Moving Beyond the Limitations of a Core Lab Model

Core labs that handle all of a health system's clinical testing needs have been viewed as the ultimate solution for efficiency, because they can be highly automated and designed to handle large volumes of samples, as well as every conceivable test. A busy core lab is a technological marvel.

But recently, decentralization has become more popular as health systems spread their geographic footprint and try to increase convenience for patients and clinicians.

How can we broaden access to care without losing the efficiency and breadth of services available from centralized labs? What are the pros and cons of decentralizing the lab?

Here,
we break it down:

Decentralizing the lab makes it easier to bring basic tests closer to the point of care across a large integrated health system and to improve turnaround time.

Each hospital in a system needs certain basics, such as coagulation testing, CBCs, and emergency department and operating room support; these can only be fulfilled from a lab that is either onsite or very close by. A core lab may be intrinsically inefficient in a system that is spread over a large geographic area.

Decentralizing the lab protects the health system and its overburdened central lab from losing its lab business to more nimble competitors by providing more convenience for patients and better access to services for providers.

Some newer tests—for example, for sepsis diagnosis—need to be done onsite because the results will be used immediately, and decentralized labs can provide that immediacy.

A decentralized approach can extend not only to satellite lab locations but also to the point of care and even into the home, with appropriate equipment and staff training.

A decentralized lab makes it harder to standardize methodologies and maintain consistent quality.

Decentralizing the lab requires investing in multiple instruments that may not be standardized with one another, even when they come from the same vendor, making it more difficult to maintain equipment, train staff, and ensure consistent results among locations.

Decentralized labs can add extra layers of complication during mergers or acquisitions, when different organizations try to synchronize training, instrumentation, and lab practices.

 

Get the best of both worlds by centralizing certain specialized tests in the facilities that have the appropriate services and specialists, while decentralizing the most commonly used tests and those where speedy results are essential.

Technology can fill in some gaps: For example, rather than having multiple full-service blood banks, a system might have blood depots with electronic cross-matching and specialty testing in a single location.

Think outside the box in deploying staff and allocating responsibilities. Consider training nursing staff to perform some testing functions or extending the skill set of phlebotomists to include aliquoting. A more versatile staff will make decentralization more efficient.

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