Staff & Recruitment

Post-Mortem Authorisation Form

In September 2006 the Scottish Government introduced a national authorisation form for post-mortem examinations. By law this is the only “consent form” that can be accepted. The authorisation form, together with two types of information leaflets and a summary form are contained within a distinctive dark blue sleeve for adults and a pale green one for children and infants.

The forms are available online through the Scottish Pathology Network.

Guidance for completing these forms can be found here: Hospital PM authorisation process

Current guidelines recommend that only senior medical staff should obtain authorisation. Junior doctors or ward staff should act as witnesses.

It is important that the authorisation form is completed correctly; otherwise the post mortem may not be carried out.

The nearest relative, or a nominated person must be given the top (white) copy and the other two copies (pink and blue) are retained.

The form is a legal document and must not be altered without the relatives consent. Any changes must be made by having all three copies together and only writing on the top white copy to ensure that all the forms are identical.

Post-Mortem Examination

Small samples of tissue, for histological purposes only, will be retained in every post-mortem to confirm macroscopic findings unless consent for this is withheld.

Detailed neuropathological examination of the brain is best done if the organ is first immersed in formalin for three weeks. If the patient has died due to a complex neurological disorder (e.g. MS, dementia, Parkinson’s disease) and it is considered that examination of the brain is very important, then specific permission to retain the brain after the post-mortem should be obtained and noted in section 2A and 2B of the authorisation form.

In cases where there is an infectious risk to those handling the body after death (i.e. pathologists, mortuary technicians, undertakers) e.g. deaths from tuberculosis, AIDS, hepatitis B or C etc. the body must be transported to the mortuary in a cadaver bag with “danger of infection” stickers attached and clearly visible.

In cases of “bodies donated to medical science” or any other issue, please contact the mortuary staff.

Authorisation forms are available from the mortuary offices during working hours and from the booking in areas in every mortuary.

Wards should arrange for collection/delivery of authorisation forms together with the summary and case records. Do not use internal mail.

All post mortems will be carried out within the mortuary at the Queen Elizabeth University Hospital, with all adult NHS post mortems being carried out on Tuesdays and Thursdays only.

On completion of the PM the pathologist will contact the requesting clinician and where practical invite them to come and discuss the findings in the mortuary at their earliest convenience. If the requesting clinician is unable to attend the mortuary, then a summary of the finding is provided via email.

A preliminary PM report is dispatched to the Consultant in charge of the patient within three working days of the PM. Case notes are normally returned with the full PM report within 3-4 weeks.

Copies of the final report, which includes histological findings, are sent to the patient’s GP and hospital consultant usually within two weeks (this can be longer if additional tests are required) of the autopsy.

Deaths must be discussed with the procurator fiscal under the following circumstances:

1. Uncertified death
2. Any death which was caused by an accident due to the operation of a vehicle, or which was caused by an aircraft or rail accident.
3. Any death associated with employment, by accident, industrial disease or poisoning.
4. Any death due to poisoning (coal gas, barbiturate, etc.).
5. Any death where the circumstances would seem to indicate suicide.
6. Any death where there are indications that it occurred under an anaesthetic.
7. Any death resulting from an accident in the home, hospital or institution or any public place.
8. Any death following abortion.
9. Any death apparently caused by neglect (malnutrition).
10. Any death occurring in prison or a police cell where the deceased was in custody at the time of death.
11. Any death of a new-born child whose body is discovered.
12. Any death (occurring not in a house) where the deceased’s residence is unknown.
13. Death by drowning.
14. Death of a child from suffocation (including overlaying).
15. Where a death occurred as a result of smallpox or typhoid.
16. Any death as a result of fire or explosion.
17. Any sudden and unexplained death.
18. Any other death due to violent, suspicious or unexplained cause.
19. Deaths of foster children.
20. Any complaint concerning care or treatment of the deceased noted by nursing or medical staff.

Do not issue a death certificate until the case has been discussed with Fiscal.

If the Fiscal decides to instruct a post mortem, the body will be removed to QEUH Mortuary. Fiscal post mortems are carried out 5 days per week.

