Test Update:
cid:image005.png@01D26D76.E2123BE0
SARS-COV-2 (Antigen) Hospital Discharge Screen
Notification Date: 7/17/24
Effective Date: 7/18/24

SUBJECT: SARS-COV-2 (Antigen) Hospital Discharge Screen is discontinued

SITE: St. Mary’s Hospital – Madison

The COVID-19 Discharge Antigen Test was implemented on March 7th, 2023, in response to Skilled Nursing Facilities requiring COVID-19 screening prior to admission. This test was used for discharge screening only, not for preadmission testing, preprocedural testing, or diagnosis.

Many Skilled Nursing Facilities have now relaxed these requirements, reducing our test utilization. As a result, Laboratory, and the Infection Prevention Committee have elected to discontinue this assay. It will be removed from all order and preference lists effective 07/18/2024.

The Antigen Hospital Discharge Screen used a different collection kit than the continuing PCR test. Please discard all collection kits labeled for the discharge screen test.

If a COVID-19 test is required for discharge, please order SARS-COV-2 (COVID-19) RAPID PCR LAB13674.

Please direct questions or comments to:
     Nyssa Sheridan, MS, MLS (ASCP)
     Microbiology Technical Specialist, St. Mary’s Madison Microbiology
     608-258-6756
     nyssa.sheridan@ssmhealth.com

Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914

Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
cid:image005.png@01D26D76.E2123BE0
Urine Lab Critical Value Elimination
Effective Date: 07/16/2024

SUBJECT: Eliminated urine critical value at St. Mary’s Hospital - Madison

SITES: ST. MARY’S MADISON HOSPITAL

Critical values are defined as values that are outside the normal range to a degree that may constitute an immediate health risk to the individual or require immediate action on the part of the ordering physician. Critical values in urine ketones/glucose serve as one parameter to identify patients in diabetic ketoacidosis, and a critical call value is currently called with urine ketones ≥ 80 mg/dL and glucose ≥ 50 mg/dL. The laboratory has received feedback from urgent care and the ED that the values do not rise to the level of critical requiring a direct notification from lab.
In order to streamline lab processes, reduce the communication burden on hospital staff, and align with SSM system ministries, the urine critical value will be eliminated. This change has been reviewed and approved by the SMM Medical Executive Committee.
Please communicate to colleagues and staff in your area accordingly.


Thank you,

Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
cid:image005.png@01D26D76.E2123BE0
NOROVIRUS DETECTION BY PCR
Notification Date: 7/1/2024
Effective Date: 7/9/2024

SUBJECT: NOROVIRUS DETECTION BY PCR available in-house 7/9/2024

The NOROVIRUS DETECTION BY PCR test will be performed in the Microbiology Laboratory at St. Mary’s Hospital in Madison (Test Code LAB02737) on 7/9/2024. 
This will decrease the turnaround time for this test significantly. 
Please review the specimen collection and specimen storage and transport conditions because some things have changed. 

Test Performance:
•           Daily 24/7, TAT ≤ 6 hours


Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
 

Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
cid:image005.png@01D26D76.E2123BE0
Urinalysis testing
Notification Date: 6/27/2024
Effective Date:  6/25/2024

SUBJECT: Urine specimen requirements have changed

SITES: ST. MARY’S MADISON HOSPITAL

Marble topped tubes are no longer acceptable containers for urine testing.
Sterile urine cups are acceptable containers for these tests:
 
TEST NUMBER TEST NAME
LAB07502 Urinalysis Reflex Microscopic Reflex culture
LAB10361 Urinalysis with Microscopic NO culture
LAB90205 Urinalysis with Microscopic Reflex to culture
LAB07530 Urinalysis Reflex to Microscopic NO culture
LAB07532 Urinalysis NO Microscopic NO culture
LAB07500 Ketones Qual Urine Auto
LAB07534 pH Urine Auto
LAB07523 Protein Qualitative Urine Auto
LAB07519 Specific Gravity Urine

Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
 

Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
cid:image005.png@01D26D76.E2123BE0
Syphilis / RPR testing
Notification Date: 5/15/2024
Effective Date: 5/16/2024

SUBJECT: RPR testing will be performed at St. Mary’s Hospital - Madison

SITES: ST. MARY’S, ST CLARE, JANESVILLE, and MONROE HOSPITALS, and DEAN CLINICS

Bringing RPR testing into St. Mary’s lab will further improve turnaround time for syphilis screening and provide more rapid turnaround time for assessment of congenital syphilis.

