The Out Patient Department delivers first contact care to the care recipients. Services provided ranges from primary care, emergency care and first contact specialist care services..
It is the branch of medicine which involves with the diagnosis and treatment of kidney diseases, including electrolyte disturbances and hypertension, caring of patients requiring renal replacement therapy, including dialysis and renal transplant patients.
The specialist physician in this field is called a nephrologist.
The Nephrology, Dialysis and Transplant Unit of National Hospital of Sri Lanka is the forerunner of providing care for renal patients in the region. It consists of the Dialysis Unit with a dedicated nephrology team, and this is the first renal unit to be established under the Ministry of Healthcare and Nutrition.
The current Nephrology team consists of Consultant Nephrologist, two Senior Registrars in Nephrology, 7 Nephrology unit medical officers, 2 Dialysis unit medical officers, one nursing sister with 16 nursing officers and 10 minor staff personnel.
The Nephrology and Transplant Unit is situated in the 2nd medical complex, catering to the renal patients of a wide variety, the services provided includes:
24 hour on call for renal service
24 hour acute haemodialysis (HD) services for emergencies
Two Nephrology clinics -Monday and Wednesday at room 34
One counselling and pre transplant workup clinic- Tuesday at room 36
One post transplant clinic - Wednesday at room 34
Haemo Dialysis clinic- every Tuesday at DU
Renal biopsy service - 3 days a week at Dialysis unit
Referral system covering NHSL , DMH, CSHW and peripheral hospitals
A Consultant Nephrologist was appointed in 2003 and took over a dialysis unit consisting of 4 dialysis machines which were shared by all medical wards. With the opening of the 2nd medical block in 2004, the dialysis unit was relocated to the ground floor with additional 4 machines.
The number of dialysis sessions carried out has dramatically increased from a little over 3000 in the year of 2003, to more than 11600 in 2013, and more than 6900, up to July 2014 (our average monthly number of HD sessions are around 1000). This is a great example of how the unit has progressed over the years in providing a steady service to renal patients. The dialysis is provided to patients with acute kidney injury and chronic renal failure, and to patients who are awaiting transplants.
In addition to the inward patients at NHSL our services extends to patients in the peripheries as well. These exceed over 20 per day, and the renal team is dedicated to providing maximum assistance to these patients round the clock, which is a unique achievement by us.
Our renal team also conducts 4 clinics a week, catering to a wide variety of renal patients, including the pre-transplant and post transplant clinics, where the patient number is increasing rapidly.
The Renal Transplant program of this unit (under the Ministry of Health) commenced in 2005 with the assistance of two vascular and transplant units of NHSL, despite the absence of an established renal ward. Our team has achieved great success over the years by providing transplant services to a considerably large number of patients in spite of the limited resources, with the number of transplants increasing steadily over the years. Transplants were done on 3 patients back in 2005, which flourished to an astonishing 57 in 2013, and we have done transplants on 46 patients as of July 2014. This is a remarkable indication of the success of the unit as a whole.
The following chart gives a summary of how the unit grew over the few years.
Number of HD
Number of KTs
New clinic patients* *
In addition to this a Second Nephrology unit is in operation under the Professorial Medical Unit.
Have a dedicated renal ward which we have been trying to establish since 2003 without much success.
Have a dedicated transplant and high dependency unit.
Establish a renal registry.
Improve the service of Continuous Renal Replacement Therapy (CRRT) for ICU patients.
Establish a cadaveric transplant program on par with developed countries.
Establish plasma exchange facilities under renal unit for the benefit of transplant patients.
Medical nutrition therapy (MNT) is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a registered dietitian or professional nutritionist. The diet is based upon the patient's medical and psychosocial history, physical examination, functional examination and dietary history.
This is the newest addition to the Clinical care services provided by the NHSL. It was established on 16/10/2014.Currently this was conducted by MSc qualified four medical officers in Human Nutrition and the administrative supervision is carried out by the Deputy Director OPD Services of NHSL and the technical supervision is assign to Dr. Renuka Jayatissa , the Consultant Nutrition Specialist. This unit is established at the OPD Building complex.
