General Laboratory Information

SUMCCL at Stanford is located on the first floor of Stanford Hospital & Clinics, 300 Pasteur Drive, Stanford, CA 94305. This laboratory’s primary focus is the in-patient & clinic population of Stanford Hospital & Clinics and Lucile Packard Children’s Hospital as well as providing testing 24/7 for all our clients.

SUMCCL at Hillview is located in Palo Alto off Foothill Expressway at 3375 Hillview Avenue, Palo Alto CA 94304 and is just minutes away from Stanford Hospital. SUMCCL at Hillview features state-of-the art Laboratory Automation and Process Re-engineering. Through proprietary man-machine integrated systems by Shoji Moriyama, PhD, SUMCCL has centralized & streamlined operations allowing an efficient collaboration between the expertise of SUMCCL medical directors and automated testing.

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Telephone

• General laboratory information
• Result inquiry/ patient test results
• Information related to test ordering and specimen requirements
• Reference/normal ranges
• To connect you to a department or person
• Directions to laboratory facilities and draw sites
• Connect you to the Billing Department*
• Courier Service
• Supply requests and delivery

Additional specific test or specimen related information can be obtained by contacting a laboratory supervisor.  Request the Medical Director or Senior Staff Member for the corresponding laboratory for consultation regarding test utilization or interpretation.

*Patients can access their bill on line at: www.Stanfordlab.com and select Patients -> mylabbill

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Courier Services

SUMCCL operates a courier network throughout the Bay Area.  Specimens are stored in appropriate containers with temperature monitors to ensure specimen integrity during transport to their testing site.  For information regarding courier service contact your Service Representative or call our Customer Service Department.

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Specimen Collection Supplies

Specimen collection supplies are provided to our Clients for specimen collection to our laboratory.

Supply Request forms are submitted with your courier.

For additional information or special specimen collection supplies call Customer Service at 1-(877) 717-3733 and request the Supply Department.

Supply Order forms are available for your use.

Be sure to rotate your supplies and check for expiration dates.  Do not use beyond the expiration date.

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Specimen Collection Tubes

• Gold-top tube - SST
• Gray–top tube (Sodium fluoride)
• Green–top tube (Sodium heparin)
• Lavender–top tube (EDTA)
• Light–blue–top tube (Sodium citrate)
• Mint-top(gel) tube (Lithium heparin)
• Red–top tube (Plain) No additive
• Royal–blue–top tube (Plain) No additive
• Royal–blue–top tube (EDTA)
• Yellow-top tube Acid Citrate Dextrose (ACD), Solution A

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Other Specimen Collection Supplies

• Anaerobic transport tube
• BDProbetec® Collection kit for Endocervix & male urethral (Pink/blue package)
• Blood culture collection kit
• Bordetella Pertussis PCR/DFA Kit collection with instructions
• Cardboard slide carrier
• C&S vials for stool culture
• Culturette single & double swab
• Digene Cervical Sampler™
• Endocervical swab
• Fungus collection device with instructions
• Gray-top urine culture transport kit with growth inhibitor
• Hardy transport media
• Nasopharyngeal swab
• Pinworm paddies
• Plastic slide carrier with 2 slides
• Plastic transport tubes
• Polyester Tipped Copan Flocked Nasopharyngeal (NP) swabs
• RPMI transport media (special order)
• Sterile containers
• Sterile saline in sterile container
• SurePath® Liquid Pap vial
• SAF vials for stool parasite exam
• Thin Prep® Liquid Prep vial
• Trichomonas Pouch
• Urethral swab
• Urine Collection containers for timed specimens
• Viral Transport media (VTM)
• Wire swab
• Yellow-top urine preservative transport tubes

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Test Requests

Laboratory tests may be ordered by either of the following:

• By use of customized hard copy laboratory test request form with client information.
• Via SUMCCL Web Portal.
• Contact the Marketing Office at 1-650-736-4207 for information.
  

Some tests require prior scheduling.  Refer to the individual test listings in the Test Directory or contact Customer Service.

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Patient Identification

All patients from whom clinical specimens are obtained must be positively identified prior to specimen collection.  Positive identification is the responsibility of the person collecting the sample.

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Specimen Labeling

The following information must be legibly recorded on a label affixed in an irreversible fashion to the specimen container:

Required Information

The specimen must be labeled with patient's name. The label on the specimen container must match the patient's name on the accompanying paperwork.  Use one label per specimen.

