Back to the Floor - Pathology
What on earth goes on in Pathology? Well pathology is the study of body tissue and fluids and there are a myriad of departments dealing with a multitude of tests and all of it confusing for the uninitiated. Now as you know I go back to the floor twice a month to find out what it’s like for our patients to be treated here, what it’s like for our staff to work here and to see if there is anything I can do to make it better place for both patients and staff. Hospitals are often enormous places and not all of our staff knows what happens in different departments so part of my blog is also aimed at making it a bit easier to understand for our staff, our governors, our volunteers and anyone else who reads it! So for those of you who live and breathe pathology do forgive me my simplistic take on a complex world.
There were two things I learned from my visit:
- This is another of those departments where it simply isn't possible to see everything in a single shift. I've done 2 shifts in the department and I'm booked in for a third. I think I'm entitled to ask for my own locker and key!
- Everyone sniffs plates. Oh it’s true alright and all will be revealed – read on!
There are over 300 people working in pathology. There’s a lot of work done behind the scenes and the patient-facing aspects include anticoagulation and phlebotomy. Around 1500 new patients and 13,000 follow up patients come to the hospital for anticoagulation tests each year. Every year the team receives 1.3 million requests for blood sciences, 500,000 requests for microbiology and 32,000 requests for cellular pathology. The infrastructure to manage and process these requests on such a scale is enormous.
The laboratory is really involved with Modernising Scientific Careers and has students at Apprenticeships, Associate Practitioner, Practitioner and Scientist levels. They are currently putting in a new pathology wide IT system and will be redeveloping estates within the auto laboratory so lots of changes happening to improve the environment.
I was invited to experience the ‘aroma of microbiology’ which I thought sounded really nice and then promptly started off in the wee/poo room. Yes indeed, that is what it’s known as locally, although technically, they reminded me, the brown stuff is known as stools. Oh my days! The smell was pretty overwhelming but the staff didn’t even seem to notice it. They spent most of the time extolling the wonderful colours of the specimens …my own facial colour was pretty unusual by this time; apparently trying not to breathe does that! When the General Manager Gill first started in pathology they told her to go and work in the stool room and she spend the first hour of her day looking for a room full of furniture. That is a true story! One day I’ll tell you the stories of when I was a student nurse and they sent me to pharmacy for Bowmans’ Capsules followed by a trip to theatre for a long weight (wait). You get the picture!
Anyway back to the story …they test 500,000 specimens each year, 96,000 are urine tests, 10,000 are poos and half of these are tested for c. difficile. Apparently it used to take a whole day to process the test but it’s now done in 25 minutes which means the patient is isolated and diagnosed earlier which has got to be better for them and their fellow patients. Did you know that C. difficile can be caused by inappropriate use of antibiotics so one of our clinicians has developed an antibiotic app that can be downloaded free of charge from iTunes. Have a look if you get a few minutes because apparently it’s excellent!
They told me that some bacteria cannot be analysed on an open bench and have to be processed in containment level 3 rooms with air cabinets to protect staff. They gave me examples of bacteria like typhoid, tuberculosis and E.coli 0157; this is pretty scary stuff to be dealing with so it’s critical that they follow all the process in order to protect themselves and others.
I went into Cell Pathology and watched one of our Consultant Pathologists cutting up some breast tissue and he showed me what a malignancy looked like and how he was able to reassure the surgeon that the malignancy hadn’t breached the margins. In the Immuno-histo chemistry department they explained how they analyse tissues to assess suitability for certain chemotherapy drugs such as Herceptin testing (our trust is the regional centre for this specialised test). Neuropathology visit was really interesting and is a highly specialised and highly trained area for analysing brain and spinal tissue. Did you know we host the tissue brain bank for the North West collaboration for research for brain tumours? It’s all very clever stuff and we really should shout more about what our clinicians do.
I was taken to see the electron microscope which had been out of action for a while but clearly holds a special place in the hearts of some staff. Currently our samples are being sent to Manchester which is causing some delay in the pathway for our patients. But as a result of a paper written by Gill and Christine Thomas and presented to the Executive Team we have agreed to fund a new Electron Microscope to support regional renal services at an equipment cost of around 200K.
The next part of my visit was to Microbiology so that means virology, bacteria and anything in-between that doesn't grow on agar plates. This is also the department where everyone sniffs plates and you know what, at first glance they seemed such ordinary people…..! What they do is to take the specimen and spread it onto an agar plate, leave it to grow for a few days, have a look and a sniff and make the diagnosis. Within about 10 minutes I was one of the gang; I had become a fellow sniffer! This is what I learned:
- Strep milleri causes abscesses - smells like toffee!
- Yeast - smells like bread or wine
- Staph. aureus smells like burnt cake
- Pseudomonas - smells like old trainers
- Flu bacteria smells like mice nest (if anyone has ever smelled one!!!)
- There’s a rather pretty fungus called ‘fluffy bunnies’ grown from not-so—pretty skin and nail bugs. One of the staff said this was her favourite. Imagine having a favourite fungus ……don’t fret, we’ll get her some counselling!
All of these tests use thousands and thousands of agar plates and when the diagnosis is made and the plate is finished with they go into the autoclaves (bit like an enormous pressure cooker) to decontaminate before being destroyed.
The team also deals with parasites and they keep books on insects close at hand. Sometimes they get worms sent in from GPs which have been brought in by anxious Mums and Dads - fortunately they often turn out to be earth worms that kids drop down the loo and are spotted by parents convinced that their little one has just passed it! That happened to me when our eldest son Ollie was about 4 years old but I’d wised up by the time our second child Myles had come along!
There are lots of things for us to be proud of; we are a referral lab for measles, mumps and rubella and carry out tests nationally. We have a great history here because our staff at Royal Preston Hospital developed the tests in the first place. Molecular testing is used to diagnose HIV, syphilis, chlamydia and a whole raft of other things. We take samples from all over the North West. Our Haematology department supports the anticoagulation service in providing results for patients on warfarin, and performs thousands of full blood counts weekly. Lucky for our teams most of this activity is done by the robots! Our transfusion team supplies blood to support ED and theatres when our patients require blood urgently. They work 24 hours a day every day to provide the highest quality of support for our patients.
Earlier this year Pathology celebrated 100 years in Preston and a national conference was held to commemorate this. It was a fabulous celebration of a fantastic laboratory service. I was privileged to open the conference and attend the dinner where our Medical Director Sean Hughes gave one of his infamous after-dinner speeches. ….. I desperately hope no one has a copy of it or recorded any part of it! I’ve included a link here to Martin’s MBE – (we’re very proud of him!) presentation and some of the pictures they used and if I tell you that in 1823 the price of leeches had risen to 3d each I hope I’ve whetted your appetite enough to take a look at it!
What really came through during these visits is the diversity of the work the pathology team does, and the range of different professions and backgrounds within the team, including scientists, technicians and lots of others – but that no matter what role, everyone is really patient-focused and conscientious about getting things right for our patients, which is great to see.
Sincere thanks to everyone in the department who took me under their wings to show me the best of their services and who patiently explained over and over just what everything did and how it fitted into our care for patients – only for me to ask the same question again!
I really enjoyed both my visits – see you soon for the third!