Patient Specific Services
Detailed nutritional assessment
Detailed dietary history and analysis of diets
Setting nutritional goals.
Tailor made nutrition care plan- enteral or parenteral
Nutrition related research
Organizing nutrition related educational programmes and skill developmental programmes.
Referrals from the OPD
Referrals from clinics
Referrals from Wards / ICU
Referrals from DMH/ CASTLE Street Hospital for Women/ Renal Unit â€“ Maligawatta.
The branch of pathology which deals with tissues and cells, that helps in diagnosis and study of diseases. In this sub speciality biopsies, surgical resections and cytology samples are used. A pathologist specialized in this field is called a Histopathologist.
In Cytology a single cell is examined usually found in fluid specimens like aspiration of tissues and tissue fluids, and are mainly used in diagnosing cancer. Cytology is also helpful in screening for fetal abnormalities, pap smears, diagnosing infectious organisms, and other screening and diagnostic areas.
The specimens for cytology are taken as;
Scraping or brushing the tissue surface
Other types of tissue incisional or excisional biopsy
In histology surgical resection biopsies and direct biopsies are examined, after preparing under frozen section and different staining techniques like hematoxylin and eosin, safranin, Oil Red O, congo red, silver salts and artificial dyes.
The history of pathology is as old and as rich as any other field in medicine. From the ancient Middle East and the era of Dr Rudolf Virchow, the â€œfather of cellular pathologyâ€ to the present times it encompasses basic principles which are still true today and the most innovative medical advances that are used to diagnose and guide management of patients.
The history of pathology in Sri Lanka dates back to 1870, when the Colombo Medical School which is the second oldest medical school in South Asia was established, and recognizing its importance in the practice of medicine diagnosing and managing patients, Pathology was one of the first subjects taught in the medical curriculum in Sri Lanka, by Dr James Loose, the first principal.
The first Sri Lankan Professor of Pathology, Prof W A E Karunaratne (1936 to1953) was the pioneer in coordinating pathological services between the laboratory and the hospital and also served as the head of Pathology of the Colombo General Hospital, as it was then known. He was succeeded by Dr G S W De Saram in 1940, followed by Dr W D Ranawale in 1954 and Dr Doris Peiris in 1964. In the late 1970s, with the development of the fields of chemical pathology and bacteriology, Dr A B V Perera and Dr Meena Mahendran were appointed in charge of the two fields, respectively. This was followed by vast improvements in laboratory services and currently the Department of Pathology of NHSL consists of four laboratories, namely, Histopatholgy, Haematology, Chemical Pathology and Microbiology.
Following the retirement of Dr Doris Peiris in 1983, Dr H R Wickremasinghe and Dr Chitrika de Silva were appointed to the General Hospital Colombo as Consultant Histopathologists in 1983 and 1984, respectively. They were followed by Dr A Ileperuma and Dr Ruchira Fernando. The National Hospital of Sri Lanka currently obtains the services of three histopathologists, Dr Janakie Fernando (Head of Department), Dr Ananthie Samarasekera and Dr Karuna Dissanayake.
The histopathology laboratory of the Colombo General Hospital had humble beginnings when all procedures were done manually and with the basic stains. Gradually special histochemical staining was initiated to facilitate diagnosis and reporting. The laboratory continued to grow under the leadership of its dedicated heads and consultants over the years, and today the Histopathology laboratory of the National Hospital houses automated tissue processors, an autostainer and provides facilities for frozen sections. Immunohistochemical staining was started in 1998 and was gradually developed over the years. Currently the NHSL immunohistochemistry laboratory provides islandwide services. The very recent acquisition of an automated immunostainer will expedite these services and aims to give a better and faster service.
