Beth Israel Deaconess Medical Center Laboratory Manual

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The Clinical Laboratories at Beth Israel Deaconess Medical Center accept specimens, perform tests, report results and bill for tests in accordance with federal Medicare regulations. The laboratories encourage physicians to order tests individually, based on medical necessity.

For almost all inpatients, ordering is done via the web-based Provider Order Entry system. For guidance on using POE, please use your web browser to go to the Caregroup portal at http://home.caregroup.org . On the top right hand side there is a link labeled "HELP". Click on "HELP" and you will see a list of links including "Provider Order Entry Info". Clicking on this will bring you to a brief overview of the system. Training guides about the use of POE are available by clicking on the link in the purple bar at the top of the page labeled "Training". Click here to go directly to the training page.

For outpatients and times when the POE system is not available, paper requisitions are used. The following information applies to both methods of ordering, but much of the data is automatically captured if you are using the POE system.

Ordering Tests:

Requisition information:
ALL test requisition forms must include the following information in legible print. If any of this information is missing or incomplete, it may result in delays in processing the orders:

• PATIENT'S NAME (LAST, FIRST, MIDDLE)
  Exactly as it appears in hospital record (on wristband or blue card).
• UNIQUE IDENTIFYING NUMBER
  A BIDMC medical record number is optimal.  Specimens sent to the laboratory from outside the hospital on patients who do not have a BIDMC medical record number should be actively identified by the patient’s date of birth.
• DATE AND TIME
  The specimen collection date must be written on the specimen label.  Time of specimen collection is optimal, but not mandatory.
• COLLECTOR’S IDENTIFICATION
  The person who identified the patient and collected and labeled the specimen must sign the specimen label and/or the requisition.  Choice of acceptable collector ID includes full name; last name and first initial; pager ID (5 digits); or phlebotomy code.  Initials are not acceptable.
• ORDERING PROVIDER – The name of the provider on the pre-printed requisition or print the first and last name of the ordering MD or nurse practitioner must be included.  Beeper number can be indicated in this field.
• RESPONSIBLE MD – The name of the provider on the pre-printed requisition or write the first and last name of the BIDMC attending physician ultimately responsible for the care of the patient must be included.  Beeper number may be indicated.
• SEND EXTRA REPORT TO – The first and last name and address of additional providers to whom the report should be sent.  This is optional on all outpatient requisitions.
• ICD 9 CODE(S) – Diagnosis codes are required on all outpatient requisitions and for specific tests, as indicated by the boxes on the requisition.
• TESTS ORDERED – The corresponding test(s) must be clearly typed, checked, or written on the requisition in ink.  Written tests must be specific.  Unclear orders may result in delays. 
• COMMENTS – Any information considered pertinent for the laboratory.  This may include comments about fasting, peak and trough drug levels, dosing information, etc.  NOTE: Do not use this section to order lab tests, as the lab will not consider this an order.
  
• ADDITIONAL INFORMATION – the following must be indicated, when appropriate:
• Collection meth/od (e.g. Clean Catch, Catheter, etc.) for all urine specimens
• Fluid type (e.g. CSF, pleural, etc.) for all non-blood/non-urine specimens
• Source for all non-blood specimens requiring microbiology testing
• Line from which specimen is drawn, when appropriate

Test name	Form	Source
Blood Bank	Green Blood Bank requisition	Office Depot form MC0517
HIV Antibody Screen & HIV Viral Load	HIV Diagnostics Consent and Requisition	Office Depot form MR0507
msAFP and Triple Screen	Maternal Screening requisition	call the laboratory
HIV Genotype	Orange insurance verification form	call the laboratory or use the link to print a form
HIV-2 Viral Load	CDC Specimen Submission Form	call the laboratory or use the link to print a form
Prenatal Genetic Screening (e.g. Cystic Fibrosis, Tay-Sachs, Canavan Disease)	Genetic Screening requisition	call the laboratory
Chimerism/Engraftment	The Blood Center of SE Wisconsin test requisition	call the laboratory or use the link to print a form
RAST	Quest Allergy Requisition	call the laboratory or use the link to print a form
State Laboratory Institute & CDC Microbiology Requisition	State Lab/CDC Requisition	Use the link to print form and send along with specimen or fax to 617-667-2750 for a previously submitted specimen
Platelet and PNH Testing Requisition	Platelet and PNH Testing Requisition	call the laboratory or use the link to print a form
State Laboratory Swine Flu Testing Form	State Lab Swine Flu Requisition	call the laboratory or use the link to print a form
Fragile X Requisition	Athena Diagnostics Genetic Testing Requistition	call the laboratory or use the link to print a form
Hematopathology / Cytogenetics / Flow Cytometry Lab Requisition	Hematopathology / Cytogenetics / Flow Cytometry Lab Requisition	call the laboratory or use the link to print a form

• Inpatients: send specimens by pneumatic tube or courier to:
  West campus: Lab, CC-248 (617-632-3230)
  East campus: Lab Control, 3rd floor Finard Building (617-667-LABS[5227])
• Outpatients: send all specimens by courier to:
  East campus: Lab Control, 3rd floor Finard Building (617-667-LABS[5227])
• Anatomic Pathology specimens can be sent to the Cutting Room
  

WRITTEN REQUESTS may be made in one of three ways:

• Additional test requests may be generated electronically, through Physician Order Entry. These requests are automatically faxed to the Clinical Laboratory.
• Additional written test requisition slips may be completed, in compliance with the above standards and sent or faxed (617-667-1533) to the Clinical Laboratory.
• An Additional Test (Add-On) Request form may be completed and faxed to the Clinical Laboratory.
  NB: Requests for Blood Bank only may be faxed to (617-754-3325).

