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150 Standalone Chapters 2020 | NMH Annual Rep t Clinical Activity 2020 was an unusual year with the challenges of responding to the SARS CoV-2 pandemic, reduced clinical activity within the hospital and the development of new services and testing capacity to meet the emerging clinical need. The Hospital Executive Management was very supportive of the department and its needs while developing new services as was the National Pathology Network and the HSE. Laboratory medicine played a crucial role in diagnosis of infection and investigation of complications due to COVID-19. Many departments had an expansion of tests including SARS CoV-2 molecular testing, SARS CoV-2 antibody testing, D-dimers and diagnosis of SARS CoV2 placentitis. Surveillance of notifiable diseases changed from weekly to daily and our IT systems were re-configured for rapid public health access to our data. IT interfaces were created to facilitate reporting of PCR results. Before these interfaces were in place, staff ensured that results were sent to public health every day including weekends and bank holidays. Diagnostic tests are crucial during this pandemic; PCR tests were initially offered to patients, staff and students who were symptomatic, and later included all patients prior to elective surgery and all overnight admissions. By year end we had an open molecular platform and multiple rapid testing systems verified and operational. This occurred within the context of fantastic teamwork both on-site in NMH and across Irish laboratories in general. The on-call staff have played a vital role throughout the pandemic – there was a rapid roll-out of urgent out-of-hours testing only a few days after on-site testing went live in microbiology. The impact of rapid testing 24/7 cannot be underestimated – a 'detected' or 'not detected' affected the type of PPE our clinical colleagues wore. Urgent testing was also important for isolation rooms, contact tracing and management of cases. We would like to thank our colleagues in the Rotunda for providing a testing service to NMH for about 1 month before we received GenXpert kits in NMH. Successes and Achievements 2020 The major success and achievement is the development of our new molecular suite with facility for both rapid and batch analysis of molecular microbiology tests. In addition, we verified antibody tests for COVID-19 and offered testing for staff. The seemingly simple verification and introduction of spot urine creatinine testing has brought major benefits for our patients and clinicians alike in management of pre-eclampsia. This is in addition to the introduction of PlGF and sFLT assays. New Blood Gas analysers were employed across the clinical areas of the hospital. Blood transfusion has verified the eCrossmatch which will be introduced in 2021. The laboratory was very well represented at the inaugural NMH Research and Innovation Day with excellent presentations by Philip Clarke (PlGF and sFLT), Aoife Reynolds (eCrossmatch) and Damian Lally (COVID-19 Antibodies). Congratulations to Damian and team for best poster prize. Aoife Reynolds completed her Masters in Biomedical Science Challenges 2020 The major challenge was to continue to provide a safe effective service meeting clinical need during a pandemic and to ensure staff safety. We are grateful to all our students who came to work in The NMH lab during the first wave of the pandemic when their studies came to an abrupt halt; the extra help was very welcome and facilitated new rosters at that time. The infrastructure of the laboratory continues to be a challenge, particularly in histology, and this will need to be addressed in 2021. The department provides a multidisciplinary 'on call' service which is staffed by 2 medical scientists every day. Training scientists to provide this service and ensuring that their competence is retained by 'update' training is a challenge particularly in a period of pandemic with space restrictions and staff working flexible rosters. Plans for 2021 Many initiatives are expected in 2021: some well underway • Plans to reconfigure the histology laboratory and perinatal pathology service • New analysers to be verified in histology and haematology • Rollout of point of care testing for glucose • Introduction of eCrossmatch • Commissioning of new chemistry analyser • Expansion of molecular microbiology services • Commissioning of a new instrument interfacing system for analysers permitting greater flexibility and rule based functions.