The histopathology laboratory of NHSL currently provides clinical training facilities to the medical students of the Faculty of Medicine, University of Colombo and the General Sir John Kotelawala Defense University. It has been one of the main training centers of postgraduate trainees in histopathology since the establishment of the postgraduate Institute of Medicine in 1974. The services of the laboratory are carried out by a dedicated staff consisting of the postgraduate trainees of the Colombo cluster, five medical officers, eleven medical laboratory technologists and other support staff. The laboratory handles around 12000 histological samples and over 8000 cytological samples per annum.
One of the main future goals for the NHSL Histopathology laboratory is the introduction of new tests that will bring our diagnostics parallel to the rest of the world and the available evidence to give better therapeutic options for our patients. These include establishment of immunoflourescence and in situ hybridization (ISH) techniques FISH, CISH, SISH and dual colour ISH for detection of amplification, gene rearrangements and mutations which will aid in providing targeted therapy in conditions such as colorectal, lung and breast carcinomas, gastrointestinal stromal tumours and lymphomas. Electron microscopy is also unavailable and will provide us with valuable information in diagnosis.
Another goal is to establish the NHSL Histopathology laboratory as a referral centre for the country with all facilities for diagnosis, training and opportunities for sub specialization.
Upgrading the post mortem rooms to the standards of a modern theatre with observation facilities is a much needed aspect for both academic and training purposes and this will improve our knowledge and research opportunities vastly.
All these goals will be feasible only with the much needed development of the infrastructure of the laboratory. With the plans to introduce new testing methods the laboratory will need a much larger space than what is currently available. The field of histopathology deals with a number of chemicals, including hazardous ones and proper storage of these as well as the safety of the staff must always be ensured. With the ever increasing number of surgical procedures being performed our storage space for specimens and slides need to increase as well. Improved grossing stations with facilities for taking photographs and radiographs is much needed. Establishment of an IT unit will aid to store macroscopic and microscopic images for future reference and these can also be provided to the clinicians and even patients together with the reports when necessary. Linking the histopathology laboratory to the theatres and wards will improve data correlation, communication and reporting vastly.
With all these improvements, validation of our procedures and obtaining accreditation is of great importance. Although the process of accreditations is time consuming and tedious, it has become an absolute necessity to move with the rest of the world in the ever evolving field of histopathology.
83519 tests were done in 2013
Through Referrals and By Appointments
The Department of Chemical Pathology is situated in the main laboratory complex of the National Hospital of Sri Lanka (NHSL) and consists of two laboratories namely Clinical Biochemistry and Immunoassay (Radioimmunoassay) laboratories. The Chemical Pathology laboratory provides comprehensive laboratory services to the patients over 24 hours, seven days a week on the basis of the tertiary referral laboratory of Sri Lanka. This is the largest medical laboratory in the government health sector, performing over 1.2 million and 0.12 million tests per annum in Clinical biochemistry and Immunoassay respectively. The laboratory provides services to, surgical wards, medical wards, other sub specialities, outpatient department and intensive care units. It supports the other hospitals island wide through a direct referral system. The funding for the reagents, chemicals; equipment and recruitment of staff is performed by the Ministry of Health, Sri Lanka in order, to deliver an efficient free health care service.
The Clinical Biochemistry laboratory is situated in the second floor of the laboratory complex. It is functioning as one of the four main pathology laboratories since the establishment of the Department of Pathology at the NHSL. At the commencement all the investigations were based on conventional manual clinical biochemistry methods. Later, in 1990, two automated biochemistry analysers were introduced. Most of the reagents were prepared in house in cost effective manner and introduced to the analysers. Due to the increasing bed strength and the requirement of variety of investigations, three more auto analysers were introduced with traceability established commercial test kits and calibrators. In 2005, sample collection was upgraded with introduction of collection tubes instead of recycled penicillin bottles. With the introduction of primary sample tubes, ward staff was able to send one sample for multiple investigations of the same patient and it enabled to minimize some of the pre analytical errors. The autoclavable glass tubes are re-cycled following an extensive cleaning procedure. The units of measurement on the reports were converted from conventional units to international units in 2007 and a new request form with a report format overleaf for clinical biochemistry was introduced. At present, the laboratory is equipped with one high capacity fully automated chemistry analyser and four low capacity fully automated chemistry analysers.
