Clinical Guidance
The transfer of pathology services to Synnovis has inevitably involved some changes to existing processes. However, much work has been done to ensure the number of changes have been kept to a minimum.
Here is a list of areas where changes apply – please click on each link for more information, or scroll down the page.
- Care Sets (Test Groups)
- Test Repertoire
- Abnormal/Critical Telephoning Limits
- Reference Ranges
- Acute Kidney Injury (AKI) Reporting
- Phlebotomy and Sample Services
- Collection times
- Best Practice for Highlighting Patient Conditions
- Connect Care
Care Sets (Test Groups)
Click here to see the Care Sets (Test Groups) that are now available through tQuest.
Test Repertoire
Tests available across Bexley, Greenwich and Lewisham have been reviewed in conjunction with local GP leads and have been aligned with the testing repertoire available to GP practices across Southwark and Lambeth.
A full list of pathology testing services now available is available by clicking here. (This will open/download a xlsx document)
You may find that some tests are no longer available. If there is a specific test that you need but cannot find, please contact the Synnovis Pathology Support Services team who will forward on your query for clinical consideration.
There are some changes to the test components of common Blood Sciences profiles and these are listed in the table below. Please be assured that everything that was previously included in these profiles is available as a separate orderable test:
| Component Tests | Important information | |
|---|---|---|
| Full Blood Count (FBC) | Additional parameters are now being reported as part of the FBC. Please find further clinical guidance on this here | |
| Renal profile | Sodium Potassium Creatinine eGFR | There is an additional option to order a Renal + Urea profile (RENU) |
| Liver function Tests | Total Protein Albumin Globulin Total Bilirubin, Alkaline phosphatase AST Gamma GT | AST and Gamma GT are now part of the LFT ALT (Alanine Transferase) is no longer included but can be ordered separately |
| Bone Profile | Calcium Corrected Calcium Phosphate Albumin Alkaline phosphatase Magnesium | Magnesium is an additional test in this profile |
| Auto-antibody Screen | Anti smooth muscle ab Anti Gastric Parietal cell ab Liver kidney microsomal abs Anti mitochondrial abs | Anti Nuclear Antibody (ANA) is no longer part of the screen but can be ordered separately |
| Connective Tissue Disease Screen | Anti Nuclear Antibody | There is a new CTD test under development that will be available shortly. In the meantime, please order ANA |
| RAST/Allergy tests | Individual Allergens available are: Cat dander Dog dander Cow’s milk Egg Fish mix Food mix Grass pollen mix House dust mite Mould mix Nut mix Tree pollen mix Wheat | These tests can be ordered separately ‘RAST’ is no longer a search prompt within tQuest – please use ‘Allergen’ or the specific name of the allergen you require |
Histology and Non-Gynae Cytology
The facility to order Histology and Non-Gynae Cytology tests within tQuest is temporarily unavailable, and a paper request form needs to be sent with the specimen. Please be assured that samples will be processed as normal and the results delivered electronically.
We are working hard to add both Histology and Non-Gynae Cytology into the tQuest electronic ordering catalogue and will notify GPs and practices when this has been completed.
Abnormal/Critical Telephoning Limits
The critical telephoning limits for some Blood Sciences tests have changed following the transfer of services. These have been developed based on the Royal College of Pathologists and NICE guidance, and in conjunction with the local clinical teams. The new telephone criteria can be seen in two documents accessible via the links in the table below. Differences are highlighted in red on these documents and there is some additional guidance about what those changes are.
It is not anticipated that there will be any changes to the notification process of any clinically significant Microbiology or Histopathology results. Further information can be found in the user guides on our User Guides and Useful Documents page
| Test Parameter | Critical result to phone |
|---|---|
| Biochemistry | Click here to see the changes in detail |
| Haematology | Click here to see the changes in detail |
Reference Ranges
Some changes to reference ranges in pathology testing have been inevitable due to Synnovis’s use of different analytical equipment, methodologies and reagents.
All Synnovis reports have the reference ranges incorporated within them and results should be interpreted in the context of these. Some tests will have interpretative comments added to results and some of these may also look slightly different.