• Patient’s full name (not a nickname)
• Medical Record Number or other unique identifier (ID)
• Date and, if appropriate, time when specimen was obtained
• Specimen source (if indicated)
• Signature or initials of the person who identified the patient, collected the specimen, and labeled the specimen.

Bar-coded pre-printed labels with accession numbers generated by an information system may be used. The date and signature/ initials must be recorded after the specimen has been drawn and after verifying that the patient name and ID on the label agrees with that on the test requisition.  This is the single most important factor in preventing errors in patient specimen identification.

• Use one label per specimen.
• Transport specimens in leak proof sealed plastic biohazard bags designed for specimen transport.
• Place the labeled specimen in the bag. The label should be affixed to the specimen container and not the bag.
• Place the matching requisition in the outside pouch of the bag.

Use of a request form wrapped around the container is not acceptable as a specimen label. Specimens will not be accepted if the information on the specimen label does not match the information on the accompanying requisition.

Specimens with labels that do not contain required information (or for which the information is not legible) will be considered improperly identified.

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Rejection of Specimens

Proper specimen collection and handling are essential to obtaining valid, timely test results.  All test requisitions and specimens must meet the defined criteria for identification, collection, volume, and testing in order to be processed. The lab will not process unlabeled, mislabeled, or misidentified specimens. When such a specimen is received, the laboratory will contact the ordering unit/clinic/physician's office. The nurse or physician will be informed that the specimen is improperly labeled.  A new specimen should be obtained.  If any criterion is not met, the attending physician, unit, or clinic will be notified immediately so that corrective action can be taken.

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Test Requisition

Specimens must also be accompanied by a test requisition that contains the following information:

• Patient's name and address
• Patient's gender
• Patient's date of birth
• Patient's last 6 digits of social security number
• Tests Required, clearly marked
• Date and, if appropriate, time when specimen was obtained
• Name and address of ordering physician or client number
• Type (or source) of the specimen
• Clinical information & ICD9 codes appropriate to ordered tests as indicated on the requisition
• Complete patient billing and insurance information

Specimens with requisitions that do not contain this information (or for which the information is not legible) will be considered improperly identified.

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Verbal Orders, Standing Orders and Add-On-Tests

Regulations require that all verbal orders for tests must be confirmed by a written signed requisition within 30 days of the request. This includes standing orders, add-on requests, and verbal orders for all patients.  The laboratory will provide the request form to be used, either via fax or by mail. No official results will be sent out until written confirmation is received from the physician. 

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Safety Precautions

All specimens should be regarded as potentially hazardous or infectious.  Universal Blood and Body Substance Techniques should be observed.

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Chain-of-custody documentation is not available. All tests performed in the clinical laboratories at Stanford are designated for medical use only.

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Proper specimen collection is vital to ensuring an accurate test result.   A fasting specimen is preferred and / or required for the majority of laboratory tests to reduce possible test interference. Please refer to the individual test listing in the Test Directory for fasting requirements and special collection techniques.

Collect the blood specimen from a vein, avoiding hemolysis and avoiding stasis due to prolonged application of the tourniquet. Use a butterfly needle for pediatric patients and for patients with difficult veins.

• Avoid collecting specimens from veins where administration of fluids will cause abnormal levels of electrolytes, glucose, or drugs.
• Avoid contamination from heparin locks for coagulation tests.
• Collect the specimen into the proper tube or container using the correct sequence of draw. See Individual test in Test Directory/Lab Guide or Request Form

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Order of Specimen Containers for Blood Draw

A. Obtain blood specimens during phlebotomy in the following order:

• Blood Culture
• Non- Additive tube (Red-top tube) (Plain)
• Coagulation tube (Light blue-top tube).  A Light blue-top tube (Sodium citrate)
• tube is never the first tube drawn.  If a coagulation assay is the only test ordered, draw 1-2cc’s into a non-additive tube (red-top) first and then draw the Light blue-top tube.
• SST Gold-top tube
• Last- Additive tubes in this order:
  Heparin:  Green-top tube (Sodium heparin) or Gel- mint-top tube (Lithium heparin). Mint-top tubes must never be used to draw cytogenetics samples
  Lavender- top tube (EDTA)
  Gray-top-tube (Oxalate/fluoride) 
  Other additive tubes
• Special instructions for collecting specimens for Metal analysis apply.