Clinical Chemistry laboratory performs analysis of almost all body fluids such as urine, cerebrospinal fluid (CSF), but mostly on serum and or plasma. At present, it accepts approximately 1500 patient samples for up to about 5000 different kinds of tests during the day time and nearly 500 samples for general biochemistry tests such as, serum creatinine, serum electrolytes, plasma glucose, urine full report and CSF analysis in the night. The biochemical tests are categorised in to sub specialities of general or routine chemistry and special chemistry.
The general or routine biochemistry tests include plasma glucose, blood urea, serum total cholesterol, serum creatinine, serum electrolytes, serum total bilirubin, serum direct bilirubin, serum aspartate aminotransferase, serum alanine aminotransferase, serum alkaline phosphatase, serum total protein, serum albumin, serum creatine kinase, serum amylase and therapeutic drug level of lithium level which cover cardiac, renal, liver and pancreatic disorders. Special chemistries include techniques such as, gel electrophoresis for serum and urine protein electrophoresis, ionized calcium performed by Ion Selective technique, serum and urine osmolality, pH analysis as well as serum total calcium, inorganic phosphate, iron, iron binding capacity and magnesium. The 24 hour urine analysis for creatinine, calcium, magnesium, electrolytes, uric acid and phosphorus are performed with prior arrangements with the laboratory.
The clinical biochemistry dynamic function tests such as, acid loading test, water deprivation test, glucose tolerance test and special qualitative tests such as, cryoglobulin evaluation are carried out with the supervision and instructions of the laboratory team and using recently prepared laboratory protocols according to the ISO 15189 guidelines. Urine and faecal analysis are also performed as routine clinical biochemistry including urine for Bence Jones protein and stool occult blood. C- reactive protein test was introduced recently and at present under evaluation and familiarization as a routine test. A new biochemistry request form with report format (ISO15189:2012 E 5:4:3) has already been prepared and will be introduced in the near future. As the reference laboratory these facilities are provided to any requested government hospital.
The tests are available 24 hours a day on a priority basis, with minimum delay following reception of patient samples at the laboratory. Urgent laboratory tests that are needed for the management of medical emergencies are given highest priority throughout the pre analytical, analytical and post analytical phases. Abnormal results and critical values are informed verbally over the phone prior to issue of reports.
Analysis of serum samples by five automated analysers reduces the turnaround time and increases efficiency of the laboratory with high precision and accuracy of the patient results. Four levels of quality control samples are analyzed on all five automated analyzers on a daily basis for validation of the precision. The purpose of these internal quality control samples is mainly to verify the acceptance or rejection of patient results. The technical validation of the quality control results are performed by the medical laboratory technologists, medical officers, biochemist and finally by the Consultant Chemical Pathologist. Quality control charts and records are maintained to carry out the trend analysis. The analytical methods are calibrated on a weekly basis on the first day of the week as well as when there is a quality control failure and at the time of change in kits and lots of reagents. Participation in two external quality assurance schemes monthly allows the laboratory to have a retrospective estimate of its performance in terms of both imprecision and inaccuracy. The â€˜blindâ€™ external quality control sample received from the Medical Research Institute, Colombo is subjected to analysis under routine conditions on all five analyzers including the analyzers used for the night laboratory service and the outpatient department. Once the performance report is received, the intra equipment evaluation is carried out to determine the laboratory position compared to the peer group of laboratories, to find the root causes of any error and to take immediate corrective actions.
This is the main training centre for all medical post graduate trainees in Chemical Pathology, medical students and trainee medical laboratory technologists. The laboratory provides facilities for research projects carried out by the professional staff. Internal audits on the pre analytical, analytical and post analytical phases of laboratory procedures are carried out routinely to improve the performance.
The clinical biochemistry laboratory has academically qualified, experienced staff consisting of a Consultant Chemical Pathologist, biochemist, senior medical laboratory technologist, fifteen medical laboratory technologists and eight other support staff.
