When two hospitals merged acute services, the challenge was to give both sites access to fast and reliable pathology laboratory test results, explains Peter Mitchell

When Kingston Hospital and Queen Mary's Hospital, Roehampton, finally merged their acute surgical and medical services in 1998, part of the deal was the integration of both pathology laboratories into one at Kingston, leaving Queen Mary's laboratory as a satellite.

It was essential to retain a lab at each site to maintain turnaround time, and each has equipment the other does not.

Queen Mary's has some specialised rapid-throughput instruments, but Kingston is equipped to perform a much wider range of assays. With tests done at both sites, and many samples being transferred from one lab to the other, some way had to be found to make results available at both sites.

On top of that, the transfer of acute services from Queen Mary's to Kingston meant a virtual overnight doubling of samples received at Kingston.

Biochemistry alone leapt to 800 samples a day from 500, and the earlier Pathway system could barely cope, taking a full minute to refresh screen displays.

'With the prospect of receiving over 800,000 requests a year, it was essential we had a system with the necessary data-processing speed,' says laboratory manager Norman Harling.

Pathway was due for replacement because of year 2000 problems anyway. Sue Martin, the consultant biochemist who managed the project, decided on a Windows NT server at each site, each running the same data management system (WinPath).

Each server collects assay results directly from all the analysers on its site, and at intervals copies its local data to the other. In this way they both maintain a results database accessible to clinicians on the wards via NT client machines. The results are always up-to-date to within a few minutes, with data transferred over the leased Megastream communications link between Kingston and Roehampton. The complete project requires the installation of 130 work stations.

The first disciplines to go live, immediately after the merger in September, were biochemistry, haematology and immunology. Microbiology and blood transfusion were added the following month, and cellular pathology and cytology in February 1999. Colposcopy will have an extra function, enabling it to collect statistics to meet the Department of Health reporting requirements. The data will also be used for administrative tasks like accounts and personnel management.

At the moment, there are 50 client machines on the wards across both sites - though Queen Mary's has only a handful. 'There are security issues in attaching the Queen Mary's internal network to Kingston's', says Sue Martin. 'QM is trying to get an accredited connection to the NHSnet, while Kingston Hospital isn't connected to NHSnet at all. So we have had to modify the link between the two hospitals' networks: only a subset of QM's network has access to the laboratory system at Kingston.

'The availability of ward enquiries has been a significant benefit, particularly to the acute areas at night. But training the ward staff is a big issue, because of the rapid turnover of agency nurses. And there are still problems in getting some doctors to use the ward systems because they do not like logging into Windows NT - which involves remembering both a user name and a password.'

The system shows if a sample has been logged in and what tests have been ordered for it - soon, a full sample tracking module will be added, Ms Martin says.

Kingston has just interfaced the new lab data software to its SMS patient administration system, so that patients' demographic details can be linked to their results. That is being tested now, and the QM patient database will be merged into Kingston's by September.

Next on the wish list is a means to scan in test request forms on both sites and eliminate re-keying of the order - often illegibly handwritten. Ultimately the plan is to have full-order communications, according to the NHS's grand strategy.