A pacemaker or other metal containing cardiac device must be removed from a body prior to cremation. This can be done by the technical staff in the mortuary at the QEUH provided that written consent from relatives for removal and retention has been obtained and delivered to the QEUH mortuary prior to the body being released to the funeral director. This service is not generally available at other mortuaries. If the pacemaker has not been removed the MCCD must indicate that a pacemaker is in situ.

Clinicians wishing to view remains should phone the mortuary staff to arrange a time to visit the mortuary and conduct a viewing.

Contacts:
Mortuary Operations Manager	0141 451 5815
Mortuary Post Mortem Manager Mortuary Scheduling and Performance Manager	0141 451 5795 0141 451 5815
Mortuary Contact Numbers:
Queen Elizabeth University Hospital (QEUH)	0141 354 9357
Glasgow Royal Infirmary (GRI)	0141 201 3186
Gartnavel General Hospital (GGH)  – Enquiries should be directed to QEUH mortuary	0141 354 9357
Royal Alexandra Hospital (RAH)	0141 314 6648
Inverclyde Royal Hospital (IRH)	01475 504 301
Vale of Leven (VOL)   – Enquiries should be directed to QEUH mortuary	0141 354 9357

NHS Greater Glasgow and Clyde Pathology Department is undergoing a digital transformation whereby glass slides are digitised and are able to be viewed on digital workstations, rather than microscopes.  This change is being undertaking in partnership with Philips Healthcare. 

The transformation will take several years to complete for histology (and longer for cytology where the technology is less mature).  We are following national guidelines and best practice recommendations from the Royal College of Pathologists (RCPath) and pathologists reporting digitally are following the RCPath validation process.  Digital Pathology is being incorporated into our quality management system and we are working towards UKAS extension to scope. 

We fully believe that this development will deliver both quality and safety benefits to our service users. 

Intra-Operative Frozen Section Requests

Pre-Booking a Frozen Section

 The requesting clinician must ensure that:

• Pathology Duty Consultant is notified of frozen section request 24 hours in advance of sample collection, via Pathology Specimen Reception on 0141 354 9513 or 0141 354 9514 (89513 or 89514)
• As per national guidance, the department will routinely process requests for frozen section analysis unless the clinician or request form indicate the patient potentially being COVID positive.
• On the day of surgery, theatre staff notify Pathology reception that the frozen section is on its way to the Laboratory.

Failure to pre-book an intra-operative frozen section may result in delays in reporting and in exceptional circumstances the request being declined.

When pre-booking an intra-operative frozen please provide the following details:

• Patient’s name and CHI number
• Requesting clinician
• Theatre name/number including hospital
• Likely time of operation
• Contact number
• Specimen type

The Consultant Pathologist will phone the result to the requesting clinician on the contact number given.

Queen Elizabeth University Hospital (QEUH)

An intra-operative frozen section service is available Monday to Friday from 9:00am to 5:00pm

Golden Jubilee National Hospital (GJNH)

An intra-operative frozen section service is provided, on site at GJNH, Monday to Thursday from 9:00am to 1:00pm. Any cases requiring a frozen section should be recorded on the GJNH theatre lists.

To arrange an intra-operative frozen section out with these times please contact the Duty Pathologist via Pathology Specimen Reception at QEUH on the telephone number below.

These specimens will be transferred to Pathology Department at QEUH for processing and should be sent by taxi to:

Specimen Reception (L3/B/021),

NHSGGC Pathology Department

Level 3, Laboratory Medicine and Facilities Management Building

Queen Elizabeth University Hospital

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

It is the responsibility of staff at GJNH to arrange rapid transfer of these specimens to QEUH as per local protocol.

Glasgow Royal Infirmary (GRI)

An intra-operative frozen section service is available Monday to Friday within normal laboratory working hours, from 9am to 5pm.

This Laboratory is only manned for pre-booked requests. It is, therefore, imperative that frozen section requests for onsite analysis at GRI are received by the Pathology Department more than 24 hours in advance, by phone call.

From time to time an urgent frozen section is required due to an unexpected finding at surgery. The department provides this service, but for intra-operative frozen section requested on site at GRI, a short delay is inevitable to allow staff to travel.

Alternatively the specimen can be sent to QEUH urgently by courier by telephoning:

01412113734 or 01412113674 (Transport Hub) and following the information below for Transporting Urgent Fresh Specimens.