The night laboratory service is under the supervision of the superintendent medical laboratory technologists. The operation of the chemistry analyzers are solely carried out by the well experienced medical laboratory technologists of the clinical biochemistry laboratory on a rotational basis. The medical laboratory technologists of the other departments offer assistance for the other activities of the night laboratory. The critical values are informed to the ward staff over telephone prior to the release of reports. The documented procedure for acceptance of samples has been prepared and the implementation of the primary sample traceability with â€˜handing over-taking overâ€™â€™ and â€˜â€™done- checkedâ€™â€™ procedure is an absolute requirement to ensure the reliability of test reports released from the night laboratory.
Accreditation of the Biochemistry Laboratory
Aiming at the laboratory accreditation under ISO 15189- 2012 guide, the laboratory has commenced a phased out programme to achieve this important activity. The documentation of a quality manual, procedure manual, sample collection manual and standard operating procedures (SOPs) for all the biochemical tests is being carried out at present. In order to monitor the pre-analytical phase and avoiding the sample mix up at the sample collection point and at the laboratory, a documented procedure has been developed with emphasis on implementing the â€˜handing over â€“taking overâ€™â€™ and â€˜â€™done- checkedâ€™â€™ procedures. A major commitment is required by all the staff involved in the pre-analytical phase. The laboratory information system will be introduced in the near future as this activity has been identified as a priority in the master plan for the NHSL. It will reduce the pre- analytical and post- analytical errors especially the transcription errors.
As per the requirement of quality improvement of the international standard, documentation and implementation of the maintenance procedures for the equipment available at the laboratory are being carried out by the staff with the assistance of the local agents. Calibration schedules, preventive maintenance procedures, contingency plans in the event of a breakdown are being partly implemented. A major activity that has been undertaken by the laboratory is the validation of the in- house analytical methods in comparison to the commercially available reagent kits. The extensive experimental evidence of performance characteristics have proved that the in-house prepared reagents are satisfactory and in fact with some analytes it is superior to the commercial reagent kits, if the analytical grade chemicals are being used in the preparation of reagents. This activity is being carried out by the experienced medical laboratory technologists, biochemist and under the direct supervision of the Chemical Pathologist. A significant cost reduction has been achieved during the purchasing of reagents.
The Clinical Pathology service will be upgraded by purchasing a polarized microscope for the accurate identification of dysmorphic red cells. A method comparison will be performed to select the best analytical method for urine and CSF protein estimation.
During the years 2014 -2015, the clinical biochemistry laboratory will be well equipped with essential laboratory equipment, funded by the Ministry of Health. A high performance fully automated open system analyser will be introduced to enhance the quality and the turnaround time of the clinical biochemistry laboratory tests with machine generated quality patient reports. A robust analyser with true open system will be purchased that can accommodate the in-house prepared reagents. A plant that generates type 2 and type 1 water to be used in the analysers and for the preparation of reagents will be installed. As the main reference laboratory test panel will be expanded by introducing the lipid profile, HbA1C by high performance liquid chromatographic analysis and further development of serum protein electrophoresis including immune-fixation technique and nephelometric analysis for the determination of immunoglobulins.
Continuous Proficiency Development and trainingIntra
A comprehensive continuous education programme is planned for the staff of the department of Chemical Pathology as a prerequisite for the accreditation process. This will cover the core Chemical Pathology subject area, quality assurance, biosafety, waste disposal and communication skills.
The Immunoassay laboratory (RIA laboratory) was established at the National hospital of Sri Lanka (NHSL) in 1989 as a tertiary referral laboratory. It is situated in the ground floor of the laboratory complex. The laboratory provides comprehensive laboratory services for the NHSL and forty six other government hospitals island wide. As a referral laboratory it is committed in providing free quality medical laboratory testing services for all the government hospitals and health institutions.
The laboratory had been initially using in-house prepared radio immunoassay reagents for testing in cost effective manner. Currently the laboratory uses traceability established internationally accepted commercially prepared radioimmunoassay reagent kits. In addition, the modern technology of chemiluminescence immunoassay has been introduced to perform laboratory tests using fully automated analyzer and internationally accepted commercial reagents.