To align with the system initiatives and reduce ordering confusion, we have streamlined the orderable syphilis tests as noted below:
  1. Syphilis Screening: SYPHILIS TOTAL AB SCREEN WITH REFLEX (LAB12272)
 
  1. Congenital Syphilis/Syphilis Monitoring: RPR WITH REFLEX TO TITER (LAB12430)

DISCONTINUED: RPR WITH REFLEX TITER AND TP-PA CONFIRMATION (LAB07050) – this traditional Syphilis screening method will be discontinued and no longer orderable.

See below information for more detail on the reverse algorithm screen.

Reverse syphilis testing algorithm starts with an assay to measure IgM and IgG antibodies specific to Treponema pallidum (TP) utilizing the Syphilis TP antibody CMIA assay which will be performed at St. Mary’s Madison. 

Advantages of utilizing the Reverse Syphilis Screening Model:
  1. The TP antibody screening test is specific to syphilis (although false positives may occur).
  2. TP antibodies are more sensitive than RPR for detecting both primary and late syphilis.
  3. The TP antibody assay can be performed within the SSM Wisconsin region to improve turnaround time.

Samples which are reactive for TP (syphilis) antibodies will be reflexed to rapid plasma reagin (RPR) confirmation testing to help distinguish between infection with T. pallidum (syphilis) versus a falsely reactive treponemal antibody result. 

The TP antibody test and RPR test can identify persons previously treated for syphilis and those with untreated or incompletely treated syphilis.
Discordant results between the syphilis TP antibody assay and RPR will be further reflexed to a second treponemal test, Treponema Pallidum Particle Agglutination (TP-PA) for further evaluation if necessary. 
Please see the chart below for interpreting results utilizing the reverse screening model.
           Table. Interpretation and follow-up of syphilis reverse screening results

Patient History		 Syphilis (TP)  IgM/IgG antibody screen CMIA
RPR
TP-PA
Interpretation
Follow - up
Unknown history of syphilis
Nonreactive
N/A
N/A		 No serologic evidence of syphilis None, unless clinically indicated (e.g. early/acute/primary syphilis)
Unknown history of syphilis
Reactive
Reactive
N/A		 Untreated or recently treated syphilis See Centers for Disease Control and Prevention treatment guidelines

Unknown history of syphilis
Reactive
Nonreactive
Nonreactive		 Probable false-positive screening test No clinical follow-up testing, unless clinically indicated (e.g. acute/primary syphilis)

Unknown history of syphilis
Reactive
Nonreactive
Reactive		 Possible syphilis (e.g. early or latent) or previously treated syphilis
Historical and clinical evaluation required
Known history of syphilis
Reactive
Nonreactive
Reactive or N/A		 Past, successfully treated syphilis
None
CMIA = Chemiluminescent microparticle immunoassay
RPR = rapid plasma reagin
TP-PA = Treponema pallidum particle agglutination

Please communicate to colleagues and staff in your area accordingly.

Please direct questions or comments to:
Amy Little Soldier                         Molly Gurney, M.D.
Laboratory Technical Specialist, Chemistry Assistant Laboratory Medical Director, Chemistry
SSM Health St. Mary’s Hospital Madison SSM Health St. Mary’s Hospital Madison
Office: (608) 258-6910 Office: (608) 258-6914
amy.littlesoldier@ssmhealth.com molly.gurney@ssmhealth.com

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914


 
Test Update:
SARS-COV-2 (Antigen) Hospital Discharge Screen
Notification Date: 7/17/24
Effective Date: 7/18/24

SUBJECT: SARS-COV-2 (Antigen) Hospital Discharge Screen is discontinued

SITE: St. Mary’s Hospital – Madison

The COVID-19 Discharge Antigen Test was implemented on March 7th, 2023, in response to Skilled Nursing Facilities requiring COVID-19 screening prior to admission. This test was used for discharge screening only, not for preadmission testing, preprocedural testing, or diagnosis.

