Laboratory Medicine Testing Policies
We ask that those submitting specimens to our laboratories become acquainted with the following policies.
Medical Necessity Information
It is our policy to provide health care providers with the ability to order only those lab tests medically necessary for the individual patient and to ensure that the convenience of ordering standard panels and custom profiles does not impact this ability. While we recognize the value of this convenience, indiscriminate use of panels and profiles can lead to ordering tests that are not medically necessary. Therefore, all tests offered in our panels and profiles can be ordered individually as well. If a component test is not listed individually on the request form, it may be written in the “OTHER REQUESTS” box. We encourage you to order individual tests or a less inclusive profile when not all of the tests included in the panel or profile are medically necessary for the individual patient.
Forensic Testing is not available through the Department of Laboratory Medicine. We refer most of these requests to each state's Medical Examiner's office. Please consult the Laboratory Medicine resident on call if a specimen analysis may have unusual legal implications through the University Medical Center general paging number, 206.598.6190.
No Charge for Testing
The Department of Laboratory Medicine Reference Laboratory Services Division bills appropriately for all tests performed. Any test that is not performed for any reason will be promptly and appropriately credited.
Test is cancelled per client; test is resulted before request to credit
If a client has ordered the test and we have run it per their request, it is too late to cancel once any results are entered in our laboratory reporting system. The bill should be sent to the ordering location rather than the patient or their insurance.
Test is cancelled per client; test has not been resulted
As long as results have not been entered in our laboratory reporting system, we will credit the test as the client has requested.
Referral to Another Lab
Tests not performed in the Department of Laboratory Medicine can be referred to another qualified, licensed reference laboratory. We will inform the ordering location of the specimen and storage requirements. A report will be sent by the Department of Laboratory Medicine to the ordering physician.
Some of our tests can be ordered as reflex panels in which additional testing is done automatically in response to particular results from the initial testing. The tests for which users can choose reflex panels are indicated in the Online Testing Guide. When additional testing is done because the user has chosen a reflexive panel, the fees for the additional testing can be found in the Department of Laboratory Medicine's fee schedule.
Whenever there is a question about the validity of a test result, a repeat will be performed upon request at no extra cost.
As a test result becomes available, it is entered into the laboratory computer system and becomes immediately accessible for transmission to downstream systems that are used by providers to look up results. Clinicians at the University Medical Center, Harborview Medical Center, Northwest Hospital and Seattle Cancer Care Alliance can view laboratory reports electronically.
Results for patients from outside UW Medicine are printed and mailed or faxed (per client's request) the next business day. Providers can call Client Support Services (CSS) at 206.520.4600 or 800.713.5198 for a verbal result if it is needed sooner. Requesting laboratory values via telephone directly to the laboratory reduces the amount of time available for technical tasks and hinders the ability of the laboratory staff to do the most effective job. Please direct your calls to CSS and they will forward to the laboratory if appropriate.
The following results cannot be faxed unless the patient name is coded:
- Sexually Transmitted Diseases (STDs)
- Drugs of abuse
- Toxicology screens
STAT gram smears will be called to the physician as soon as they are available.
Positive microbial cultures, initial positive result (smear or culture) from sterile sites will be called to the physician.
Microbial susceptibility tests are available daily and are usually reported within 24 hours after pure culture of the organism has been prepared. Anaerobic susceptibilities are performed daily. Susceptibility testing for fastidious organisms, including anaerobes, may require 48 hours or longer to complete.
AFB smear positive respiratory specimen concentrates can have Respiratory TB PCR testing performed by the Xpert Mycobacterium tuberculosis Assay UPON REQUEST. This test is performed daily.
The Department of Laboratory Medicine's Client Support Services occasionally receives requests to return specimens to clients. These requests will be reviewed and may be honored if the circumstances fit into an appropriate category. The procedure for returning samples is outlined below.
- Samples may be returned to the ordering location only. If the request comes from another entity, they will be referred to the ordering location.
- A sample may be returned only if it is in the original container that we received it in, with client labeling intact. Exceptions must be approved by the Laboratory Medicine Resident.
- Client must cover the cost of returning a sample. If it is returned using a shipping company, the client's account number should be given as the payer. When possible, we will utilize our courier or the client's courier to return the sample.
- Date requested, date returned, name of patient, patient ID number (indicating location), contact person, specimen type, and shipping temperature are to be recorded in hc1 client database.
- Requests for human samples for research testing will be forwarded to firstname.lastname@example.org.
- Requests from legal entities will be forwarded to the Laboratory Medicine legal representative.
There is no STAT fee. Many procedures are available STAT, 24 hours a day, as indicated in the Online Testing Guide of this manual. Others may be treated as STAT after consultation with a Laboratory Medicine resident on call or a division head. The Laboratory Medicine resident can be reached through the UWMC general paging, 206.598.6190.
