For specimens sent to referral laboratories, the referring laboratory must properly follow all requisition, collection and handling specifications of the referral laboratory.

• Specimens must be collected in proper containers. (Refer to sections B and C below)
• Outdated/expired containers may not be used.
• Samples that are improperly labeled or stored may not be processed.
• Specimens may need to be rejected for quality purposes if the quantity is not sufficient, or if the sample is clotted or hemolyzed.

HFH Collection and Handling Specifications for Routine Specimens

A. HFH Special Timing for Collection

• When submitting breast tissue pathology specimens removed for lesions clinically suspicious for malignancy, the cold ischemia time (removal of the tissue from the patient (TOC) and time placed in fixative (TIF)) must be included in the requisition form. Refer to Breast Tissue Pathology ELUG
• Muscle Biopsies - the specimen should be submitted to the pathology department immediately and identified as a muscle biopsy to the pathology personnel. Offsite specimens should be delivered to the Henry Ford Hospital Pathology Laboratory as soon as possible. Regardless if the biopsy is done in house or off site, the specimen must arrive by 3:00 p.m. Refer to Muscle and Nerve Biopsy ELUG
• Nerve Biopsies- In house specimens should be submitted to pathology immediately labeled "fresh nerve biopsy." Offsite specimens should arrive at the Henry Ford Hospital Pathology Laboratory as soon as possible. Refer to Muscle and Nerve Biopsy ELUG
• Lymph Node Biopsy for Lymphoma Work-up - In house specimens are submitted to pathology immediately fresh on ice or on a saline soaked pad labeled "lymph node biopsy for lymphoma work-up." Biopsies from remote sites should arrive at the Henry Ford Hospital Pathology Laboratory as soon as possible. Refer to Lymph Node Biopsy ELUG
• Kidney Biopsies- In house specimens are handled by Surgical Pathology Staff immediately after removal from patient.  Offsite specimens must be delivered the same day as collection by cab, A1 delivery service, or courier and arrive at the Henry Ford Hospital Pathology Laboratory, preferably by 4:00 p.m. Monday - Friday. Refer to Kidney Biopsy ELUG
• Embryo, Fetus and Stillborn surgical samples require specific handling and paperwork to be submitted along with the samples. Refer to Tier 1: Fetal Demise / Neonatal Demise Procedure for workflow specific to department.

Final Disposition of Stillbirth
HFHS Final Disposition of Fetus

B. HFH Type of Collection Container and Amount of Specimen to be Collected

• Use appropriate surgical specimen containers according to the size of specimen submitted. The lids of the containers must be appropriately closed to avoid any leaking of body fluids and/or fixatives.

C. HFH Types and Amounts of Fixatives

• 10% neutral phosphate-buffered formalin (NBF) is the preferred fixative and should be used for fixation of routine surgical pathology samples. For fixation of specimens in formalin, specimens must be fully submerged with 10% neutral phosphate-buffered formalin to approximate specimen volume of 10:1 or higher, or if not feasible (e.g., large specimens) at least 4:1.
• Special handling and transport of specimens (e.g., triaging of tissue especially if limited need for refrigeration, immediate delivery) - refer to ELUG entry for the specific tissue type.

D. Specimen Labeling Requirements

• For patient safety, each specimen container must have a label firmly affixed to the container, not the container lid or biohazard specimen transport bag, that contains the following minimum information:

• Patient’s full name (last name, first name)
• Patient’s medical record number
• Date of specimen collection
• Time of specimen collection (time sensitive specimens)
• Specimen description or anatomic site of the specimen (non-blood body fluids, microbiology, cytology and surgical tissue specimens)

• Properly labeled specimen(s) must be accompanied by a requisition (which has been collected in Epic) containing the following information:

• Patient’s full name (last name, first name)
• Patient’s medical record number
• Date and time of specimen collection
• Source or site of specimen (non-blood body fluids, microbiology, cytology, and surgical tissue specimens)
• Preoperative and postoperative diagnosis and clinical history (cytology and surgical tissue specimens)
• Test(s) requested
• Collector identification
• Patient location
• Ordering physician name and doctor code (senior staff only)
• ICD diagnostic code (OPD charges and IPD professional charges

• The person that collects a specimen from a patient for laboratory analysis is responsible for establishing the identity of both the patient and the specimen(s) at the time of collection. Patient identification must be verified immediately before any specimen collection procedure. Specimens MUST be labeled in the presence of the patient.
• Patients with ID bands will be identified by comparing their ID band to the specimen label or requisition.
• Patients who are not required to wear an ID band will be identified by asking the patient to state their first name, last name, and date of birth.
• Specimens submitted to the laboratory without the required information will not be accepted for processing. Unlabeled surgical specimen containers will not be accepted for testing and may require recollection.
• Note: Although extenuating circumstances may exist and some information may be retrievable after specimen receipt by the laboratory, this will require the licensed caregiver, physician or nurse, to come to the laboratory to provide the missing information and sign a Specimen Labeling Resolution form, accepting responsibility for the accuracy of post-collection labeling. Post-collection labeling (rehabilitation) will be permitted under the following circumstances only:
• The test is a Vital Value and delay resulting from recollection could compromise care
• Clinical reasons exist for avoiding recollection (requires approval of pathologist/division head, laboratory supervisor, or designee)
• The patient is unavailable for recollection (requires approval of pathologist/division head, laboratory supervisor, or designee).

E. Test Requisition

• Electronic order entry or paper requisition forms may be used to initiate laboratory tests.  It is the responsibility of individuals performing electronic order entry of laboratory tests to accurately and completely transcribe the tests ordered by the physician. A laboratory order must include:

• The patient's last name, first name, medical record number (MRN)
• Patient location
• Ordering physician including secondary provider
• Diagnostic code(s) for requested tests
• Specimen collection date and time
• Individual tests meeting medical necessity or HCFA approved panels, or tests where the physician has acknowledged medical necessity requirements and reimbursement limits
• A paper requisition must accompany every surgical pathology and cytopathology specimen