15 Nov

The IEQAS Annual Conference 2024 took place at the Ashling
Hotel, Dublin 8 on Thursday 3rd October 2024, with over 150 delegates, invited
speakers and sponsors. The day lived up to expectations and delivered a diverse
and relevant programme, with lively discussion and positive response. The first
plenary session was kindly sponsored by the ACSLM and chaired by Mr Dermot Mc
Brierty, representing the ACSLM. Dermot introduced the first plenary speaker,
Professor Martin Cormican, HSE lead for the HSE Outline Strategic Plan for
Laboratory Service Reform, 2025-2034. Martin provided a comprehensive overview
of the draft plan, now at an advanced stage (and including 15 detailed
recommendations). These recommendations entail the HSE and HSE funded
laboratory services to provide sustainable, quality, analytical and
interpretive services, as foundation for improved healthcare. The plan is
relevant for reference and clinical diagnostic laboratories, Public Analyst
Laboratories (PALs) and Public Health Microbiology Laboratories (PHMLs) – the
latter two grouped as Health Protection Laboratories, in the plan. Martin
pointed out the key opportunities and challenges around services, scientific
and technological developments, organisational change, recruitment and
retention of skilled staff, service integration, infrastructure, maintaining
quality systems and ensuring for public health emergencies. Key recommendations
Martin particularly mentioned include implementation of the developed
Postgraduate Training Programme for Medical Scientists, development of an
integrated Clinical National Reference Laboratory Service (CNRLS) and
development of a HSE Central Laboratory Campus management, proposed as a single
national service, with development of Laboratory Networks within all the Health
Regions. This would allow integration of quality systems, investment in
automation of sample processing, new technologies such as digital pathology,
electronic ordering, inter-laboratory electronic information transfer, secure
patient own laboratory data, phlebotomy services, role expansion for laboratory
aides along with career progression opportunities for scientists, including
advanced and autonomous practice.
Delegates digested Martin’s presentation, over coffee and
delicious oatmeal cookies (sponsored by Roche), with colleagues and fellow
scientists. Everyone had the welcome chance to catch up with friends from other
laboratories.
The next plenary session chaired by Dr Peadar Mc Ging, opened
with Dr Ann Leonard, Research & Innovation Chief Medical Scientist and Ms
Caroline Murray, Senior Medical Scientist in the Laboratory Medicine Innovation
Hub, both at Tallaght University Hospital (TUH). Ann and Caroline introduced
the audience to the ‘Get It Right First Time (GIRFT) Ireland’. Ann and Caroline
outlined how, in 2021, the National Health Service (NHS) in England undertook a
comprehensive review of their pathology services under the auspices of the
GIRFT programme, which culminated in a comprehensive pathology report in May
2022. This included recommendations covering all phases of the Total Testing
Process. In 2024 the Laboratory Medicine Innovation Hub (LMIH) at TUH, in
conjunction with Peri-Analytic and Laboratory Medicine Society (PALMSoc),
repeated the survey and created a GIRFT pilot project, covering Clinical
Chemistry only, with six large teaching hospitals across the country
participating. Trends seen were reviewed and compared to trends identified in
the NHS report. It is planned to extend the project to additional Hospitals and
all laboratory discipline services.
Next the IEQAS conference got to take ‘A
Walk Down Granby Lane’ - an apt title for the insightful presentation given by
Dr Alana Lawlor, GP with the Granby Clinic, Dublin, on challenges and demands
of primary care for the homeless and the role of the hospital laboratory within
this. With Austin O Carroll and Mark Murphy, Alana runs the Granby Clinic,
where they provide free primary care, on a walk-in basis, five days a week. In
2023, the Granby Clinic saw an average of 100 patients a day. Alana is clinical
lead of the Mobile Health Unit, which provides primary care to rough sleepers,
in and around Dublin, three nights a week. She is the Assistant Scheme Director
for the North Dublin City GP Training Scheme. The Granby Centre provides
primary care to marginalised patients, particularly the homeless and those
needing addiction services. Alana recognises that Laboratory services,
especially NPT/POCT are crucial to the care of patients, but that this
population presents additional challenges. Alana noted the issues with follow
up such as those due to homelessness, addiction, literacy and language
barriers, medical history and specific issues relating to clinical laboratory
testing. She discussed sampling and result follow up along with future
developments such as an infectious disease surveillance unit.