Labelling Frozen Section Specimens

The normal requirements for labelling specimens and request forms apply to frozen sections in addition to the following criteria on the request form:

• Hospital
• Theatre
• Date and time of request.
• Requesting clinician
• Alerts to known or suspected danger of infection
• Clinical History
• Theatre contact number

Transporting Urgent Fresh Specimens

QEUH site:

Fresh (unfixed) specimens should be sent directly to:

Specimen Reception (L3/B/021),

NHSGGC Pathology Department

Level 3, Laboratory Medicine and Facilities Management Building

Queen Elizabeth University Hospital

Tel:  0141 354 9513 (89513) or 0141 354 9514 (89514)

Other Sites

Fresh (unfixed) specimens taken at other sites out with stated service provision at GJNH and GRI should be sent directly to the Pathology laboratory at QEUH by courier.

The courier should be telephoned by theatre staff, telephone Eagle Couriers on 08451231230 at least 30 minutes before the specimen is available on the day of the operation.

 The information required by Eagle couriers includes:

• Hospital site
• Theatre collection point
• Advise that this is an “Emergency Pathology Specimen”.
• Codes used for each location should be as per local protocols.
• Please telephone Pathology Specimen Reception on 01413549513 or 01413549514 (89513 or 89514) when the courier is on the way

Fresh/Urgent Paediatric Specimens

Paediatric Rectal biopsies for diagnosis of Hirschsprung’s disease via Acetylcholinesterase histochemistry must be sent fresh (not fixed) as is done for frozen sections (see above).

Please ensure that for all specimens indicative of paediatric neoplasia/cancer/tumour that the paediatric team are notified (89531) in advance of submission and the specimens are submitted fresh/unfixed as is done for frozen sections (see above).

Fresh Lymph Nodes for Suspected Lymphoma

Excised lymph nodes, for suspected lymphoma should be bisected alone their long axis at the time of removal.

Half of the specimen should be placed into a sealed container with buffered formalin. The second half of the specimen should be placed in dry container, without formalin and sent “fresh” to the Pathology Department to allow ancillary testing to be undertaken.

It is particularly important that any Danger of Infection is recorded on the request form.

Follow the instructions above for Transporting Urgent Fresh Specimens.

Orthopaedic Amputations

The orthopaedic theatre should contact Pathology Specimen Reception at least 24hrs before procedure is scheduled on 01413549513 or 01413549514 (89513 or 89514) to request that a dedicated large amputation specimen container is sent to relevant theatre.

Specimens such as amputations that have a high ratio of surface area covered by skin should be sent unfixed. If there is a surgical stocking, leave in place.

Reasons for this are:

• Poor penetration of skin by formalin
• Moving and handling considerations

To contain potential leakage, put the amputation into a large plastic bag or wrap in drapes as appropriate and then put into the amputation container.  Never use yellow or orange bags or containers as this corresponds to the code for waste incineration.

Please follow the instructions for transporting urgent fresh specimens above. It is important to advise the courier that this is a large specimen (requires van rather than motorcycle courier).

Paediatric rectal biopsies for diagnosis of Hirschsprung’s disease do not need to be sent fresh. These specimens may be sent in formalin. There is no requirement to discuss these cases with the duty pathologist.

Paediatric tonsils do not need to be sent fresh. These specimens may be sent in formalin. Lymph node excision biopsies querying malignancy vs infection MUST be discussed well in advance with the duty consultant paediatric pathologist.

Please ensure that for all specimens indicative of paediatric neoplasia/cancer/tumour that the day duty pathologist is notified in advance of submission and the specimens are submitted as specified by the day duty pathologist’s instructions. ALL fresh specimens including frozen sections must be discussed directly with the day duty pathologist well in advance of submission.

Urgent Paediatric Specimens

The following procedures must be followed for all urgent paediatric fresh specimens including frozen sections, fresh tumour biopsies and fresh tumour resections.

Any queries regarding urgent specimens should be directed to the duty Paediatric pathologist by telephoning the paediatric office on 89478 and asking to speak to the duty paediatric pathologist.  Please note: there is no formal OOH Paediatric Pathology on-call service. If advice/assistance is urgently required out of hours, please contact switchboard who can contact a paediatric pathologist. The paediatric laboratory team may be contacted on 89531.

