 | 2010 |
|---|---|---|---|---|---|---|---|---|---|
| Basic Biochemistry | 145181 | 213908 | 263386 | 292644 | 513233 | 561198 | 613321 | 592216 | 773109 |
| Endocrinology | 431 | 413 | 403 | 429 | 551 | 1323 | 1527 | 1731 | 1935 |
| Clinical Pathology | 259948 | 237744 | 261366 | 405533 | 505533 | 547930 | 607287 | 720504 | 984945 |
| Cytopathology | 2184 | 3392 | 4269 | 3841 | 3841 | 3082 | 3328 | 3862 | 3789 |
| Hematology | 2199 | 3186 | 3652 | 4369 | 4369 | 4795 | 6035 | 13076 | 20924 |
| Histopathology | 3817 | 4091 | 4142 | 4125 | 4125 | 4390 | 5510 | 5786 | 6018 |
| Bacteriology | 8168 | 6155 | 7314 | 18089 | 44130 | 49639 | 49924 | 49552 | 64761 |
| Mycology | 103 | 110 | 142 | 293 | 204 | 288 | 292 | 402 | 520 |
| Virology / Serology | 12154 | 15415 | 17113 | 12334 | 18432 | 18849 | 17286 | 18858 | 24846 |
| Parasitology | 94 | 130 | 181 | 57 | 120 | 172 | 132 | 185 | 124 |
Pathology
ANATOMIC & SURGICAL PATHOLOGY:
The Department of Pathology has a dedicated histopathology lab service for all material received from the theatres and wards of TVMCH and other affiliate hospitals. The laboratory has automated processing systems and undergoes quality assurance reviews between the pathologists. This unit of our department is the standalone supplier of rare specimens of tissue material for pathology museums in government run medical schools in the southern region of State of Tamilnadu.
CLINICAL PATHOLOGY:
The Department has a fully deployed Clinical Pathology unit in the TVMCH for patients being seen at the affiliate hospitals. All areas of Clinical study including the study blood, urine and body fluids are available. The lab routinely undergoes quality assurance reviews between the pathologists and with EQAS programs. The laboratory has automated Cell Counters, Automated Urine Analysis System and ESR analyser. This lab works 24×7 with a team of dedicated technicians.
LABORATORY HEMATOLOGY:
The Department of Pathology has a dedicated Hematopathology service easily accessible for patients being seen at the TVMCH and other affiliate hospitals. All areas of Hematopathology are available for consultation including: study of peripheral blood, bone marrow, lymph nodes, or extra-nodal tissues. The lab routinely undergoes quality assurance reviews between the pathologists and with EQAS programs. The laboratory has automated Cell Counters, ESR analyzers and Coagulation Systems.
CYTOPATHOLOGY:
The Department has a dedicated cytopathology service including a PAP smear program for the Obstetrics & Gynaecology OPD and Wards, FNAC OP & Fluid Cytology services for patients being seen at the TVMCH and other affiliate hospitals. All areas of cytopathology are available for consultation including: study of surface nodules, CT Scan and Ultrasonogram Guided studies. The lab routinely undergoes quality assurance reviews between the pathologists.
IMMUNOPATHOLOGY:
The Department runs immunopathology service that includes a wide panel of immunocytochemical and immunohistochemical stains. The lab routinely undergoes quality assurance reviews between the pathologists.
Biochemistry
| I. CLINICAL BIOCHEMISTRY [7.00AM-7.00PM] | |
|---|---|
| Blood Glucose | Blood Glucose : Fasting Samples to be taken at 7.00am after over night fast. PP Samples to be taken 1 ½ hrs/2hrs after break fast. |
| Random | Sr Lipid Profile : Fasting Samples to be taken at 7.00am after over night fast. |
| Fasting | Minimum Volume 2ml Specify time of sampling. Samples should reach lab within 15mts. Turn around time 3hours |
| Post Prandial | |
| Blood Urea /BUN | |
| Serum Creatinine | |
| Serum Lipid Profile | |
| Cholesterol | |
| Triglycerides | |
| LDL | |
| HDL | |
| VLDL | |
| Cholesterol /HDL ratio | |
| LDL/HDL ratio | |
| Serum Electrolytes | Do no squeeze arm for sampling. Specify time of sampling. Minimum Volume 2ml Samples should reach lab within 30mts. Turn around time 3hours. |
| Na, K | |
| Cl, HCO3 | |
| Serum Proteins | |
| Total | |
| Albumen | |
| Globulin | |
| Plasma CPK[MB] | |
| Serum Uric Acid | |
| Serum Calcium | |
| Serum Cholinesterase | |
| Liver Function Test | |
| SGOT | |
| SGPT | |
| ALP | |
| LDH | |
| Sr Bilirubin Total | |
| Sr Bilirubin Direct | |
| Sr Bilirubin Indirect | |
| Glucose Tolerance Test | TUESDAYS ONLY : Patient has to be directly referred to the CDL. Turn around time 5hours |