VERBAL REQUESTS

• In emergency and surgical situations, verbal requests will be accepted by the Lab (west 4-3230 or east 7-5331) or by the Blood Bank (west 4-3300 or east 7-4480).
• Verbal requests for non-emergencies are not accepted. Customer Service requests written documentation at the time of the telephone call.

ADDITIONAL INFORMATION:

1. When space allows, hematology (CBC) specimens are stored 3 days and discarded on the morning of the fifth day.
2. When space allows, chemistry specimens are stored 5 days and discarded on the morning of the sixth day.
3. Tests may be added onto specimens already in the laboratory within a reasonable amount of time, if specimen requirements are met. (See below and see 6)
4. When multiple specimens have been received in the laboratory on a given patient, the specimen from the most recent date will be used for the add-on, unless otherwise specified.
5. If the add-on is unacceptable, for any reason, the ordering provider will be notified.
6. The following time restrictions (from collection) apply:

2. Inpatient blood test order sheet/ requisition

3. Blood gas requisition and whole blood analytes

4. Urine and fluids: Inpatient/ EW requisition

5. HIV Diagnostics Consent and Requisition

REQUISITION #1 Outpatient Laboratory Requisition   Outside Laboratory Requisition Example: The patient is an outpatient, and has had a CBC with differential, prothrombin time, glucose, hepatitis B surface antigen, and hepatitis C antibody ordered by a house officer. The patient's care is being overseen by a staff physician. Notes: All relevant ICD-9 codes for the visit have been recorded at the top of the requisition by the ordering MD The specimen collector's ID code, as well as the date and time of specimen collection are listed. The prothrombin time and glucose test require specific medical necessity justification with ICD-9 codes next to their order. If the ICD-9 chosen were not included in the Medicare list of codes supporting medical necessity, a Medicare patient must sign a waiver form acknowledging the lack of Medicare coverage for payment of the test. The ordering MD has written in his name (if you are a staff physician sending specimens regularly to the BIDMC laboratories, and would like your requisitions to include your printed name, contact your laboratory account representative at 617-667-LABS). An additional report has been requested for another caretaker.	REQUISITION #2 Inpatient blood test order sheet/ requisition Inpatient Blood Test Order Sheet/Requisition Example: The patient is an inpatient, and has had a CBC (without a differential), a potassium, BUN, creatinine, and uric acid ordered. The house officer has signed the requisition, which is also the order form. Notes: Order only the tests you actually need. Note that the patient has a discrete order for potassium, rather than the entire collection of four electrolytes, and a discrete order for the BUN without the creatinine. The specimen collector's ID code, as well as the date and time of specimen collection are listed.
REQUISITION #3 Blood gas requisition and whole blood analytes Blood gas requisition and whole blood analytes Example: The patient is an inpatient, and has had an arterial blood gas ordered. Notes: The patient is an inpatient; therefore no ICD-9 code is required The specimen collector's ID code, as well as the date and time of specimen collection are listed. The sample data provided in the right hand column will be included in the lab results for your use in tracking the patient’s associated clinical conditions. This form can also be used for outpatients; in such cases, an ICD-9 code proving medical necessity must be provided in the blank at the top of the form. Helpful hints for using the Blood Gas & Whole Blood requisition: All of the tests listed on this sheet can be run from a single heparinized syringe (<=1ml) Please do not "write in" any tests on this sheet. If you sending a blood gas(i.e. pH, pO2, pCO2), please tell us if it is arterial or venous. The remainder of the respiratory information is optional. Only fill in the patient temperature if you want us to report temperature corrected results.	REQUISITION #4 Urine and fluids: Inpatient/ EW requisition Urine and fluids: Inpatient/ EW requisition Example: The patient is an inpatient, and has had a urinalysis – dipstick plus sediment exam – ordered. Notes: Please specify the mode of collection; this will be reported with the result. The specimen collector's ID code, as well as the date and time of specimen collection are listed.
REQUISITION #5 HIV Diagnostics Consent and Requisition HIV Diagnostics Consent and Requisition Example: The patient is an outpatient, and has had the antibody test for HIV ordered. Notes: All relevant ICD-9 codes for the visit have been recorded at the top of the requisition by the ordering MD. The specimen collector's ID code, as well as the date and time of specimen collection are listed. The requisition includes a consent, which must be signed by the patient and provider obtaining consent. Forms received without signed consent, or HIV serology written in on another requisition, will not be processed by the laboratory. On outpatient requisitions, the name of the responsible physician must appear, even if the test has been ordered by a house-officer. The ordering house officer’s name appears in the blank "Ordering RN or MD". An extra report can be mailed to another caretaker, by listing the name and address of the individual in the space provided. HIV testing CANNOT be added on to an existing sample - please draw a new sample.	Additional Test (Add-On) Request Additional Test (Add-On) Request

Revised/Reviewed 7/23/2009