This final plenary session was certainly food for thought,
for delegates, as they headed to lunch, (kindly sponsored by Eurofins Biomnis)
and before finding their way to the suites for the afternoon specialised
workshops in Clinical Chemistry, Haematology, Microbiology and Blood
Transfusion.
The Clinical Chemistry workshop included a presentation and
overview by Dr Lucille Kavanagh, Principal Clinical Biochemist in the Mater
Misericordiae University Hospital (MMUH), of the Renal Stone analysis service. Lucille
explained the overall increasing prevalence and decreasing age onset,
highlighting the value of the analysis service, for diagnosis of treatable
conditions such as cystinuria, uric acid stones and primary
hyperparathyroidism.
Ms Lorraine Mc Govern, medical scientist in the
Biochemistry department of Letterkenny University Hospital, spoke about her
work on the evaluation/implementation of the new Roche Elecsys sFlt1/PIGF ratio
in the diagnosis and management of pre-eclampsia (PE) in the hospital. Lorraine
described how PE, a multi-organ disorder, causes significant morbidity and
mortality to the mother and foetus in affected pregnancies. She went on to
explain that the current guidelines recommend diagnostic methods which are non-specific
and insensitive in diagnosing or predicting the onset of PE. Lorraine evaluated
the effectiveness of using the ratio (based on the new diagnostic guidelines,
DG49, published by NICE in the UK), to diagnosis and classify patients into
low-risk to increased risk of developing PE. The study tested 57 suspected
pre-eclampsia patients, results indicating use of the ratio as an additional
diagnostic tool for PE at the hospital (a ratio >38 indicating a need for
increased surveillance/early delivery, while also reducing unnecessary
admission of low-risk patients).
The challenges and successes, of the Near Patient Testing
Quality Improvement Project, was presented by Ms Noreen Montgomery, Chief
Medical Scientist at the Clinical Biochemistry Department of Sligo University
Hospital (SUH). Noreen’s presentation outlined the Quality Improvement plan
that was undertaken, beginning in 2020, with multidisciplinary collaboration,
that resulted in a "culture" change in the Emergency Department at
the hospital. Noreen spoke of the >90% reduction in non-compliance rates by
July 2024. She also emphasised the central role of the laboratory in the
leadership and coordination of NPT activities, with patient safety at the
forefront. Dr Peadar McGing, IEQAS Chair, not only gave the Chair address and
chaired the second plenary session but then regaled the conference delegates
with a memorable and personal presentation about ‘When the Biochemist becomes
the Patient’. Retired and former Principal Clinical Biochemist at the Mater
hospital, Peadar is also a Fellow of the Royal College of Pathologists and has
Fellowship of the Association for Clinical Biochemistry & Laboratory
Medicine. After nearly 40 years of carrying out analyses and reporting results
he found himself on the other side of the bench. It was discovered that a
problem with his vision turned out to be (with identification and removal of) a
craniopharyngioma (benign brain tumour - thankfully), followed by 6 weeks of
daily radiotherapy. Peadar discussed how biochemistry and other laboratory
tests, including knowing his own prediagnosis baseline levels, contributed to
diagnosis and monitoring of his condition. IEQAS endeavours to provide clearly
presented reports to participants, for its Clinical Chemistry scheme. The final
presentation at the Clinical Chemistry workshop was given by Ms Bernadette
Jackson, Naas General Hospital, explaining the information available in these
reports and reviewing a selection.
Beginning the Haematology Workshop session
was the much anticipated and ever valuable ‘IEQAS Blood Cell Morphology Annual
Review’ by Dr Catherine Flynn, Consultant Haematologist, St James’s Hospital.
Dr Flynn’s research and clinical interests include malignant myeloid,
transplantation, bone marrow failure syndromes and haematological diseases
during pregnancy.
Mr Selvin Nakka, Medical Scientist in the Haematology
Department, St James’s Hospital, has keen interest in blood cell morphology and
reporting peripheral blood films, with added, extensive experience in the
diagnosis of malaria. He is a tutor in both these areas for both TU Dublin
undergraduate students and Medical Scientist colleagues at St James’s. Selvin’s
interesting case was that of a 46-year-old man presenting with acute confusion
and general malaise, where peripheral blood smear examination proved to be key
to the accurate diagnosis and successful treatment of the man for lead
poisoning, due to a history of prolonged Ayurvedic medicine use. Jack Molloy is
a recent graduate of the TU Dublin Medical Science programme and carried out
his final year research project, on pseudo-thrombocytopenia (PTCP), in the
Haematology laboratory in St. Vincent's University Hospital. PTCP is a
relatively common laboratory-diagnosed condition that interferes with automated
platelet counts and can lead to unnecessary further testing. The goal of the
study, using 1461 samples, was to produce evidence for procedural changes and
streamline investigative pathways. Gaby Couch has also just graduated from
Biomedical Science at TU Dublin, completing her final year research project in
the Haematology laboratory at the Mater Misericordiae University Hospital
(MMUH). Gaby spoke about her project at the Haematology workshop, involving
Lupus Anticoagulant (LA) testing, current guidelines and her investigation into
newer alternatives for this testing.
