On 17 November 2022, we swapped to brand new chemistry analysers at Guy’s and St Thomas’ hospitals. This will be followed by installation of new haematology analysers in Spring 2023. This Q&A focuses only on the chemistry analyser upgrades – information about haematology equipment is above.

These analysers serve the two hospitals – Guy’s and St Thomas’, as well as a number of local GP services (most of those in Lambeth and Southwark boroughs) and a small number of NHS providers further afield who send samples for specialist testing. We worked closely with GP leads and acute colleagues from endocrinology, oncology, cardiology and other relevant specialties to ensure that clinical service users were well informed and understood what would be different for the small number of tests which changed more notably, e.g. in reference ranges and/or testing method. More about these can be found in the questions that follow.

As part of the five-year programme to transform pathology services across south east London, major investment is being made into the replacement of ageing laboratory analysers with modern equipment. Once the roll-out programme is completed, all testing services – including results - will be standardised across all Synnovis services. This will mean consistency for all service users in terms of ordering tests and interpreting results, which will be particularly helpful to colleagues who move regularly between different sites or services, e.g. locums.

One of the first steps was to replace the core biochemistry equipment used at Guy’s and St Thomas’ hospitals with five new analysers. This has reduce downtime caused by breakdown and maintenance, as well as helping to improve laboratory performance.

Reference ranges for most tests have changed, however in the majority of cases the changes are very minor and there are only two exceptions where changes are notable. These are listed below:

• Troponin (cardiology and A&E)
• Transferrin and transferrin saturation

You can view a document containing all reference range changes by clicking here.

We continue to engage with the relevant clinical groups to work through what this means for ordering tests and patient management:
To assist clinicians with interpretation, test reports will continue to include the relevant reference ranges, and results falling outside of the reference interval will be clearly marked.

For the most part, the differences in reference ranges are so minor that they will make no difference to how you care, treat or manage your patients.
Unless you are requesting any of the tests listed below, there is no reason to consider altering your clinical practice.

• Troponin (cardiology and A&E)
• Transferrin and transferrin saturation

Because we have changed the brand of equipment used, most tests have seen a slight variation in results but these are insignificant.
All haematology, blood transfusion and coagulation tests are unaffected.
The table below shows the tests where results have change significantly. For this reason it is not clinically appropriate to trend results with those pre-November 2022. 

Critically urgent results will continue to be telephoned through to clinicians on detection as part of Synnovis’ standard operating procedure

These tests relate to tumour markers. Owing to the change in equipment supplier, these tests and the results generated have changed notably, as detailed above. For a period of seven months, and available exclusively to oncology clinicians, a new test profile containing both the old and the new test will be available. This will allow the re-baselining of tumour markers for patients undergoing post-treatment follow-ups.

The new cortisol assay performs differently compared to pre-November 2022. As such the interpretation of short synacthen tests in particular has changed. This has been updated in our Trust Endocrinology guidelines and includes interpretation of a equivocal response.  

The Troponin test is changing from measuring Troponin T to Troponin I. A new assay is being tested, and a new policy and algorithm are being created with clinical leads within cardiology. Further information will follow as soon as it is available.

Transferrin will now be measured (reported in g/L) instead of total iron binding capacity (TIBC). Transferrin saturation (TSat) will still be calculated but using the transferrin measurement instead of the TIBC calculation.

Transferrin is now measured (reported in g/L) instead of total iron binding capacity (TIBC). Transferrin saturation (TSat) will still be calculated but using the transferrin measurement instead of the TIBC calculation. This has been a significant improvement as results will no longer be overestimated as seen when using TIBC.

No, tests will be ordered in the same way that you did before the equipment change. The catalogue of tests and test profiles has remained largely the same. Some test names have changed slightly and these are reflected in the testing catalogue. There is a small number of additional tests available to specific groups, such as oncology, to meet their specific patient management requirements during the transition from old to new tests.

Yes, all tests are reported back using the same digital system(s) as you useed pre November 2022. Reports include a comment reminding you to be aware that reference ranges may have changed, and reference ranges are also included on the report

Everything remains the same - there is no change in sample type or the method of collection, i.e. phlebotomy processes, tubes etc..

Overall, replacing the aged analysers with new ones will reduce risk - there is less chance of analysers going wrong causing downtime, and the new assays are more sensitive and accurate than some of the older ones. In the future, the standardisation of tests and testing equipment across the Synnovis pathology network in south east London will reduce the risk of human error for colleagues working across multiple services, because they won’t need to alternate between different tests or reference ranges. It will also improve pathology service resilience, allowing the mobilisation of specialist staff between laboratories at other sites when additional capacity is needed.

Where reference ranges change, we have made this clear in reports. 

Because our analytical platform is changed on 17 November from Roche to Abbott, there was a temporary voluntary suspension from our UKAS-accredited scope of the majority of assays. The tests listed below continued to be analysed on Roche and therefore retain UKAS accreditation:

• α1-antitrypsin
• AMH
• Ammonia
• CTX
• P1NP
• βhCG for use as a tumour marker

Please be assured that the level of quality assurance around these assays remains at the same high level as always. The methods have been fully validated and approved by our Scientific and Clinical Leads, although the assays will temporarily be outside of our ISO15189 scope of accreditation until approved by UKAS.

General queries about the equipment replacement programme should be sent to: LetsTalk@synnovis.co.uk

For all clinical or service requirements, the dedicated customer service team remains the first port of call. They can be reached on:

0204 513 4300
customerservices@synnovis.co.uk
 
Contacting customer services directly will ensure that your query is tracked and monitored through to satisfactory resolution