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Alternate-site testing: adjusting to a new trend.

Alternate-site testing: Adjusting to a new trend They crop up in even the smallest institutions and go by various names--labs that we call off site, alternate site, ancillary, satellite, or decentralized. Whatever their names, labs that lie beyond the boundaries of the main lab are increasing, and we must deal with them.

The typical ancillary lab (if there is such a thing) offers a limited test menu. Especially familiar are the blood gas and off-site Stat labs designed to provide fast test results for critical care patients.

* Effects of regs. For years, ancillary laboratories were tolerated by lab directors who had more important things to worry about. Recent legislation such as CLIA '88, however, has refocused our attention on all levels of laboratory testing, large and small alike.

For some time now, regulators have been aware of the importance of maintaining high-quality operations in ancillary as well as central laboratories. Ancillary labs tend to be offshoots of hospital departments other than the main laboratory operation. One dangerous result is that people who work outside the main lab are not always fully cognizant of the ever-changing rules and requirements surrounding the clinical laboratory.

* Ease of use. The rapid rise of user-friendly instruments over the last decade has contributed to the substantial expansion of ancillary labs in recent years. Before, a cental laboratory could deny the usefulness of ancillary operations by pointing out that analytical instruments required highly trained operators and frequent calibration. That argument diminished as state-of-the-art, self-calibrating instrumentation began to require a decreasing amount of operator input. Should this trend continue, I foresee more and more work flowing outside the main lab.

* Value. Are ancillary labs necessary? The answer largely depends on the effectiveness of the main laboratory. If the main lab can do a test accurately, quickly, and economically, there is no need to go off site. If we can't accomplish this, we shouldn't complain if someone else can.

The best way to appraise any ancillary lab is to gauge whether it provides the type of testing needed and the level of service expected. One way is to evaluate service financially. The main lab, with its economies of scale, should be able to demonstrate with ease its ability to perform a test more economically than lab areas located in distant nooks and crannies of the institution.

* Speed. Among the most common reasons given for forming an ancillary lab is the need to improve turnaround time. It may be possible to deflate that reason by stepping up efforts to shorten turnaround time in the main clinical laboratory--with messengers, pneumatic tube systems, or any other efficient means of transport. Since analysis time should be about the same at either site, transportation is the key factor.

* Future will tell. I don't mean to imply that ancillary labs are not providing fine services. What concerns me is that these services may unnecessarily duplicate work and increase costs to the hospital--costs that more and more institutions are unable to justify.

Other situations, such as the need to support research, may demand the existence of ancillary laboratories. I recommend that if you can't lick 'em, join 'em. In such cases, the main lab should play an important role in assuring that testing in subsidiary labs is of high quality and performed according to regulatory guidelines.

Down the road, when CLIA '88 finally takes shape, the issue may take care of itself. Many ancillary lab directors and hospital administrators may decide it is not feasible for their small operations to maintain the high level of proficiency testing, hire the caliber of workers, and pay the accreditation fees projected under the new regulations. Lab management must help ancillary lab directors and staff to understand the implications of CLIA '88 and should offer to assist them in meeting patients' needs.

While most of us have enough to handle in the base laboratory, we must not ignore ancillary operations. Whether we consider them viable branches of our labs or merely unwanted appendages, it is up to us to make sure the overall quality of testing does not suffer as mini-labs proliferate throughout our facilities.
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Author:Maratea, James M.
Publication:Medical Laboratory Observer
Article Type:column
Date:Mar 1, 1991
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