Clinical notices

When there is a clinical notice, information about it will appear here.

Referrals to the Barts Health Centre (Inherited Arrhythmia Service)

6 August 2019

The Inherited Arrhythmia service at St Bartholomew’s Hospital  looks after patients who have signs or a family history of various heart conditions (including Brugada syndrome, long QT syndrome, catecholaminergic polymorphic VT), as well as people who have lost a relative from sudden arrhythmia death or people who have survived a cardiac arrest and no cause was found (idiopathic VF).

These conditions are usually dominantly inherited so we recommend first-degree relatives are screened in the first instance.  Our specialist clinics offer a one-stop-shop for the bulk of the tests which range from ECGs, echocardiograms, exercise tests and holters.  If you are suspicious that a patient has one of these conditions or has a first-degree relative with one, please refer them to the service via the electronic referral system. 

We can be found under Cardiology Genetics > Inherited Arrhythmia Service (RAS).  Alternatively, if you would like to discuss a referral first please call the specialist nurses on 0203 76 58644.  If you have a patient with a cardiomyopathy, they will need to be seen in the Inherited Cardiovascular Diseases clinic.

Change in the criteria which determines if urines are cultured

9 May 2019

Background

Urine microscopy is a quick and effective way of ruling-out infection and ensures that resources are used to culture urine samples from patients most likely to have a urinary tract infection.

At present, for most samples, if microscopy detects ≥30 WBC/μl OR ≥750 bacteria/μl, the urine will be cultured.

Urine samples from some patients, children   and pregnant women for example, undergo culture irrespective of the microscopy result.

What is changing

From 27th May 2019 only urine samples with both ≥30 WBC/μl AND ≥750 bacteria/μl, will be cultured. Therefore, you may notice a reduction in the proportion of urine samples with culture results.

Urine samples from children and pregnant women will continue to undergo culture irrespective of the microscopy result

What is the reason for the change

An internal study was conducted which found that using the ‘OR’ criteria resulted in a significant number of false-positive culture results, which in turn may have led to unnecessary antibiotic therapy. Using the ‘AND’ criteria retains a good level of sensitivity and, when negative, accurately rules-out infection in 80% of cases.

Urine containers

We still require urines to be sent in the kima tubes (see picture). This assists the laboratory hugely, allowing for rapid automated testing and reduces the risk of errors.

Further information

Contact microbiology (details are available via MicroGuide App or Barts Health switchboard)

Useful reference

Patient leaflet [pdf] 389KB T

Trust leaflet [pdf] 654KB

Plain Urine Samples for Clinical Biochemistry Tests.docx 37KB

Radiology reports

29 October 2018

We previously identified an ICT error that affected a number of GP practices in Tower Hamlets, Newham and Waltham Forest receiving an electronic message about radiology reports.

Whilst this has been corrected, and we have contacted the affected GP practices, if GPs have any queries, please contact the Clinical Support Services Governance Team or phone 0207 377 7667.

 

Paper Switch Off for GP referrals

3 September 2018

Our Trust now has 100% of services for consultant led outpatient clinics available on the NHS e-Referral Service (eRS).

GPs should refer patients via eRS, unless the service is one of the exclusions listed below. Any paper referrals (i.e. email, post or fax) sent to the Trust will be returned to the practice without an appointment being made.

If there are no bookable appointments available on eRS please use the ‘defer to provider’ option. Please do not stop the eRS transaction and refer to paper.

The following services are currently excluded and referrals will continue to be accepted outside of eRS:

Locally agreed exclusions

  • Rapid access chest
  • TIA (transient ischemic attack)
  • Gynae emergency clinic
  • Dermatology emergency clinic
  • Ear, nose and throat (ENT) emergency clinic
  • Ophthalmology emergency clinic
  • Paediatric emergency clinic

National exclusions

  • Tertiary referrals
  • Follow-up appointments
  • Referrals from Dentists and Optometrists
  • Referrals from Prison
  • Referrals for Defence Medical Services patients based outside England
  • Referrals from Private GPs
  • Referrals from Out of Hour GPs or GPs based at Urgent Care Centres
  • Same-day/A&E services
  • Services which are accessed through self-referral/walk-in services.
  • Termination of pregnancy
  • Cross-border referrals from Wales and Scotland
  • Patients who do not have an NHS Number
  • Patients who have opted out from having their information transferred electronically

Please ensure that you attach the referral in eRS as soon as possible, if nothing is attached within seven days the request will be returned.

If you have any queries regarding access/training for eRS, please contact your local GP eRS facilitator.

Single Point of Access Go Live

13 April 2018

From Monday 16 April 2018  all referrals to the Tower Hamlets Community Health Services will be managed via the Tower Hamlets Single Point of Access. The existing referrals forms will be removed, however, there will be a grace period of 3 months, with the expectation that within two months all referrers will be using the New Referral Form.
 
Referrers will use one single form for above the following services, across both Barts Health and ELFT services. This will simplify the process for referral and avoid referrers using multiple forms for referrals:

  • Rapid Response Team
  • Continence Service
  • Extended Primary Care Teams (EPCTs)
  • Foot Health Service
  • Lower Limb / Leg Ulcer Management
  • Nurse-led Community Heart Failure Team
  • Community Diabetes Service
  • Adult Respiratory and Rehabilitation  Care Service (ARCaRe)
  • Community Dietetics Service
  • THCNT - Community Neuro Team including Community Speech and Language Service

All referrals will need to be sent to the Single Point of Access electronically via thgpcg.spa@nhs.netfrom this date rather than sent directly to the service.  
 
Referrals via fax or post will not be accepted from 16 April 2018.

Benefits to this change are:

  • A one-stop online process - rather than lots of different referral forms
  • A universal referral form with one area for key patient information - reduces time lost to completing separate referrals with repetitive information
  • Less risk of referrals being lost in the post or not being printed on fax machines
  • With many different agencies providing services, is simpler for referrers rather than tracking down the right organisation to refer to.
  • 24-hour service so able to process referrals at any time. More cost-effective than each service having own admin processes

This change is part of the new model of care with the new Community Health Services within Tower Hamlets Together, which includes GP Care Group, Barts Health Trust and East London Foundation Trust.

Separate EDTA bottles needed for Full Blood Count (FBC) and HbA1C Analysis 

12 December 2017

With a view to improving the service we provide to patients, we have assessed the impact in Pathology of the increasing number of requests for HbA1C

Currently only one EDTA (purple top) tube for Full Blood Count (FBC) and HbA1C assay can be shared for both tests. However due to the increasing number of HbA1C requests this practice is causing a detrimental effect on the turnaround time expected by our users.

To address this issue, from Monday 8 January 2018, please now provide one EDTA (purple top) tube for the Full Blood Count (FBC), and a separate EDTA (purple top) tube for the HbA1C test.

Please ensure that you have sufficient stocks of EDTA bottles (4ml) in your practice for this change. We estimate that an extra 30% over your normal order will be needed. 

If you wish to discuss this further please contact Angela Heins, Blood Sciences Manager: angela.heins@bartshealth.nhs.uk