The laboratory performs specialized hormone assays such as Growth hormone, Cortisol, Luteinizing hormone, Follicle stimulating hormone to diagnose endocrine disorders, tumour markers such as, Cacinoembryonic antigen, Prostate specific antigen, Alpha feto-protein for the diagnosis of malignancies. Dynamic function tests such as, Insulin tolerance test, Glucagon stimulation test, overnight, low dose, prolonged dexamethasone suppression tests, short synacthen test and growth hormone levels following oral glucose tolerance test are used for the evaluation of the pituitary and adrenal glands. Tests such as, Adrenocorticotrophic hormone and Parathyroid hormone are exclusively done by the RIA laboratory for the government health sector. Sample analysis of highly specialized tests such as, inferior petrosal sinus sampling (IPSS) is also performed in collaboration with the endocrinology unit. The panel of laboratory tests has been recently expanded by introducing new tests such as, plasma aldosterone, plasma renin and urine microalbumin, some of which are very expensive and not freely available even in the private sector.
RIA laboratory also provides clinical advisory services, which includes the clinical interpretation of laboratory results, advice on appropriate selection of laboratory tests, investigation and monitoring strategies for individual patients and for specific diseases. There is close liaison with clinicians and other health care professionals within the community and other hospitals to ensure best practices in the use of the service.
Every assay is performed with the use of traceability established calibrators to generate reliable test results. The expected quality of the tests is maintained with the use of internationally accepted third party internal quality controls of low, medium and high levels. All the assays are performed by well trained medical laboratory technologists and all the results are technically and clinically validated by a laboratory panel consisting of the Consultant Chemical Pathologist, Postgraduate trainees in Chemical Pathology, medical officers, Biochemist and medical laboratory technologists.
Apart from providing a comprehensive pathology service, the laboratory is capable of meeting the training requirements of various professionals such as, medical postgraduates, undergraduates and trainees in medical laboratory technology in the health sector. The laboratory also provides facilities for devising and conducting basic and applied research for the development of laboratory practice in chemical pathology.
The Immunoassay laboratory has qualified, experienced staff consisting of a Consultant chemical pathologist, Biochemist, senior medical laboratory technologist, six medical laboratory technologists and five other support staff.
Accreditation of the Immunoassay Laboratory
The process of laboratory accreditation to fulfill the requirements of the ISO- 15189- 2012 has been commenced with the improvements of quality system. The guidelines for sample acceptance from the National hospital as well as from out station hospitals have been prepared. The establishment of the primary sample traceability will be implemented through the â€œhanding over â€“taking overâ€™â€™ and â€˜â€™done- checkedâ€™â€™ procedures. An inter-laboratory comparison for hormones and tumour markers is a major requirement for accreditation.
Establishment of new tests
The Immunoassay laboratory will be equipped with latest immunoassay technology by purchasing a fully automated chemiluminescence immunoassay analyser to provide an efficient service for the government health sector. Tests such as, 25 â€“ OH vitamin D, serum IGF-1, estradiol and total testosterone are to be established in the near future. The laboratory has also planned to establish a comprehensive therapeutic drug monitoring system as a future development to fulfill the requirement of drug analysis.
Continuous proficiency development
An annual training plan is designed to improve the theoretical and practical knowledge of all the members of staff of the laboratory.
The National Hospital situated in Colombo in a 32 acre block of land is the largest teaching hospital in Sri Lanka and the final referral centre in the country consisting of 3000 beds. it is the training centre for under graduates and post graduate trainees of the Faculty of Medicine. The nursing training school, Colombo, PBS, and Schools of Radiography, Pharmacy, Cardiograph, physiotherapy and occupational therapy are also affiliated to the National Hospital.
Message from His Excellency Maithripala Sirisena
President Democratic Socialist Republic of Sri Lanka
The National Hospital of Sri Lanka is truly deserving of this message of felicitation and encouragement on this 150th Anniversary of service to the people of Sri Lanka.