| Body Fluid Analysis | Specify time of sampling. Minimum Volume 2ml Samples should reach lab within 30mts. Turn around time 3hours |
| Stone Analysis | Turn around time 7days |
| Urinary 24hour Protein | Turn around time 6 Hours |
| Urinary Creatinine | Turn around time 6 Hours |
| Urinary Screening for In Born Errors of Metabolism | Turn around time 6 Hours |
| Thyroid Profile Test | FRIDAYS ONLY : Fasting Samples to be taken at 7.00am after over night fast. Case selection for tests only after discussion with Medical Officer i/c Biochemistry. |
| T3 | |
| T4 | |
| TSH | |
| OTHERS | |
| EMERGENCY BIOCHEMISTRY [24X7] | |
| Blood Glucose | Minimum Volume 5ml Specify time of sampling. Samples should reach lab within 15mts. Turn around time 1hour |
| Blood Urea /BUN | |
| Serum Creatinine | |
| Ser Electrolytes | |
| Na, K, Cl, HCO3 | |
| Ser Cholinesterase | |
| Sr Bilirubin Total | |
| Sr Bilirubin Direct | |
| Sr Bilirubin Indirect | |
| Body FluidAnalysis | |
| Plasma CPK[MB] | |
| EMERGENCY CLINICAL PATHOLOGY LABORATORY[24X7] | |
| Blood Hemoglobin | Turn Around time 1hour |
| Urine Acetone | Turn around time 15mts |
| Fluid Cell Count | Inform the lab prior to taking sample. And should reach the lab within 10 mts Turn around time 1hour |
| Occult Blood | Turn around time 1hour. Inform the lab prior to taking sample |
| CLINICAL PATHOLOGY LABORATORY[7.00AM-7.00PM] | |
| 1] BLOOD | Send Samples in EDTA Bottle [Red Neck] |
| TC, | Send Samples in EDTA Bottle [Red Neck]. Shake the bottle before sending sample to lab [to reach lab within 1 hour]. Turn around time 4hours. Minimum volume 2ml |
| DC, | |
| Hemoglobin | |
| ESR | |
| Platelet Count | Do not squeeze the limb to take blood. Send Samples in EDTA Bottle [Red Neck]. Shake the bottle before sending sample to lab [to reach lab within 1 hour]. Turn around time 4hours. Minimum volume 1ml |
| Smear forMP/MF | |
| Retic Count | |
| 2] URINE | Send in plain labelled capped bottle. No additives. Minimum volume 3ml |
| Albumen | |
| Sugar | |
| Deposits | |
| Blood | |
| Acetone | |
| Bile Salts | |
| B Pigments | |
| 3] BODY FLUIDS Cell Count | Send in plain labelled capped bottle. 1 drop of Formalin / 10cc. Turn around time 4hours. Inform the lab prior Sample should reach lab in 10 mts. Minimum volume 1ml |
| 4] MOTION | Send in plain labelled capped bottle. Turn around time 4hours. Inform the lab prior to sending sample. Should reach the lab in 30mts. |
| Ova | |
| Cyst | |
| Blood | |
| Red Sugar | |
| 5] SEMEN ANALYSIS | Send in plain labelled capped wide mouth bottle. Turn around time 6hours. Inform the lab prior to sending sample. And should reach the lab within 5mts. Minimum volume 2ml |
| HEMATOLOGY[7.00AM-1.00PM] | |
| Hemogram | Take Blood in EDTA Bottle [Red Neck]. Shake the bottle before sending sample to lab [to reach lab within 1 hour]. Turn around time 4hours. Minimum volume 3ml. Do not squeeze the limb to take blood. The requisition should have clinical history & lab test results. |
| Peripheral Smear Study | Take Blood in EDTA Bottle [Red Neck]. Shake the bottle before sending sample to lab [to reach lab within 1 hour]. Turn around time 4hours. Minimum volume 1ml. Do not squeeze the limb to take blood. The requisition should have clinical history & lab test results. |
| Bone Marrow Study | The Medical Officer i/c of CP/Hematology should be informed prior to taking sample. Requisition should have clinical history, Peripheral Smear study & Hemogram results. Sample to lab to reach lab within 1 hour. Turn around time 24hours. Minimum 6 slides. Peripheral Smear to accompany BMA slides. |
| Hemolysis Profile | The Medical Officer i/c of CP/Hematology should be informed prior to taking sample. Requisition should have clinical history, Peripheral Smear study & Hemogram results. Sample to lab to reach lab within 1 hour. Turn around time 24hours. Minimum volume 3ml. Peripheral Smear to accompany sample. |
| 1] Coombs Test | |
| 2] Os Fragility T | |
| 3] Sickle Test | |
| 4] Heinz Body T | |
| 5] AutoHemolysis | |
| 6] NESTROFT | |
| 7] Incubated OFT | |
| Hemostasis Test | The Medical Officer i/c of CP/Hematology should be informed prior to taking sample. Requisition should have clinical history, Peripheral Smear study & Hemogram results. Sample to be taken in tube issued in lab by technician. Sample to reach lab within 10mts. Turn around time 4hours. Minimum volume 3ml. Peripheral Smear to accompany sample. |