Many Skilled Nursing Facilities have now relaxed these requirements, reducing our test utilization. As a result, Laboratory, and the Infection Prevention Committee have elected to discontinue this assay. It will be removed from all order and preference lists effective 07/18/2024.

The Antigen Hospital Discharge Screen used a different collection kit than the continuing PCR test. Please discard all collection kits labeled for the discharge screen test.

If a COVID-19 test is required for discharge, please order SARS-COV-2 (COVID-19) RAPID PCR LAB13674.

Please direct questions or comments to:
     Nyssa Sheridan, MS, MLS (ASCP)
     Microbiology Technical Specialist, St. Mary’s Madison Microbiology
     608-258-6756
     nyssa.sheridan@ssmhealth.com

Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914

Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
Urine Lab Critical Value Elimination
Effective Date: 07/16/2024

SUBJECT: Eliminated urine critical value at St. Mary’s Hospital - Madison

SITES: ST. MARY’S MADISON HOSPITAL

Critical values are defined as values that are outside the normal range to a degree that may constitute an immediate health risk to the individual or require immediate action on the part of the ordering physician. Critical values in urine ketones/glucose serve as one parameter to identify patients in diabetic ketoacidosis, and a critical call value is currently called with urine ketones ≥ 80 mg/dL and glucose ≥ 50 mg/dL. The laboratory has received feedback from urgent care and the ED that the values do not rise to the level of critical requiring a direct notification from lab.
In order to streamline lab processes, reduce the communication burden on hospital staff, and align with SSM system ministries, the urine critical value will be eliminated. This change has been reviewed and approved by the SMM Medical Executive Committee.
Please communicate to colleagues and staff in your area accordingly.


Thank you,

Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
NOROVIRUS DETECTION BY PCR
Notification Date: 7/1/2024
Effective Date: 7/9/2024

SUBJECT: NOROVIRUS DETECTION BY PCR available in-house 7/9/2024

The NOROVIRUS DETECTION BY PCR test will be performed in the Microbiology Laboratory at St. Mary’s Hospital in Madison (Test Code LAB02737) on 7/9/2024. 
This will decrease the turnaround time for this test significantly. 
Please review the specimen collection and specimen storage and transport conditions because some things have changed. 

Test Performance:
•           Daily 24/7, TAT ≤ 6 hours


Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
 

Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
Urinalysis testing
Notification Date: 6/27/2024
Effective Date:  6/25/2024

SUBJECT: Urine specimen requirements have changed

SITES: ST. MARY’S MADISON HOSPITAL

Marble topped tubes are no longer acceptable containers for urine testing.
Sterile urine cups are acceptable containers for these tests:
 
TEST NUMBER TEST NAME
LAB07502 Urinalysis Reflex Microscopic Reflex culture
LAB10361 Urinalysis with Microscopic NO culture
LAB90205 Urinalysis with Microscopic Reflex to culture
LAB07530 Urinalysis Reflex to Microscopic NO culture
LAB07532 Urinalysis NO Microscopic NO culture
LAB07500 Ketones Qual Urine Auto
LAB07534 pH Urine Auto
LAB07523 Protein Qualitative Urine Auto
LAB07519 Specific Gravity Urine

Please communicate to colleagues and staff in your area accordingly.

