Laboratory testing in acute care settings: a personal perspective

Laboratory Medicine plays a central role in the management of acute conditions in the emergency department (ED), yet its clinical impact is often under-recognized and variably implemented across healthcare systems. This opinion paper aims to describe the conceptual, operational, and evidence-based foundations of urgent laboratory diagnostics in acute care settings (especially in the emergency department), emphasizing the need for structured and standardized approaches. The lack of a single universal guideline for urgent laboratory testing has led to development of several national and international consensus documents. These frameworks, including those from SIBioC-AcEMC, DGKL/DIVI, and EFLM TF-PLE, consistently highlight the importance of prioritizing clinically meaningful tests and aligning laboratory workflows with emergency care demands. Across these initiatives, core parameters such as hemoglobin, electrolytes, blood gases, lactate, creatinine, and coagulation markers emerge as essential components of emergency diagnostic pathways. Operationally, urgent laboratory testing can be structured according to clinical urgency and turnaround time (TAT), and further categorized into essential, critical and supportive panels. This stratification enables optimized resource allocation, improves laboratory efficiency, and supports clinical decision-making in time-sensitive scenarios.