| 1] Bleeding Time | |
| 2] Clotting Time | |
| 3] PT – INR | |
| 4] APTT | |
| 5] Fibrinogen | |
| 6] Clot Lysis Time | |
| 7] Platelet Count | |
| CYTOPATHOLOGY[8.00AM-1.00PM] | |
| FNAC | Requisition should have clinical history, Lab results. Turn around time 24hours. |
| [Fine Needle Aspiration Cytology] | |
| Guided FNAC | Medical Officer i/c Cytology to be requested. Requisition should have clinical history, Lab results. Turn around time 24hours. |
| CERVICAL/VAGINAL SMEAR STUDY | Requisition should have clinical history, Lab results. Turn around time 24hours. |
| BUCCAL SMEAR STUDY | Requisition should have clinical history, Lab results. Turn around time 24hours. |
| HISTOPATHOLOGY[10.00AM-4.00PM] [COLLEGE] | |
| Requisition should have DETAILED clinical history & ALL relevant Lab results. The Samples should be sent in 10% Formalin – filled to 10 times the volume of the biopsy. Turn around time 5days. | |
Microbiology
| II. CLINICAL MICROBIOLOGY [8.00AM-4.00PM] | |
|---|---|
| Divisions | Investigations |
| Bactriology | Direct Microscopy |
| Gram Stain | |
| Acid fast stain | |
| Fluorecent sstains | |
| Culture and Sensitivity | |
| Clinical Serology | Widal Test |
| Card Tests | |
| Rheumatoid Factor | |
| Aso Test | |
| RPR Test | |
| Clinical Virology | Card Tests |
| HBSAG | |
| Dengue – IgM, IgG | |
| CHIK | |
| LEPTOCHEK | |
| ELISA | |
| DENGUE – IgM | |
| CHIK | |
| JAP Encephalitis | |
| HIV | |
| Mycology | KOH MOUNT |
| Lactophenol Cotton Blue Mount | |
| Fungal Culture | |
| Parasitology | Stool Examination |
| Wet Saline & Iodine Mount | |
| Modified Acid fast Stain | |
| Blood Smear Examination for MP/MF | |
| Theatre Sterilisation | Aerobic Culture |
| Anaerobic Culture for Tetanus | |
| Specimen | Instructions |
| URINE | Send in sterile screw cap container to the lab within 2 hours or refrigerated at 4°C and delivered within 24 hours. |
| Mid stream urine | DO NOT collect urine from bedpans, urinals, or catheter bags |
| Indwelling | |
| catheter urine | |
| SPUTUM | If TB is suspected, use precautions to prevent spreading of infection. |
| Induced sputum | Deep cough from the chest should be collected. |
| Suction tip | Collect sputum in a dry wide mouthed sterile container |
| Bronchoalveolar | Transport to the laboratory as soon as possible |
| lavage | Refrigerate at 4°C if there is delay in delivery. |
| Bronchial wash | Send three consecutive samples |
| PUS | Aspirated pus is ideal. swabs – only an alternative |
| Superficial | Send it in a dry sterile container within 2 hours. |
| Wounds | Avoid contamination with surrounding normal flora on skin etc. |
| Abscess | |
| Pustule | |
| Ulcer | |
| Deep wound | |
| SWABS | Send in a dry sterile container at the earliest |
| Throat, Urethra | |
| Vaginal, Aural | |
| Nasal swab | |
| CONJUCTIVAL SWAB | Use swab premoistened with sterile saline and send at the earliest |
| CORNEAL SCRAPINGS | Collect and Bedside inoculation of material in to Blood agar, Chocolate agar, SDA, Thioglycollate broth. Send immediately. |
| BODY FLUIDS | Collect in a dry sterile container and send to the lab without delay. |
| pleural fluid | |
| pericardial fluid | |
| peritoneal fluid | |
| synovial fluid | |
| amniotic fluid | |
| vitreous fluid | |
| CSF | Collect in a dry sterile container and send to the lab without delay. CSF is never to be refrigerated |
| STOOL | Send it in a clean leak proof container with Cary-Blair/VRM. |
| Transport to lab as soon as possible | |
| Send stool rather than rectal swabs | |
| BLOOD | Wash the area with soap &water and then with 70%alcohol |
| Do not palpate again | |
| Wear gloves while collecting - Drawn blood and immediately place in blood culture bottles and send within 24 hours. | |
| Incubate at 37c | |
| DONT REFRIGERATE | |
| TISSUE BIOPSIES | Collect in a dry sterile container and send to the lab without delay |
| It is not necessary to add sterile water to biopsies unless they are very small and in danger of drying out. | |
| Microbiology specimens should never be put in formalin. | |
| SKIN SCRAPINGS & | Scrape the skin from active edge of lesion in a dry sterile petri dish/black paper |
| SLIT SKIN SMEAR | |
| NAIL SCRAPINGS | Send clipings of affected area |
| Hair Clipings | Pluck hairs with intact shaft |
| Cut hairs are not satisfactory | |