Specific and clinically significant changes have been identified in the following tests:
| Test Code | Discipline | Important information |
| Anti Nuclear Antibody | Immunology | These will be reported differently in the short-term and you will now receive an ANA immunofluorescence pattern. If it is positive, we would then go on to do DNA and ENA antibodies. There is a new method under development which will report numeric values, as was the case prior to transfer. Please contact Synnovis Pathology Support Services with any queries and they will direct you to the Immunology department. |
| Faecal Calprotectin | Reference Biochemistry | Reference Ranges and comments: • <50 µg/g faeces: Normal • 50-150 µg/g faeces: Intermediate; please repeat test in 4 to 6 weeks’ time (if this is a repeat test and/or there is clinical concern, consider referral) • >150 µg/g faeces: High; suggestive of IBD or other inflammatory pathology. Consider referral to secondary care. NB: Known IBD: interpret results in context of clinical assessment. There has been a slight change to the previous indeterminate range, which was 50-120 µg/g with a positive result >120, bringing the ranges into line with the reporting guidance for faecal calprotectin in primary care – IBD-pathways (selondonccg.nhs.uk) |
| Haematocrit | Haematology | Units are now reported as L/L (Standard International units) instead of % (conventional units). This means that the number in the result is still the same, but is reported as 0.35 rather than 35%. |
| Lamotrigine | Reference Biochemistry | Units are now mg/L (were µmol/L). Reference Range is 2.5 – 15 mg/L (was 4-60 µmol/L). |
| NT-proBNP | Biochemistry | NT-proBNP is reported in ng/L, rather than pmol/L. All results will be issued with the following interpretive guidance, in line with NICE guidelines NG106 Chronic Heart Failure in Adults: Management (2018): <400 ng/L Heart failure unlikely; 400-2000 ng/L Requires review in heart failure clinic within 6 weeks (request ROUTINE appointment on e-referral); >2000 ng/L Requires review in heart failure clinic within 2 weeks (request URGENT appointment on e-referral). |
| Serum potassium | Biochemistry | Reference range is 3.5-5.3 mmol/L (was 3.5-5.0 mmol/L)* This aligns with the range recommended by the Pathology Harmony Group in 2011 and will help prevent patients from having their results flagged as normal by some of their care providers, and abnormal by others. This range is also more appropriate for the potassium results observed in the local healthy population. *Applies only to GP practices served by King’s College Hospital and Princess Royal University Hospital sites (not Guy’s and St Thomas’ Hospital, due to IT reasons) |
The above list is not exhaustive and the most up to date reference range for any given test will appear on all results reports. As reference ranges on Synnovis tests may differ slightly to those that GPs and practices were previously used to, it is important that results are viewed in association with the ranges given on the corresponding report.
Acute Kidney Injury (AKI) Reporting:
With the transfer of testing to Synnovis, it is not possible for us to report a patient’s AKI status on the first renal profile we process, so you are advised to monitor this using your own historical creatinine data. We will be able to report AKI on any subsequent samples received and, in line with the abnormal/critical telephoning limits guidance, we would notify the requester with any AKI stage 2 or 3 flags.
For Acute Kidney Injury Warning Algorithm Best Practice Guidance, click here.
Phlebotomy and Sample Services
The transfer of services has meant changes to the way specimens are requested and who tests them. Any bloods or samples requested by Lewisham and Greenwich NHS Trust (LGT) clinicians must be tested by LGT, while any bloods or samples requested by GPs must be tested by Synnovis.
All affected GP practices, community sites and healthcare workers (including community nurses) have been contacted with details of the changes and instructions on what they need to do differently.
All bloods and samples requested by GPs need to be put into orange bags provided by Synnovis, for collection by CitySprint couriers. Consumables can be ordered through Synnovis’s consumables ordering portal.
Further guidance, advice and support is available from the Synnovis Pathology Support Services team.
Collection Times
Major efforts have been made to ensure that any changes to sample collection times have been kept to a minimum. Comprehensive testing has been performed across all routes, with additional collections added and others removed where this has been requested.
Any queries regarding collection arrangements should be directed to Synnovis Pathology Support Services.
Best Practice for Highlighting Patient Conditions
Please provide all relevant clinical information to support requests, including any relevant pre-existing medical conditions, as this will help our reporting clinicians to provide appropriate advice regarding interpretation and assist them in making decisions around notification and follow-up.
Connect Care
LGT colleagues are continuing to use the Connect Care system to view Primary Care results for an interim period while a longer-term solution is developed. This was a known technical issue prior to the transfer that we have been working on jointly with LGT to resolve. We will ensure updates are provided on this situation as soon as possible.
Synnovis Pathology Support Services
Call 020 4513 7300 or email customerservices@synnovis,co,uk