B. Pediatric Microtainers must be obtained in the following order:

• Lavender-top (EDTA)
• Green-top (Heparin)
• (Red-top) Non- Additive

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Specimen Collection and Processing

• Collect the required amount of specimen.  While small amounts of blood are now used for many automated tests, there are minimum requirements. Optimum collection volumes allow for the test to be repeated and verified if necessary.
• Minimum volumes are to be used for patients where unnecessary blood loss may affect patient status.
• When difficulties are encountered with blood volumes, consult the laboratory.
  Avoid hemolysis, which can elevate certain analytes (e.g., LDH, K, AST).
• Use of the wrong container can result in erroneous results, which will necessitate redraw of the specimen.
• Follow specific specimen processing & transport instructions.
• Never decant or aliquot the specimen from one type of container to another.
• Unusual specimens (lipemic, icteric, hemolyzed) may require a repeat specimen.
• When using tubes with anticoagulants, especially for coagulation tests, a sufficient fill volume is required to ensure the appropriate specimen dilution. See Coagulation Studies Specimen Collection, Processing and Transport instructions.
• Use the proper container and mix all specimens containing anticoagulant or preservative by gentle inversion for 15 seconds.

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Specimen Submission

• Patients full name (not a nickname)
• Medical Record Number or other unique identifier (ID)
• Date and, if appropriate, time when specimen was obtained
• Specimen source
• Signature/ initials of collector
• The label should be affixed directly to the specimen container and not the bag

Bar-coded pre-printed labels with accession numbers generated by an information system may be used.

• Place the labeled specimen in the provided leak proof sealed plastic biohazard bag
• Place the matching requisition in the outside pouch of the bag

Use of a request form wrapped around the container is not acceptable as a specimen label.

Specimens will not be accepted if the information on the specimen label does not match the information on the accompanying requisition.

On all requests forms, the following information is required

• Patient's name & address
• Patient's gender
• Date of birth
• The last six digits of the patient's social security number or other unique identifier (ID#)
• Date and if appropriate, time of collection
• Test requested
• Type or source of the specimen
• Requesting physician/ or Client Number
• Clinical information if requested
• All applicable medical necessity codes (ICD-9)
• Complete billing and insurance information

Providing additional relevant information may be important in alerting the laboratory of the need for special handling or specimen work-up.

Tests sent to reference laboratories must have patient history information. The need for such information is indicated on the test request form.

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Specimen Collection using Separator Tubes

Collect blood in Gel- mint-top tubes or SST Gold top tubes for most chemistry tests or as specified in test requirements.  Mix by gentle inversion for 15 seconds.  Centrifuge at 3,000 – 3500 rpm for 10 to 15 minutes.  Proper centrifugation is critical for proper separation. Store and transport specimen upright (helps maintain separation).

Some tests require plasma or serum to be separated and refrigerated or frozen within a defined time frame. If frozen do not allow to thaw. See Special Handling for specific test in Test Directory.

Store the spun specimens upright in the refrigerator unless otherwise specified by the test requirements.

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Urine Specimen Collection

Random collection for Routine Urinalysis or Urine Culture   All urine specimen should be collected as clean catch urine specimens.  The first voided morning specimen is preferred. Urines for Urinalysis require immediate refrigeration or transfer to a urine preservative/or growth inhibitor transport tube for urinalysis or culture as applicable.

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Patient Instructions: Male

• The hands are to be thoroughly washed with soap and water and dried with a paper towel.
• The initial portion of urine is passed into the toilet bowl. A portion of the remaining urine should be passed into a sterile, screw-cap plastic cup. (Mid-stream)
• Aliquot a portion to a urine transport tube (contains preservative) for routine urinalysis or special urine culture transport tube for Microbiology testing.
• Transport the specimen to the lab immediately or refrigerate if transport is delayed.

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Patient Instructions: Female

• The hands are to be thoroughly washed with soap and water and dried with a paper towel.
• With one hand the patient should spread her labia and keep them continuously apart until the urine is voided into a sterile screw-cap container.
• The patient should cleanse the urethral meatus from front to back.
• The patient should void the urine and after the first portion of the urine is passed, a specimen should be caught in the sterile container without stopping the stream. The sterile container should be held in such a way that contact with the legs, vulva, or clothing is avoided.
• Aliquot a portion to a urine transport tube (contains preservative) for routine urinalysis or special urine culture transport tube for Microbiology testing.
• Transport the specimen to the lab immediately or refrigerate if transport is delayed.

