ONCE CUTTING EDGE, IN-CLINIC TESTING IS NOW commonplace. Your practice likely owns hematology, chemistry, electrolyte, and
endocrine analyzers. And more hospitals than ever run electrocardiograms and ultrasounds, use blood gas and coagulation analyzers,
and test for proteinuria and infectious diseases like Giardia, Lyme disease, and ehrlichiosis. Yet are you using your in-house testing instruments to their potential?
Of course, in-clinic labs aren't designed to replace reference labs; they should augment and complement outside services.
For example, if you're performing hematology in-clinic and you see abnormal cells on the blood films, you'd submit the blood
film to the outside lab for a veterinary pathologist to review. Or if in-clinic thyroid testing revealed a low total T4, you'd submit a sample to your reference lab for a free T4 by equilibrium dialysis.
Perspectives: Before you buy that new piece of equipment ...
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Yet on the day that you need to perform a CBC and a chemistry panel with lipase to diagnosis acute canine pancreatitis, your
in-house lab might save a patient's life. Of course, not every case is clear-cut. And you and your team might not always access
all the tools at your fingertips every day. But here are 10 reasons to keep the dust off your in-house testing tools.
MEDICAL MANAGEMENT
1. Better emergency and critical care
In-house testing takes the guesswork out of emergencies, so you can begin treatment right away. And in some cases, the turnaround
time from an outside lab may be longer than your patient can afford. Saturday night's case of diabetic ketoacidosis can't
wait for a Tuesday diagnosis. Plus, critical care cases frequently require extended monitoring—including monitoring of electrolytes
and levels of blood gases, lactate, ionized calcium, and so on—only available through in-clinic analysis.
2. More information on sick patients' conditions
Your in-house lab gives clients an immediate diagnosis. Consider this scenario: A 3-year-old female spayed golden retriever
presents to your clinic with vomiting which started four hours ago. She's bright, alert, and has a normal physical exam. So
you draw blood for a CBC, chemistry panel with lipase, and electrolytes. With testing, you may know whether she needs hospitalization
or outpatient treatment. You can prescribe medication and monitor treatment based on scientific conclusions, not speculation.
And you can do all this within minutes.
Equipment: Must-haves for your lab
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In-house testing has changed the standard of care. It's not an option to hold off on ordering lab work because you're pressed
to make a therapeutic decision and you don't want to wait for results. In fact, in-house testing is contagious. Once you're
truly tapping your in-house capabilities, you'll realize how limited you've been without them. (See "Must-Haves for Your Lab".)
3. Improved safety with preanesthetic testing
You can't ignore the benefits of preanesthetic testing. When I give talks and ask the audience members how many offer preanesthetic
testing, about 80 percent of them raise their hands. And increasing numbers of practices are making such testing mandatory,
including my practice. This procedure helps you avoid anesthetic or surgical complications and lets you establish baseline
laboratory values for comparison as pets age.
Review your preanesthetic testing protocols, and consider adding hematology and electrolyte testing to all preanesthetic panels.
Anesthetizing patients with such issues as anemia, polycythemia, leukopenia, leukocytosis, or thrombocytopenia is contraindicated
without further investigation. Anesthetizing patients with electrolyte abnormalities can also be dangerous. And anesthetizing
patients with hyperkalemia or hyperthyroidism can be deadly. Given the risks, it's just not worth taking a chance.
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