Financial justification of alternate site testing.

Fixed costs are higher and variable costs lower for clinical laboratory testing than for alternate-site testing (AST). For AST to become cost-effective, variable costs must be reduced. Four models for accounting for the costs of clinical laboratory testing and AST are compared. A common error is to omit some of the indirect costs of a cost-per-test analysis for AST, thereby providing false claims. For a cost-per-test analysis, we recommend that identical categories be used for both the central laboratory and for AST. However, cost-per-test data alone do not completely represent institutional costs or savings associated with laboratory testing at any site.

Managed care and the hospital laboratory: survival of the fittest.

The authors review the reasons behind the currently evolving restructuring within the healthcare industry and its implications for hospital laboratories. They predict a continuing decline in the volume of inpatient care with a similar effect on the volume of hospital laboratory testing. They also foresee a shift to independent laboratories in the volume of outpatient testing--currently a key revenue source for many hospital laboratories. For those hospitals that redefine their mission, inpatient testing for higher-acuity patients is one role, as is managing point-of-care testing in nontraditional settings.

PCR (polymerase chain reaction) and the future of molecular testing.

Molecular testing is no longer exotic, distant, or complex. It's moving into your lab and revolutionizing the rapid diagnosis of pathogenic organisms as well as your role as a laboratorian.

Enhance laboratory workflow to save steps and money.

Beware: Small savings in the lab may be expensive for the hospital. Examine the flow of laboratory operations in the context of the entire facility.

Selecting laboratory instrumentation. Part I.

Analyses of technology and workflow can help a lab determine whether it needs a new instrument or other changes to improve operations.

New technologies in chemistry instrumentation: the basis for clinical chemistry automation.

The analytical and operational capabilities of clinical chemistry analyzers will continue to evolve as new technologies are developed. This will lead to increasingly greater automation and enhanced ease of use. However, it will be important for the laboratorian to understand these technologies in order to effectively integrate them and interact with them in the health care environment.

Automation of routine chemistry analysis.

A variety of chemistry analyzers exist for performing routine analysis, including sample-based and random access instruments with a wide range of throughput capabilities. Representative analyzers based on dry and liquid reagent technology are discussed.

Instrumentation for STAT analyses.

There are a wide variety of analyzers capable of performing STAT testing. Some are dedicated devices, while others are also used for routine work. The degree to which these instruments can meet the laboratory's requirements will depend on laboratory design, test menu, and volume. These factors should be considered when evaluating the appropriateness of a STAT facility and the selection of equipment.

Integrating automation into the clinical laboratory.

The selection of new instrumentation is a complex process. Each step must be carefully evaluated, since mistakes will remain in the laboratory for years to come. Infatuation with technology often leads to expensive mistakes.