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Timed Urine Collections:  24 Hours

Containers and/or preservatives are available from the Supply Department or from the local PSC. Request a 24-hour Urine Collection Container and specify test.

Preservatives are not added to the container with the exception of Metanephrines, which require10 grams of Boric Acid at the start of collection. For the majority of timed urine collection. Refrigeration is the only preservative. All specimens must be delivered to the laboratory immediately upon completion for processing and addition of preservatives if applicable.

• If applicable chemical preservatives are added in the laboratory as soon as the specimen is delivered.
• In order to calculate body surface area for Clearance test, Height and Weight must be given and a blood specimen is required.
• Write information on the attached Request Form.
• If multiple tests are ordered, more than one method of preservation may be required and additional specimen collection periods at a different time will be necessary.
  • Dietary restrictions may apply. See specific test for information.
  • Some specimens require protection from light.
  • Patient Instruction forms are available upon request.

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Patient Instructions: 24 Hour or Timed Urine Collection

• The specimen container does not contain a preservative (exception of Metanephrines, which require 10 grams of Boric Acid at the start of collection)
• Refrigeration is the only preservative for most tests. It is critical to keep the specimen collection container refrigerated during collection and delivery to the laboratory.
• Collect the specimen in a separate disposable container and add collection to 24-Hour container. Do not void directly into container.
• When adding specimen to container add carefully to avoid splatter.
• If splatter occurs wash off with cold water.
• Normal fluid intake is allowed during the collection period.
• Dietary restrictions are required for some tests (check Test Directory/Lab Guide or as directed by physician).
• Refrigerate container during collection and transport. (A small cooler with ice works well)

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Instructions for Day of Test

Day 1:  Discard first morning specimen and record time.

START TIME:______________

Collect ALL specimens during the remainder of the day and night. Do not void directly into container. Collect the specimen in a separate disposable container and carefully pour into 24-hour container. Refrigerate during and after collection.

Day 2:  Collect the first morning specimen and then stop collection

STOP TIME:_______________

• Label specimen with patient’s full name, date and time start and end of collection. This presumes that the time of arising is the same on day (1) one and day (2) two.
• Attach completed Test Request form. (See Specimen Labeling section) Tighten lid securely.
• Keep upright. Transport to Doctor’s office or laboratory as soon as possible.
• Keep refrigerated during transport.

• Note: The entire urine voided in the 24-hour period must be included. If the amount of specimen exceeds capacity of the 24-hour urine container use a clean container and refrigerate immediately. Contact the laboratory for further instructions. Be sure to label each container as: 1 of 2 or 2 of 2 as appropriate and note on requisition that two (2) containers are submitted.

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Other Timed Urine Collection Instructions: 2, 6 or 12 Hour

1. Discard initial specimen
2. Record the time start __________
3. Collect all specimens voided within the requested time frame.
4. Record the time stop___________
5. Label the specimen with patient’s full name, date & time of collection
6. Attach test request form. (See Specimen Labeling section)

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Storage and Transport for Timed Urine Specimens

Consult the Individual test in the Test Directory for specific collection instructions, preservative, storage, temperature and transport information.

To submit aliquot, mix specimen well by inverting container several times (be sure lid is securely tightened), measure total volume and submit aliquot as indicated in Test Directory/ Lab Guide or submit entire specimen container. Note amount & name of preservative if added.

Be sure to write on the label and on the Test Request form the:

• Patient name
• Test name
• Date of collection
• Timed Interval of collection
• Total Volume or Submit entire specimen collected in original collection
• Check urine specimen containers to be sure lids are secured.
• Keep specimens in an upright position
• Prepare specimen for submittal promptly to the laboratory
• Keep refrigerated during transport.

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Availability of Results

Turnaround time is defined as the period of time from receipt of the specimen in the laboratory to release of the result. Results of routine tests drawn are generally available the following day. In some cases, owing to the complexity of the test or when the test is not performed on a daily basis, a longer turnaround time may be indicated (see individual test listings).

