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Inside the Lab Laboratory management, Clinical care, Profession

The New Decentralization Trend

For decades, hospitals have followed a centralization model for their clinical testing needs. Thanks to extensive outsourcing, it’s now routine to send out samples to reference labs for diagnostic testing. But this has come at a cost – results take longer and patient care can suffer because of it.

In the clinical laboratory community, we are finally reversing this trend in a move that allows us to serve our patients and our institutions better than before. Particularly at healthcare systems with multiple hospitals and clinics, administrators and clinical care teams are beginning to view core laboratories as a major asset. I have seen this decentralization trend at numerous healthcare systems across the country and have participated in it at two different hospital networks. At the Sharp Healthcare Copley Laboratory, for example, we perform a large proportion of testing needs for our system. Our team of pathologists includes both general and specialized pathologists. Together, we have created a boutique genetics laboratory that builds on our expertise in women’s and prenatal health, microbiology, and oncology, deploying both commercially available and laboratory-developed tests. We use a hybrid of in-house and outsourced testing to maximize our strengths and minimize our weaknesses.

Decentralization happens best when health systems with multiple hospitals use one core lab and one pathology department to bring better efficiencies, talent, pricing contracts, and clinical care to their patients and health systems. In this model, each hospital retains key testing, such as stat tests. Repatriation happens at the core laboratory. Core labs can repatriate many – sometimes even most – test orders and can expand or trim down pathology services as appropriate. Testing in-house means that the laboratory and the pathologists can retain the testing data, which not only helps with patient management, but also makes it easier to evaluate the overall costs and value of the testing. Our laboratory chose to bring in prenatal testing, such as spinal muscular atrophy screening by fragment analysis, and saw a significant improvement in turnaround time and savings to the system.

A laboratory’s ability to build its own test menu is invaluable. This way, each laboratory can prioritize the perceived benefit for individual tests and test classes by choosing between sending out and processing in-house. Without the core facility, there are no alternatives to send-out testing for the vast majority of the diagnostic menu, which carries its own risks. In addition, the core lab team’s expertise provides invaluable consultation services to healthcare providers, helping them to select the right tests and interpret the results.

Experience has shown that many laboratories are resourceful when responding to emergency situations such as the ongoing COVID-19 pandemic, in which local labs have been invaluable to their communities. This resourcefulness is ideally suited to responding to regional needs in a way that reference labs cannot.

For pathologists looking to establish core laboratory testing, I recommend focusing on the interests and talents of your team members. Diverse talent within your team allows you to respond to your healthcare system’s needs. Our laboratory chose to grow into molecular pathology; others may grow into cytogenetics, flow cytometry, or something completely different. Your team’s formation is your growth opportunity. If you focus on your team and your system’s needs, it should be easy to spot the opportunities that are right for your patient population and clinical care partners.

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About the Author
Kendal Jensen

Director of Molecular Pathology, Sharp Healthcare, San Diego, California, USA.

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