There are some supplies that are routinely provided to outside clients at no charge i.e. requisition forms, specimen bags, etc. Please call Client Support Services for more information, 206.520.4600 or 800.713.5198.
Test Turn Around Time
The manual of Laboratory Services lists the days on which the test is set up and the day the test is expected to be resulted. Repeated tests take additional time.
The University of Washington observes a number of minor holidays. These include Martin Luther King Jr.'s birthday, President's Day, Veteran's Day, and the day after Thanksgiving. Client Support Services will operate normal courier service and observe usual office hours on these days. However, since these are holidays for the UW, laboratories will be on holiday staffing and test run schedules may be altered.
Unlabeled or Mislabeled Specimen
In order to meet the patient safety goals of the Joint Commission for Accreditation of Health Organizations (JCAHO), Laboratory Medicine requires our users and clients to place at least two patient identifiers on every specimen’s label. The most common and appropriate patient identifiers are: Name, Birth date, Assigned Patient ID Number and Assigned Specimen ID Number. The patient’s floor, clinic, hospital or provider, or the specimen’s collection date are not valid identifiers.
The identifiers used must appear on both the specimen and on the requisition paperwork. The laboratory cannot accept responsibility for identification of unlabeled/mislabeled specimens. If a specimen is unlabeled/mislabeled:
- The ordering location will be notified.
- For specimens originating in University of Washington Medical Center (UWMC), Harborview Medical Center (HMC), or associated facilities, the requested lab work will be cancelled, except in rare cases where recollection of the specimen would place the patient in danger, and the specimen is reasonably identifiable. In those rare instances, the originating person(s) must receive authorization from the chief medical office, chief nursing officer or stat nurse on call. If authorization is given, the originating person must then identify the specimen(s) and sign the original requisition indicating acceptance of responsibility for the identification of the specimen. In this rare event, the specimen will be processed and the laboratory will complete an "Unusual Incident Report" documenting the event.
- For specimens originating at location outside the University system (i.e. an outreach client location), the requested work will be cancelled and the ordering location will be notified. The only exception are those rare cases where recollection of the specimen would place the patient in danger, and the specimen is reasonably identifiable. In those rare instances, the originating person(s) must receive authorization from the medical director of the outreach program or their designee. If authorization is given, the originating person must then identify the specimen(s) and sign the requisition indicating acceptance of responsibility for the identification of the specimen. In this rare event, the specimen will be processed and the laboratory will complete an "Unusual Incident Report" documenting the event.
Discrepancy between specimen label and requisition form
A requisition form must accompany specimen(s) sent to the laboratory. The patient's name and hospital number on the requisition form must match name and number on specimen container.
When a discrepancy exists, specimens are unacceptable and the policy that is followed is the same as that described above for unlabeled/mislabeled specimens.
Unacceptable Specimen Conditions
All specimens sent to the laboratory must be collected according to the department specifications.
Examples of sample collection errors include:
- Improper patient preparation
- Improper specimen handling in transport to the lab
- Incorrect specimen container type
- Incorrect container used in urine and stool collection
- Incorrect preservative used in specimen collection
- Insufficient quantity of specimen
- Contaminated or damaged specimen
- Needle left on syringe
In addition, each patient's specimen(s) and requisition sheet must be contained in a single, separate specimen bag. We cannot accept specimens and paperwork from multiple patients if they are gathered together in a single bag.
The ordering provider's name and NPI (National Provider Identifier) must be included on the requisition.
Please ship specimens to University of Washington Medical Center, Room NW 220, 1959 NE Pacific St., Seattle, WA. 98195.
We will notify you promptly if discrepant specimens or paperwork are received in our processing area.
If a specimen is judged to be unacceptable for testing, the ordering location will be notified. No specimen will be discarded without notifying the ordering location.
Laboratory Support and Contacts
Laboratory Medicine Resident On Call
Technical and clinical inquiries on assays performed at the University of Washington should first be directed to Client Support Services at 206.520.4600. If necessary, they can redirect the inquiry as appropriate. Laboratory Medicine Residents (LMRs) are on call 24/7 and one of the primary service functions of the LMR is to assist other health care professionals with selection and interpretation of laboratory tests.
Some laboratory tests need approval by the LMR on call before ordering. Contact the LMR directly at 206.598.6190 (UWMC paging operator). If difficulty is encountered in locating the on call resident, the Chief Resident has a back-up pager and should be called at the above number.
The Laboratory Medicine Resident serves as an intermediary between those professionals involved in direct patient care and the laboratory staff. Efficient operation of the laboratory is facilitated by communication with the RESIDENT ON CALL. Documentation is maintained on each request for service or information, and changes in laboratory services are determined, in part, by suggestions in this record.
Questions regarding neuropathological, renopathological, or anatomical procedures may be directed to 206.598.6400; for cytogenetics, call 206.598.4488.