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Tracking each step of the antenatal screening pathway

Posted by: and , Posted on: - Categories: Screening Quality Assurance Service

Have you ever bought an item from one of the major online retailers?  You can check availability of stock, process your payment and confirm a suitable delivery date and time – all online. In many cases you can also track your order and follow the different stages to delivery of your goods.

In the same way that we track our online orders we also need to track each step of the antenatal screening pathway. So let’s focus on tracking a screening sample, such as a blood sample.

There are many steps involved, from taking the sample, dispatching the sample, analysing the sample and reporting the results. Ultimately, the true test that the process has worked is that we communicate the result to the patient in good time.

Each of the NHS antenatal screening programmes defines achievable standards for reporting blood test results. For example:

  • 98% of antenatal sickle cell and thalassaemia (SCT) screening test results should be reported within three working days of sample receipt in the laboratory
  • more than 99% of Down’s, Edwards’ and Patau’s screening test results in the fetal anomaly screening programme (FASP) should be reported within three working days of sample receipt in the laboratory
  • more than 97% of HIV, hepatitis B and syphilis screening test results in the infectious diseases in pregnancy screening (IDPS) programme should be reported within eight working days of sample receipt in the laboratory

Screening programmes need failsafe processes. If something goes wrong, these processes ensure it can be easily identified and action taken to correct it before any harm occurs. The concept of failsafe is not widely understood, so let’s break it down with an HIV screening example:

Mrs Russell books at 8 weeks and accepts HIV screening, her blood sample is taken and despatched to the screening laboratory. Do you:

  • check you have her results within 8 working days as per standards?
  • follow up with the screening laboratory if you don’t have a result within 8 working days?
  • simply wait until her next appointment which might be around 16 weeks?

Let’s assume her blood sample taken at 8 weeks was lost and never arrived in the laboratory. If you only checked her results before her appointment  at 16 weeks you would have lost 8 weeks in putting it right and delayed any potential intervention she may need. Consider what would happen if she was found to be HIV positive on subsequent screening.

We know from screening safety incidents that some maternity services do not check screening results in line with the above antenatal timeliness standards. This means that if a screening sample is inadequate/needs repeating or if it never arrived in the screening laboratory, they do not find out until reporting on key performance indicators (KPIs) three months later.

Failsafe processes must be timely to help you identify what is going wrong as it is happening.

Some questions to consider

Would you know if there is something going wrong in your sampling to results process?

Are you tracking the process to know?

Are you just keeping your fingers crossed and hoping for the best?

What one step can you take to improve your processes in 2016?

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  1. Comment by Phil Bullock, CHS in cytology posted on

    Failsafe is a very neccessary part of all programmes as stated here. However as long as pathways span organisations with no overall pathway framework in place - certainly the case for cervical screening, and I suspect the same for antenatal - then the potential for failure will always be greater.

    A review of all programmes is needed to close these loopholes and provide national software packages that deal with these issues whilst making all relevant information available to Healthcare pratcitioners working within diverse programmes.

    • Replies to Phil Bullock, CHS in cytology>

      Comment by Denise Dixon posted on

      We are currently reviewing and updating the screening pathways and associated failsafe maps (ANNB, DES, AAA) to highlight to healthcare practitioners and commissioners where the loop holes are and providing suggestions about local processes they may wish to put in place to minimise things going wrong.