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914
 

Test Update:
A message from Adam Morgan, M.D. (Laboratory Medical Director | SSM Health St. Mary’s Hospital - Madison) ...
Syphilis / RPR testing
Notification Date: 5/15/2024
Effective Date: 5/16/2024

SUBJECT: RPR testing will be performed at St. Mary’s Hospital - Madison

SITES: ST. MARY’S, ST CLARE, JANESVILLE, and MONROE HOSPITALS, and DEAN CLINICS

Bringing RPR testing into St. Mary’s lab will further improve turnaround time for syphilis screening and provide more rapid turnaround time for assessment of congenital syphilis.

To align with the system initiatives and reduce ordering confusion, we have streamlined the orderable syphilis tests as noted below:
  1. Syphilis Screening: SYPHILIS TOTAL AB SCREEN WITH REFLEX (LAB12272)
 
  1. Congenital Syphilis/Syphilis Monitoring: RPR WITH REFLEX TO TITER (LAB12430)

DISCONTINUED: RPR WITH REFLEX TITER AND TP-PA CONFIRMATION (LAB07050) – this traditional Syphilis screening method will be discontinued and no longer orderable.

See below information for more detail on the reverse algorithm screen.

Reverse syphilis testing algorithm starts with an assay to measure IgM and IgG antibodies specific to Treponema pallidum (TP) utilizing the Syphilis TP antibody CMIA assay which will be performed at St. Mary’s Madison. 

Advantages of utilizing the Reverse Syphilis Screening Model:
  1. The TP antibody screening test is specific to syphilis (although false positives may occur).
  2. TP antibodies are more sensitive than RPR for detecting both primary and late syphilis.
  3. The TP antibody assay can be performed within the SSM Wisconsin region to improve turnaround time.

Samples which are reactive for TP (syphilis) antibodies will be reflexed to rapid plasma reagin (RPR) confirmation testing to help distinguish between infection with T. pallidum (syphilis) versus a falsely reactive treponemal antibody result. 

The TP antibody test and RPR test can identify persons previously treated for syphilis and those with untreated or incompletely treated syphilis.
Discordant results between the syphilis TP antibody assay and RPR will be further reflexed to a second treponemal test, Treponema Pallidum Particle Agglutination (TP-PA) for further evaluation if necessary. 
Please see the chart below for interpreting results utilizing the reverse screening model.
           Table. Interpretation and follow-up of syphilis reverse screening results

Patient History		 Syphilis (TP)  IgM/IgG antibody screen CMIA
RPR
TP-PA
Interpretation
Follow - up
Unknown history of syphilis
Nonreactive
N/A
N/A		 No serologic evidence of syphilis None, unless clinically indicated (e.g. early/acute/primary syphilis)
Unknown history of syphilis
Reactive
Reactive
N/A		 Untreated or recently treated syphilis See Centers for Disease Control and Prevention treatment guidelines

Unknown history of syphilis
Reactive
Nonreactive
Nonreactive		 Probable false-positive screening test No clinical follow-up testing, unless clinically indicated (e.g. acute/primary syphilis)

Unknown history of syphilis
Reactive
Nonreactive
Reactive		 Possible syphilis (e.g. early or latent) or previously treated syphilis
Historical and clinical evaluation required
Known history of syphilis
Reactive
Nonreactive
Reactive or N/A		 Past, successfully treated syphilis
None
CMIA = Chemiluminescent microparticle immunoassay
RPR = rapid plasma reagin
TP-PA = Treponema pallidum particle agglutination

Please communicate to colleagues and staff in your area accordingly.

Please direct questions or comments to:
Amy Little Soldier                         Molly Gurney, M.D.
Laboratory Technical Specialist, Chemistry Assistant Laboratory Medical Director, Chemistry
SSM Health St. Mary’s Hospital Madison SSM Health St. Mary’s Hospital Madison
Office: (608) 258-6910 Office: (608) 258-6914
amy.littlesoldier@ssmhealth.com molly.gurney@ssmhealth.com

Thank you,
Adam Morgan, M.D.
Laboratory Medical Director
Pathology, SSM Health St. Mary’s Hospital Madison
700 South Park Street
Madison, WI 53715
Office: (608) 258-6914


 
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