Discussion with the duty pathologist – All Cases

All cases must be booked in advance (ideally at least the day before) by telephoning 0141 354 9478 (89478) and discussing the case and your requirements with the duty consultant paediatric pathologist. Please provide patient details, including name and CHI number, date of surgery, approximate time of surgery and a contact number for theatre.

The surgeon or interventionalist performing the biopsy / resection must speak directly to the duty Paediatric pathologist prior to the procedure in every case to establish the specimen requirements.  Failure to follow this procedure may render the biopsy un-interpretable.

The instructions below are general instructions and must not replace a case by case discussion with the duty pathologist.

• Tissue for frozen section should be kept dry and placed in a suitable container labelled with the patient’s details (ideally a small plastic dish wrapped in a yellow plastic bag). Do not place small biopsies on paper, wrap them in gauze or paper or place in saline.
• Unless indicated otherwise by the day duty pathologist, all fresh tumour biopsies should be placed in PINK tissue culture fluid for transport to the laboratory.
• Unless indicated otherwise by the day duty pathologist, all fresh tumour resections should be kept dry and placed in a suitable container labelled with the patient’s details.

Transport to the Laboratory – All Cases

All fresh paediatric specimens must be conveyed immediately in person or by porter to pathology (3^rd floor, Laboratory Medicine Building). It is the responsibility of the surgical team to arrange urgent transport of the specimen to pathology. The sample must not be sent via the POD system and must not be placed in a purple bag. It must be taken directly to pathology specimen reception on the 3^rd floor. The specimen should be marked as “Urgent. Frozen section.” Staff transporting the specimen must inform specimen reception staff that it is an urgent fresh specimen for frozen section.

When the specimen leaves theatre, theatre staff must inform the laboratory by telephoning 89531.

Paediatric Renal Biopsies

The following procedures must be followed for all paediatric renal biopsies:

Discussions with the Duty Pathologist and the Laboratory

All Renal biopsies must be discussed with the Duty Paediatric Pathologist on 89478 as well as with laboratory staff on 89531 (see below).

These specimens will be collected in theatre by a biomedical scientist who will separate the sample for immunofluorescence and electron microscopy.  Notification of such biopsies to the laboratory must be done as far in advance of the biopsy as possible by telephoning 89531. Failure to do so may result in delay since staff will have to be available to attend theatre to undertake this procedure.

The placental request form is linked here

Criteria for Examination

The local criteria for placental examination are:

Stillbirth

Miscarriage > 14/40

Birth weight < 3rd centile

Drop in fetal growth of > 2 quartiles or > 50 percentiles

Absent or reversed EDF on umbilical artery Dopplers

Spontaneous preterm delivery or prolonged preterm rupture of membranes less than 32/40

Iatrogenic preterm delivery less than 32 weeks

Severe early onset (less than 32/40) pre-eclampsia requiring iatrogenic delivery

Massive abruption with retroplacental clot

Fetal hydrops

Severe fetal distress defined as: pH<7.05 or base Excess > -12 or scalp lactate >4.8mmol/l

Severe maternal sepsis requiring adult ICU admission

Severe fetal sepsis requiring ventilation / level 3 NICU admission

Caesarean hysterectomy for morbidly adherent placenta and

Monochorionic twins with twin to twin transfusion.

Required Data Terms

Listed below are the data items that are required for pathological examination of placentas. Obligatory data items are in bold and the remainder should be added as required. Please include these data items on the pathology request form accompanying the placentas.

Please write clearly on the forms

· Mother’s name

· Mother’s date of birth

· Address

· Hospital Number and CHI number

· Date of delivery

· Date placenta sent for pathology examination

· Referring Hospital

· Referring consultant

· Midwife or trainee doctor’s name and contact extension / bleep number

· Gravida and Parity

· Gestation

· Indication for examination (see below)

· Livebirth (Y/N):

· Birth Weight and Centile:

· Mode of delivery:

In cases of stillbirth / late miscarriage, page 2 of the placenta form must be completed by a doctor of ST7 or consultant level. Please provide the following information:

Presence or absence of maceration

Interval between IUD diagnosis and delivery

Additional clinical details including any relevant antenatal history

Placentas not Requiring Pathological Examination

Any placentas not indicated for placental examination by our local protocol do not need to be sent for pathology. If sent to pathology, they will be stored with no initial examination. A brief report indicating the placenta has been stored will be issued shortly after the placenta is received (generally within a fortnight). These placentas will be retained for 3 months in the pathology department prior to disposal. Full macroscopic examination with histology will only be performed on request with additional clinical details indicating why such examination is required.

