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OBJECTIVE: To provide accurate and
timely diagnoses of diseased tissues removed at Medical Center of Louisiana
in New Orleans.
DIAGNOSTIC AND CONSULTATIVE SERVICES
All surgical specimens on human tissues removed in the Hospital must be sent
to the Pathology Department where they will be properly processed, examined and
reported.
Material received in the Surgical Pathology Laboratory is assigned to
either the LSU or Tulane service depending upon the prefix of the hospital
number. Medical school designations cannot be arbitrarily changed; each
specimen becomes the responsibility of the designated school service.
All specimens must be identified with the patient's name, clinic or ward,
hospital number, and the type of tissue submitted. Clinical diagnoses,
relevant history, and operative findings should be included on the pathology
request slip. The submitting physician must legibly sign the slip, include
his service and beeper number. In case of any apparent incorrect labeling or
mix-up in the identification of a biopsy specimen, such specimen will not be
processed by the laboratory. Specimens should be transported directly from
the operating room or the treatment room to the Pathology Laboratory.
The proper identification of the specimen and the care and preservation of
the specimen are the responsibility of the attending physician until the
specimen is received in the Pathology Laboratory. Surgical specimens must not
be removed from the hospital prior to the examination by the Pathologist.
Special research techniques or surgical materials are never indicated as a
primary procedure. If a positive diagnosis has been made on biopsy material,
additional biopsies may subsequently be taken for special research
techniques.
Diagnostic studies on tissue processed by routine histopathologic
techniques are required by hospital rules. Deviations from this standard
procedure will be referred to the chief resident and staff of the clinical
services as well as Tissue Committee. It is the responsibility of the
clinician to alert the pathologist to the need for bacteriologic studies. Material
to be cultured should be submitted in a sterile container and should be kept
separate from material submitted for histopathologic study. If a question
arises regarding the techniques for obtaining and handling tissue for
culture, the clinician should consult with the Pathology Laboratory.
SLIDES FROM OTHER HOSPITALS
If it is necessary to request slides from private hospitals or from other
Louisiana Hospitals on individuals who are presently patients at Medical
Center of Louisiana at New Orleans,
please submit your request for these slides through the Histopathology
office. The letter should be signed by the requesting physician. As soon as
the slides arrive, they will be assigned a special number and examined by the
appropriate surgical pathology service. A report will be sent to the Record
Library to become part of the patient's permanent record and a copy of the
report will be sent to the requesting physician.
CONSULTATIONS
Consultations between the pathology laboratories of the two local medical
schools should be handled in a formal manner. The clinician who desires the
consultation should request that the slides be sent to the consultant by the
responsible pathologist. A verbal report which results from an informal
consultation cannot be used to legally justify a particular type of treatment
and is not recognized by Medical Center of Louisiana at New Orleans.
SLIDE CHECK OUT
Slides which are needed for conference directly concerned with medical care
may be checked out of the files at Medical Center of Louisiana at New Orleans, but should
be promptly returned. Physicians who do not comply with this rule will lose
their privileges in the Pathology Laboratory. Problem cases will be referred
to the Chief on the respective service. Lack of cooperation at this level
will result in the loss of privileges for the respective service. These cases
will be referred to the Hospital Director.
The slide becomes part of the permanent hospital record of the patient. The
paraffin block is also part of the permanent record and should be preserved
in anticipation of the need for additional studies. Wet gross tissue is saved
for a one month period of time following the final interpretation of the
histopathologic preparations. This wet gross tissue is available to the two
medical schools for preparations of study sets or for additional studies.
Sections prepared from paraffin blocks of surgical pathology material at
either of the two medical schools should be given Medical Center of Louisiana
at New Orleans labels and should be returned
to the files at Medical Center of Louisiana at New Orleans, following completion of
indicated studies. It is not the responsibility of the Pathology Laboratory
to furnish slide sets to residents in training. Abuses of the files in the
Pathology Laboratory will be referred to the Director of the Laboratory.
Gross surgical specimens are dissected and described every day in the
Histopathology Laboratory. The house staff is invited to review the gross
specimens by arranging a convenient time with the Pathology residents on each
service (LSU 903-2496 or Tulane 903-2422). No surgical specimen is to be
dissected by anyone other than a member of the Pathology staff without
specific approval of the responsible pathologist.
In cases where the surgeon wishes to see the specimen dissected in the
operating room, a member of the pathology staff assigned to frozen sections
should be called to assist in or perform this service.
The material received in the Laboratory must correspond to that indicated by
the surgeon in his description of the operative findings and of the specimens
removed. Discrepancies will be referred to the Chief Resident of the
responsible service .
FROZEN SECTION CONSULTATION
The concept behind the frozen section is that of consultation between
physicians. Frozen section consultation should be scheduled when the
operation is scheduled. A frozen section generally is indicated when there is
a need for an immediate therapeutic decision. Occasionally, a frozen section
is indicated to shorten the patient's hospital stay or to qualify the patient
for an emergency status on the operative schedule. Frozen sections are not
indicated for the personal convenience or curiosity of the surgeon when an
immediate therapeutic decision is not involved. Request for frozen section
consultations should be accompanied by a pathology request slip with adequate
documentation of the need for frozen section. A pathologist will be on call
for emergency frozen section consultations in any cases in which a frozen
section has not been scheduled, and can be reached via the paging operator.
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