Pathology - The Facts. Where can I have a pathology test?

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Pathology tests can be performed at the place of collection and/or transported to a pathology laboratory, which should be accredited, for processing. Here is a snapshot of places to have a pathology test, including some points to consider.

What is an accredited pathology laboratory?

The National Association of Testing Authorities (NATA) and the Royal College of Pathologists of Australasia (RCPA) jointly perform an accreditation assessment of pathology laboratories seeking approval as an Approved Pathology Laboratory. Accredi tation is performed against quality standards defined by the National Pathology Accreditation Advisory Council (NPAAC) which is a ministerially appointed expert body that develops and maintains the standards for accreditation of pathology laboratories.

How do you know if a pathology laboratory is accredited?

Look for the NATA/RCPA logos or endorsement certificates, or ask the laboratory staff if they have NATA/ RCPA accreditation. Patients can also refer to the NATA website which lists all Medical Testing laboratories currently accredited in Australia.

Approved Pathology Collection Centres (APCCs)

APCCs are the facilities to which patients take their pathology request form to have their pathology specimen or sample collected for testing in the pathology laboratory. They are inked to accredited pathology laboratories and are subject to ongoing monitoring processes to ensure the quality of pathology collection services.

Medical consulting rooms

Treating practitioners routinely collect pathology specimens, such as Pap smears or wound swabs, as part of their consultation. Most pathology tests collected by treating practitioners are sent to an accredited pathology laboratory for testing.

Hospitals

Hospitals require a large amount of pathology testing to support their diagnosis and treatment activities. This includes tests on pathology samples collected during operations, such as the diagnosis and staging of cancers. Pathology laboratories that service hospitals must comply with those institutions’ accreditation systems, and with NATA/RCPA pathology laboratory accreditation.

At home

Collecting pathology samples at home may be required due to illness or immobility, or due to a test requirement such as a 24hr urine collection. If a treating practitioner requests the test, and the sample is sent to an accredited pathology laboratory, then it will be tested within an accredited framework. A pathology collector can collect the sample during a home visit, or patients may need to collect their own sample for some tests. Because most patients do not have any training in pathology collection procedures, common problems that may occur with self-collected samples include:

• the sample might be identified incorrectly such as writing the wrong type of specimen on the label
• the sample might be collected incorrectly such as using a poor technique to collect a mid-stream urine specimen
• the sample might be stored incorrectly such as a urine specimen not being placed in the refrigerator
• the patient might not carry out necessary follow-up actions such as returning the collected sample to the pathology laboratory within a suitable timeframe to prevent it deteriorating. Patients should be aware of these potential issues when they collect their own sample.

Patients should be aware of these potential issues when they collect their own sample.

Non-accredited settings

Testing offered by complementary health care professionals, some pharmacies or non-accredited pathology laboratories usually operate outside of an accredited framework which may have implications for the quality of the test results. Some of the risks associated with these tests may include:

• that there may be no evidence that the tests offered are appropriate or relevant
• the tests may be performed and interpreted by staff without appropriate laboratory qualifications, training or experience
• the tests may have a high risk for false-positive (testing positive for a disease or condition that isn’t present) and false-negative (testing negative for a disease or condition that is present) results which create unnecessary stress or false reassurance for the patient
• the test results may require follow-up testing to confirm their accuracy
• the tests may be expensive and are not eligible for a Medicare rebate which means the patient will probably be responsible for the full cost of the tests.

Can I choose which pathology laboratory I go to?

Yes. From 1 July 2010 legislative changes enabled patients to choose which pathology laboratory they go to, unless the request form is directed to a particular pathology laboratory for the reasons listed below.

Why should I go to a particular pathology laboratory?

There are a number of reasons why a treating practitioner may request pathology tests from a particular pathology laboratory. These include:

• the treating practitioner may be familiar with the particular reporting style of a pathology laboratory, and /or have specialised infrastructure and procedures in place to enhance communication of information and test results to the requesting practitioner. If a patient takes their request to a different pathology laboratory then these benefits may be lost
• chronic conditions may require regular monitoring with pathology tests, and the results may be more difficult to track over time if the tests are not performed using the same method, equipment and reporting style of one pathology laboratory
• not all pathology laboratories perform all tests, so the treating practitioner may direct a patient to a particular pathology laboratory that performs the relevant range of tests they have requested
• treating practitioners have a legal obligation to act upon the results of pathology they request. They may encounter difficulties following-up test results if they don’t know which pathology laboratory per formed the pathology tests
• the pathology laboratory may have difficulty communicating urgent results outside normal business hours if the requesting practitioner is not a regular requester and their after hours contact details are not known to the pathology laboratory. This can lead to the involvement of emergency services to deliver the test results.

Can I order my own pathology test?

Ordering pathology tests is a complex process and interpreting the results requires medical training. Pathology laboratories are also under no obligation to perform a pathology test without a treating practitioner involved in the process. Even if they do agree to perform the test, Medicare benefits will not be payable and the patient will be responsible for the full cost of the pathology tests.