Clinical laboratory: bigger is not always better

Area of Science:

• Clinical Pathology
• Laboratory Medicine
• Healthcare Management

Background:

• Global laboratory services are consolidating through mergers, acquisitions, and outsourcing to enhance efficiency and reduce costs.
• The relationship between test volume and cost per test is complex and non-linear, influenced by various factors beyond simple volume.

Purpose of the Study:

• To analyze the relationship between laboratory test volumes and costs.
• To advocate for a paradigm shift from volume-based efficiency to patient-centered laboratory services.
• To highlight the importance of quality indicators in laboratory performance.

Main Methods:

• Analysis of the non-linear relationship between laboratory test volumes and cost per test.
• Review of data on laboratory errors, diagnostic errors, and patient harm.
• Discussion of process and outcome quality indicators for laboratory services.

Main Results:

• High costs are associated with low volumes up to one million tests annually.
• Beyond this threshold, laboratory organization, not just volume, significantly impacts final costs.
• Current focus on volume and efficiency overlooks patient safety and the integral role of labs in diagnosis and therapy.

Conclusions:

• Laboratory services require a shift from a volume-driven model to a patient-centered approach.
• Harmonized quality indicators, performance specifications, and laboratory stewardship are essential for improving patient safety and service quality.
• Competition should be based on quality and performance, not solely economic value.