A number of tests are also available:

Stat:     (4-hour) M-F 9 AM to 4 PM
Rush:    Same Day on Regional Schedule. M-F 9 AM to 4 PM

Regions:

• South Bay Region
• Central Coast Region
• San Francisco/Peninsula Region
• East Bay Region

Note: In cases where special handling or processing is required, please contact the laboratory prior to sending the specimen.  Call Customer Service at 1-(877) 717-3733

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Result Reporting

When verified and released, all patient laboratory results are available electronically.  Patient reports are distributed via the laboratory web portal, teleprinter, courier, fax, or U.S. mail.

Requests for additional copies of outpatient reports should be made at the time of the initial test request. Full name and address information of the recipient should be written legibly on the request form.

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Telephone Reports

Requests for telephone or fax reports of results should be indicated on the original test request. Routine results will be called or sent by fax within 1 business day. For areas, which do not have access to the computerized reporting system, all stat results will be reported by telephone as soon as completed.

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Critical/Panic Value Policy

Critical/Panic values are defined as values that are outside the normal range to a degree that may constitute an immediate health risk to the individual or require immediate action on the part of the ordering physician.  It is the policy of the clinical laboratory to call the critical values listed as soon as completed and verified.  See Critical/Panic Value List.

• Critical/Panic values results that are completed between 8:00am and 8:00pm will be called to the ordering physician immediately.
• Critical (Panic) Values completed between 8:00pm and 8:00am will be referred to the Laboratory Clinical Pathology Resident or Laboratory Director, unless the results are of questionable sample integrity.
• The Clinical Pathology Resident or Laboratory Director will determine whether the results should be called immediately or held until 8:00am. 

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Notification by the Laboratory of Critical (Panic) Values

• The ordering physician’s office will be called and the results communicated to an RN or MD.
• Documentation will be made of the call listing the first initial, last name, title of the person receiving the call and the time the call was made. 
• For verification the person receiving the call will be asked to repeat the critical value results back.
• If there is no answer, the physician’s answering service or physician that is covering for the ordering physician will be called or paged.
• If unable to contact a responsible party within 30 minutes, the supervisor will be notified.  Documentation will be made of all attempts (times and phone numbers called) into the computer and a Panic Notification Form will be completed.  The supervisor will contact the on call clinical pathology resident or the laboratory director.
• The supervisor will document in the computer the reporting of the critical value to the Clinical Pathology Resident or Laboratory Director. The Clinical Pathology Resident or Laboratory Director is the “clinically responsible individual.”  The notification time will be the time the Clinical Pathology Resident or Laboratory Director is notified.

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Laboratory Definitions

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Medicare Coverage of Laboratory Testing

When ordering laboratory tests that are billed to Medicare/Medicaid or other federally funded programs, the following requirements may apply.

Medicare only pays for tests, which it considers medically necessary for the diagnosis and treatment of the patient.  Medicare will not pay for a screening test for a disease when the patient displays no symptoms or evidence of a disease except for certain specifically approved procedures and may not pay for non-FDA approved tests or those tests considered research only.  Ancillary services are expected to have on file, a diagnosis or complaint that shows a medical necessity. The ordering physician must provide an ICD-9 diagnosis code, not a narrative description if required by the fiscal intermediary or carrier. 

Organ or disease oriented panels should be ordered only when all components of the panel are medically necessary.

Medicare National Limitations Amounts for CPT codes are available through CMS or intermediaries.

If there is reason that Medicare will not pay for a test the patient should sign an “Advance Beneficiary” (ABN) Form to acknowledge that he/she is responsible for the cost of the test if Medicare denies payment.  The fact that Medicare may not pay for a particular item or service does not mean that the physician should not order it.  It does mean that Medicare probably will not pay for the laboratory tests.

The “Advance Beneficiary” (ABN) Form is on the back of the Pink (Billing) copy of the requisition.  The tests that are listed are for the following reasons:

• Medicare does not pay for these tests for your condition
• Medicare does not pay for these tests as often as this (denied as too frequent)
• Medicare does not pay for experimental or research use tests

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Note to Test Directory/Lab Guide Users

The Test Directory/ Lab Guide provide an alphabetical listing of most of the tests performed at Stanford Clinical Laboratory or which may be referred to our contracted referral laboratories.  Because clinical laboratory medicine is an ever evolving and changing science there may be tests that are not currently in this listing and for which you would like information or would like to order:  Please contact our Customer Service Department and request assistance from the Technical Department.

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