1.

Understand the test ordering patterns of outpatient doctors and healthcare professionals

The testing needs of outpatients are significantly different than hospital inpatients. In an acute care setting, laboratory test results are used to support the diagnosis and treatment of patients, with the goal of improving their health and sending them home. Outpatient testing needs are not as acute and may be more complex. In an outpatient setting, laboratory testing is used for:

• Screening and prevention to identify risk factors for chronic illness.
• Diagnosis to identify illness, and testing ranges from basic to highly complex.
• Following a diagnosis, testing to ensure that the treatment was effective.
• Monitoring a patient disease state, compliance, or the ongoing effectiveness of treatment.

Laboratory tests that are routinely ordered in an outpatient practice may be rarely ordered on a hospital inpatient. In an outreach program, the laboratory test menu must be responsive to the needs of all.

2.

Identify insourcing opportunities

It is not feasible for a laboratory to perform every test that a clinician may order. Hence there is a role for a reference laboratory, to perform the tests that cannot be performed in the hospital laboratory. However, the hospital laboratory must periodically evaluate and enhance the test menu to provide better turnaround time, manage costs, and have more control over the testing process.

When send-out test volumes justify bringing the test in house, considerations may include:

• Using existing instruments or technical capability by adding a new test to an existing technical platform.
• Investing in technology by adding new tests based on technologic advancements and availability.
• Financial feasibility, also known as “make versus buy,” when it costs less to perform the test compared to sending it out.
• Keeping an eye to the future, monitoring volumes, and identifying tests that are esoteric today but may become mainstream and routine tomorrow, based on industry changes and technologic innovation.

3.

Optimize turnaround time

Outreach customers expect excellent turnaround time. Within the hospital laboratory, some test volumes may not justify setting up certain tests every day. If turnaround time is a competitive factor in the market, it may be necessary to adjust setup schedules to meet customer needs. In a growing outreach market, test volumes will likely increase, helping justify running those tests more frequently.

4.

Align the test menu with hospital or health system strategic initiatives

As health systems expand their clinical departments and become medical centers of excellence, the laboratory must be able to support the clinical needs of the practice. A cancer center requires strong internal pathology support. A women’s center may require a robust menu for sexually transmitted infections. A senior care program may require a point of care menu for PT-INR support. Clinical collaboration will ensure test menu alignment across the organization.

5.

Be a proactive partner with the medical staff

Not every test that is ordered is necessary. Just because the clinician ordered it doesn’t mean that it is in the best interest of the patient. Effective laboratory stewardship programs may include guidelines related to test order frequency, test cost, tests that are ordered once in a lifetime, tests that should never be ordered, etc. Collaboration with doctors and medical professionals will ensure that the right test is performed in the right setting at the right time.

An outreach program that can be responsive to the testing needs of its customers will always have a competitive advantage. Local turnaround time and quality are competitive strengths that ensure long-term outreach success.