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What is Shared Care Pathology?

How pathology can enable a continuous patient care pathway across primary and secondary care?

In the spring of 2011 a group of GPs from Southern Derbyshire and Pathologists from the Royal Derby Hospital established a joint working group called Southern Derbyshire Shared Care Pathology. Our aim is to optimise patient care by customising our pathology services to fit the needs of patients in and around Derby. As part of this process we have established a series of guidelines, which have been agreed locally by GPs and hospital specialists, looking at many disorders in which pathology plays a pivotal role. 


 

What is Shared Care Pathology?

Our guidelines aim to provide information on:

  • Which patients should be investigated

  • Appropriate first line testing strategies

  • Appropriate and clinically useful further testing strategies

  • Accurate and consistent diagnoses

  • Stratification of patients into the appropriate pathways

  • The provision of pathology monitoring services

 

All of these will be included in each guideline.


 

One Stop Shop

By developing the correct investigation process, and by doing all the necessary testing at first pass, this minimizes the inconvenience to both GPs and patients, plus provides a diagnosis and stratifies the patient into the correct care pathway in the shortest possible time.

Therefore, often from a single sample Pathology can provide:

  • Accurate diagnosis
  • Advice on course of action
  • Extra information via internet link
  • Telephone advice line
  • Patient care pathway
  • Follow up actions

 

This is the one stop shop to diagnosis and stratification of patients.


 

Directive Requesting

Perhaps the first and arguably the most important step is that the right tests are requested on the right patient. Identifying which symptoms merit the most appropriate investigations, and agreeing the best first line tests which should be done are both key in this process. Where available we use national guidelines to establish local advice. We will encourage the use of “diagnostic profiles” using electronic GP ordering systems that will ensure that the right tests will always be done on the right patients.


 

Appropriate Extra Testing

When an abnormal result is produced further testing is often required to make an initial or even final diagnosis. In most cases the most logical step is to do all this extra testing on the original sample received by the laboratory. It is better for the patient, in that they will not need to be bled again. It produces a diagnosis more quickly. It reduces the work for the requesting GP. It reduces the number of patient interactions and will save money.

Appropriate extra testing is not an automated process, which could be wasteful. Our guidelines clearly show how and why these extra tests are done, using clinical data from the patient to rapidly establish a diagnosis.


 

Directive Reporting and Stratifying Patients into Pathways

The role of the clinical pathology service is not just to produce numbers. Its role is to say what these numbers mean (interpretation), and give advice on the further management of the patient (direction). We are bridging the gap between primary and secondary care, using the appropriate hospital specialists and GPs to show how a patient should be managed locally dependent upon the pathology findings. This guidance also includes which patients need to seen urgently, and which patients can be managed in the community.