A good quality Virology / Microbiology service
- requires entry of relevant clinical details, as this allows laboratory staff or the electronic system to allocate the most appropriate tests
- offers “syndromic order sets” in preference to individual tests whenever appropriate. This can facilitate appropriate testing and reduce the risk of missed or delayed diagnosis. Example scenarios, in which serological testing for a panel of relevant causes would normally be better practice than testing for individual infections, include: acute hepatitis; glandular fever syndrome; lymphadenopathy; or culture negative endocarditis
- requires the entry of the date of onset of symptoms, when applicable, to facilitate meaningful testing and interpretation
- requires the entry of date(s) of exposure for testing following disease contact (eg pregnant woman exposed to rash)
- prompts the requesting practitioner to enter the geographic and temporal details of any relevant travel history
- selects “syndromic order sets”, and or reallocates individual tests requests to “syndromic order sets” when appropriate
- adds additional tests, where there is a clear indication that this would be of immediate clinical benefit
- rejects requests: some tests will be appropriate only if specific clinical details are provided or a certain interval has elapsed from the date of onset. If it is decided not to perform the requested test, a report explaining the decision is released, in order to allow the user to provide more information to support their request.
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- It should be noted that laboratories can alter the tests requested if inappropriate, and perform other necessary tests at their discretion
- Some criteria which could also lead to rejection of clinical specimens for testing
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- unlabelled or improperly labelled specimen
- non‐sterile or leaking specimen/sample container
- inappropriate specimen transport conditions
- illegible or absent information on the request form
- mismatched form and specimen
- inappropriate specimen type
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- re-allocates to a non-serological test type: for instance, requests for hepatitis NAAT from non-specialists may be submitted by mistake instead of a request for serology. It may be clinically (and financially) preferable to perform hepatitis serology testing, if experienced scrutiny of the clinical details and any previous test results supports this, as hepatitis B/C NAAT is usually appropriately requested only after a diagnosis of this infection is made based on serology tests
- involves the Medical Virologist / Microbiologist in deciding what tests are appropriate. More clinical information, or a review of the patient, may be required.
PHE Document “Good practice when undertaking serology assays for infectious diseases (publishing.service.gov.uk)”