Placentas with the following are not indicated for examination and do not need to be sent to pathology unless there are additional relevant indications:

• Pre-eclampsia with onset after 32/40 and not requiring iatrogenic delivery
• Maternal sepsis not requiring adult ICU admission
• Maternal pyrexia
• Possible abruption
• Fetal distress not fulfilling the following criteria: pH<7.05 or base Excess > -12 or scalp lactate >4.8mmol/l
• Maternal Group B streptococcus
• Maternal diabetes or other maternal disease with normal pregnancy outcome
• Known trisomy 13, 18, 21 / Turners
• Congenital anomaly
• Uncomplicated twin pregnancy
• Twin placentas for assessment of chorionicity
• “Gritty” placenta
• Placenta praevia
• Post-partum haemorrhage
• Polyhydramnios
• History of previous molar pregnancy
• Cholestasis
• Hepatitis B/C, HIV
• Single umbilical artery
• Uncomplicated velamentous cord
• Placenta with accessory lobe
• Normal pregnancy

Test Name	Specimen/Container Requirements	Further Information:
Electron Microscopy	Specimens for electron microscopic analysis should ideally be no larger than 1-2 mm3 and placed into a vial of fresh 2% Glutaraldehyde fixative as soon as possible after specimen retrieval. Blood/Fluid Specimens should be discussed with the EM unit directly. (0141 3549420 or 01413549422). If specimens are sent through the post they must comply with post office regulations. EM sampling from a histology wax block must be accompanied by a representative light microscopy slide.	Freshly prepared glutaraldehyde has a 7 day shelf life and must be stored to 4-80c prior to use. This fixative is available with advance notice from: Electron Microscopy Unit, Pathology Department, Level 2, Laboratory Medicine and Facilities Management Building, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF (0141 3549420 or 01413549422). All unused Glutaraldehyde should be returned to the EM unit for disposal. Samples to be placed in a purple specimen bag.
Primary Cilial Diskenesia Service	Specimens are only accepted in the laboratory if taken from the clinic Specimens should be placed into M199 media with penicillin-streptomycin added – supplied by the EM laboratory.	Contacts for more info about the service and clinic.:  Paul French Jennifer Sweeney Anne Devenny

Specimens for EM analysis should ideally be no larger than 1-2mm³ and placed into a vial of fresh 2% Glutaraldehyde fixative as soon as possible after specimen retrieval apart from blood/fluid specimens which must be discussed with EM unit directly.

Freshly prepared glutaraldehyde has a seven-day shelf life and must be stored between 4-8⁰c prior to use. This fixative is available with advanced notice from the Electron Microscopy Unit, NHSGGC Pathology Department, Level 2, Facilities Management and Laboratory Medicine Building, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF (0141 3549422).

Each specimen must be accompanied by a request form with the minimum of 3 matching patient identifiers.

Due to the small size of the specimen container, there is limited space for patient’s details but at least the patients CHI and first and surname must be provided on the specimen container.

Requests for urgent results should be clearly marked on the request form and contact telephone or bleep numbers provided. The consultant pathologist should be notified first by telephone, if an urgent result is required.

Specimens should be sent for EM analysis in the same manner as routine histopathology specimens.

If specimens are sent through the post they must comply with post office regulations. EM sampling from a histological wax block must be accompanied by a representative light microscopy slide.

All unused Glutaraldehyde should be returned to the EM unit for disposal.

EM Analysis should normally be available within 5-12 days once the sample has been received by the department for processing. This may change due to service provision. If appropriate any samples marked as urgent will have an accelerated turnaround.

Sample results are affected by a number of factors including delay in fixation, use of inappropriate fixative/old fixative and incorrect sample size (1-2mm³ is recommended; if a sample is too big this can cause sub-optimal fixation, if too small will not give a good representation of morphology).