1.8 - Send out processing General Information

John C. Lee, MD

857-203-5944

BHS	Mary Pitts	857-203-5403
Bedford	Bhumikaben Patel	781-687-2976

BHS Send Outs	857-203-5975
Bedford	781-687-2603

West Roxbury:	857-203-5975 ext. 3-5975
Flow Cytometry Lab:	857-203-5942 ext. 3-5942

Cytogenetics
HLA Phenotyping
Semen Analysis
Emergency Toxicology Testing
Stat Test Requests
Chain of Custody drug testing

1. Requisition and Specimen Identification:
   1. For LEDI sites: A shipping (LEDI) manifest must accompany each batch of specimens. LEDI manifests are used for all testing performed in Clinical Pathology (Chemistry, Hematology, Immunology, Microbiology, Virology, and Molecular) and in Anatomic Pathology (Cytology). Manifests should be set up so that special information like 24hr total volume appear electronically on the manifest. Cytology samples should also be sent with patient summary reports.
   2.  If there are problems with the manifest system sites can use the “long form accession list” instead. This long form should only be used for small numbers of tests. Your VA designation must be noted on the Long form list.
   3. For non-LEDI CBOC Lab sites: A remote site tracking log must accompany each batch of specimens.
   4. Blood bank samples from Brockton and Jamaica Plain are sent via an internal LEDI manifest system.
   5. All specimens must be labeled with the following information: Patient full name, full SS#, collection date and time, total volume of timed urine collections, sending lab’s accession number, and type of sample (urine/serum/plasma, etc.). A computer generated label will be acceptable.
       
2. Shipping:

   VISN 1 REFERENCE LAB 113WR Room 1B124
   VA BOSTON HEALTHCARE SYSTEM
   WEST ROXBURY DIVISION
   1400 VFW Parkway
   West Roxbury, MA 02132
   857-203-5975 ext. 3-5975
   Place a white "WEST ROX" label on the outside of the packages
   Place a yellow “WEST ROX CYTOLOGY MANIFEST” label on the outside of packages containing cytology manifests.
   
   VA CONNECTICUT
   WEST HAVEN DIVISION
   950 Campbell Ave
   West Haven, CT 06516
   (203) 932-5711 Sp. Chem ext. 2927
   (203) 937-3441 Virology
   Place an orange "VA-CT" on the outside of the packages
   
   **Room number must be included to guarantee delivery to laboratory in a timely fashion.

   1. Each VA will purchase pour off tubes specified by NCL-West Roxbury and appropriate shipping containers that meet state and federal regulations for transporting diagnostic or infectious specimens.
   2. All specimen are transported by Quest Lab services, VA shuttle, or other commercial courier service must be addressed to the appropriate NCL Lab listed below (please refer to the test specific section of this manual for location of testing):
   All shipping containers will be returned to the sending laboratory via the shuttle. Igloo coolers will be returned/exchanged by the shuttle driver.
    
3. Specimen Collection Procedures:
   Specimen collection and shipping requirements are contained in this joint directory.  If a test is not listed, please contact West Roxbury Send out Department or the Bedford Lab  for appropriate instructions. Frozen refrigerant packs should accompany the specimens; dry ice may be necessary with overnight delivery to ensure specimen integrity and eliminate freeze/thaw cycles. A separate mailing container must be used for those specimens requiring room temperature storage and transport. Please separate the specimens from the requisitions in case of leakage. Care should be taken to buffer (by using paper towels for example) the refrigerant pack from the specimens.
    
4. Reporting Results:
   1. Electronic
      Test results will be transmitted through the LEDI system as soon as they are verified in the testing site (provided the sending lab has set up their LEDI system for the tests). All reported results will have the sending lab’s accession number or unique accession number indicated in the report.
      Every morning a VISTA routine pulls all LEDI results in to a Vista mail message and transmits them to the sending site.
   2. Normal Values and Panic Values:
      Normal values for tests performed at the West Roxbury Lab are published in the test section of this directory. The West Roxbury Lab staff will immediately contact the sending lab if a test result is in the panic value range.
   All questions pertaining to the status of test requests, results reported, etc. should be directed to the Testing Lab.
    
5. Cancellation of Tests:
   1. The ending lab will notify the Testing Lab by phone to cancel any test already received by the Testing Lab.
   2. Unacceptable specimens: The sending lab will be notified upon receipt of any specimens that can not be analyzed. Reasons for unacceptability include the following: improper temperature, incorrect specimen type, incorrect specimen volume, incomplete patient/specimen identification, compromised specimen integrity, etc.
       
6. Testing Exceptions and Special Instructions:
   The following list of tests should be processed by the sending facility using their current protocol and vendor, due to integrity of specimen or urgency of test results:
7. Billing Issues:
   The VISN has established a single control point for all referral testing which is monitored by the VISN NCL Director. All send out testing comes under this account, therefore, ALL billing and accounting will be done through the NCL at the Brockton/West Roxbury Division.