Meanwhile, in the Microbiology workshop
session, delegates enjoyed hearing about - ‘Antimicrobial Stewardship
Accreditation: How we (and the lab) did it’ - the title of the talk by Ms
Claire McSherry, St Columcille’s Hospital. The Antimicrobial Stewardship (AMS)
team, at St.Columcille’s, included AMS accreditation as a key priority in their
AMS annual plan, 2023. Claire discussed the journey to this and stated that in
October 2023, the hospital was awarded Level 3 BSAC GAMSAS accreditation -
which represents the highest achievable level of accreditation. Dr Nicki Rees,
registrar at St Vincent’s University Hospital, followed with a comparison of
laboratory practices in clinical microbiology, between Ireland and South Africa
(and as she states - not just the rugby!). Nicki highlighted the variations
between the countries, in epidemiology, technology and political environments
and how that this impacts laboratory practices. Nicki’s interest areas include
antimicrobial and diagnostic stewardship, neglected tropical diseases, the
human microbiome and health education.
Point- of- Care Testing (POCT) or Near Patient Testing
(NPT) provides rapid, accurate and precise results that facilitate diagnosis
and patient management. Dr Gemma O’Brien detailed the experiences in Beaumont
Hospital, in implementing COVID, Flu A and B POCT in the emergency department
there, during the height of the COVID- 19 pandemic. Gemma O’Brien has a total
of 20 years’ experience working as a Medical Scientist in the fields of
Clinical Chemistry and NPT and is now based in Beaumont Hospital, working as
Chief in NPT. Her experience has involved introducing and developing NPT
accredited services across a multitude of laboratory disciplines. In 2024,
Gemma has lead Beaumont Hospital’s NPT department in being the first NPT
service in Ireland to have all its services electronically integrated to the
National Medical Laboratory Information System (MedLIS).
The MedLIS experience
in Blood Transfusion at Beaumont Hospital was the topic running concurrently in
the Blood Transfusion workshop, with speakers - Ms Anne Geaney and Mr Paul
Sheridan. They provided the delegates with an overview and particular focus on
Pathnet Blood Transfusion implementation and experience. Anne is the Blood
Transfusion and Data Migration lead on the MedLIS project. Paul Sheridan is a
Senior Medical Scientist in Blood Transfusion at the hospital, responsible for
the Blood Transfusion MedLIS Lead. Major incident planning for Blood
Transfusion was the next talk by Ms Cathy Leddy, Connolly Hospital, who
discussed the Connolly Hospital experience, including three major incident
drills, completed in conjunction with North Dublin hospitals, Dublin Fire
Brigade and the hospital wide drill. Cathy focused on the learning outcomes,
improvements and training for the planning. The Blood Transfusion National
Children’s Hospital Project - by Ms Martina Williams, CHI Crumlin, was the
final Blood Transfusion workshop presentation. Martina Williams is the Chief
Medical Scientist for both the Crumlin and Temple St Blood Transfusion
laboratories in Children’s Health Ireland. Martina explained how this involves
the merging of two laboratories in a new purpose built, state-of-the-art,
hospital facility, with the Transfusion Laboratory Information System being
implemented at the same time. The presentation focused on the work to date and
ongoing challenges for the team.
The IEQAS conference thus concluded, leaving
delegates with much to discuss and hopefully having gained new insights and
ideas for their own laboratories and practice. The Irish Quality Assessment Scheme are
delighted with another successful and well supported conference. A big thanks
to all involved and to those who attended. A special send-off to Patricia
Howley, who has retired from IEQAS after 25 years. The Book of Abstracts 2024,
with full details of the conference programme, sponsors and speakers can found
on the IEQAS website at www.ieqas.ie.
Sponsored By: ACBI, ACSLM, Brennan &
Company, Cruinn Diagnostics, Eurofins Biomnis, Labquality, Roche.
Maria Phelan , Irish External Quality Assessment Scheme CLG