Impact of technological developments and organizational strategies on clinical laboratory cost reduction

Health care reform efforts, largely under the aegis of managed health care initiatives, have prompted clinical laboratories to increase efficiency and reduce both expenditures and test turnaround times. The adoption of newer technologies is viewed as a mechanism of achieving the latter objectives, but direct and indirect costs and outcomes are often difficult to project. Issues explored in this article include the impact on a large university hospital-based clinical microbiology laboratory following the application of various technological approaches to organism recognition and susceptibility testing and the consolidation of certain testing services. Included are applications of an automated blood culture system; radiometric detection, identification, and susceptibility testing of mycobacteria; and the use of molecular probes to identify various microorganisms. Assessment was made through retrospective review of direct costs, estimates of average test report turnaround times, work flow changes, and real or perceived outcomes. Both the application of technology per se and consolidation of an independent virology service into the general microbiology laboratory enabled improvement in test report times and led to direct or indirect cost reduction. Managerial strategies to bring about organization changes throughout all clinical laboratories in response to a major hospital-wide cost reduction program are also presented together with financial outcomes achieved.