10 reasons to test in house

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.

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.

Perspectives: Before you buy that new piece of equipment ...

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.

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".)

Equipment: 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.

4. Improved patient care with drug monitoring

Many patients, especially senior pets, routinely take NSAIDs, levothyroxine, methimizole, phenobarbital, potassium bromide, phenylpropanolamine, ACE inhibitors, insulin, nutraceuticals, chemotherapy drugs, glucocorticoids, and immunosuppressive medications. Monitoring lets you check more closely for side effects and watch for coexisting diseases. For example, feline hyperthyroid patients receiving methimizole should be closely monitored for renal disease, because treatment for hyperthyroidism may result in renal decompensation.

Another issue: Internet pharmacies. Patients of clients who purchase from Internet pharmacies need more frequent monitoring because you don't know the source of these medications or how they've been stored.

5. Meeting the needs of older pets with senior testing

Senior testing lets you check for hidden diseases. Plus, it lets you establish baseline data, so you can tell early when something isn't right.

Our practice takes a different approach to senior profiling based on whether the patient's a healthy older pet or an older pet requiring dental prophylaxis or anesthesia for other procedures. Older patients receiving dental procedures or anesthesia for any reason are tested in-clinic on the morning of the procedure. We use these blood tests for preanesthetic profiles to help us avoid complications. Since we've already scheduled the procedure, doing the blood tests in-house doesn't interrupt our workflow. Sending blood to the outside lab for senior pets not in need of dentistry makes sense because we're not using the results the same day.

CLIENT SERVICE

6. Clients save time

We're a time-oriented society. Given a choice, clients would prefer a one-trip solution rather than running back and forth to the clinic while their veterinarian tries another guesswork treatment. In fact, Internet pharmacies constantly advertise to our clients about the "inconvenience of visiting the vet," so make it more convenient!

7. Less client anxiety

How many times have you endured several anxious days waiting for lab results? Remember, most clients consider their pets valued family members. The sooner you diagnose the problem, the sooner you can treat the patient and ease your clients' concerns. In-hospital testing decreases your stress as well by replacing "educated guesswork" with solid diagnostic decisions.

8. Immediate results build immediate value

Have you visited Jiffy Lube or any other car maintenance drive-thru lately? They've mastered the art of building value for clients. I recently visited for just an oil change, but I also purchased an air filter because the mechanic showed me the old dirty filter. I complied because I actually saw the problem—much like our clients can see abnormal lab results on the lab report printout. Client compliance increases dramatically when clients can see what you see.

Your in-house lab gives clients tangible evidence that pets are healthy or sick, and sharing this information reinforces the value of your services. And remember, a normal result is a good thing and worth just as much as a problematic result. Don't hesitate to charge your full fee. Instead, clearly explain what the tests mean in layman's terms. Clients will be relieved—and more than willing to pay for their peace of mind.

BUSINESS MANAGEMENT

9.Better time management for you

Clients never call at convenient times to discuss lab results. Instead, you're in surgery, with another client, or on the phone trying to trace the lab work you sent out four days ago. How often have you explained minor elevations in blood urea nitrogen or alkaline phosphatase to a client, only to repeat the conversation when the spouse calls 10 minutes later? What about discussing lab results over the phone with a client you don't even remember meeting?

Now imagine examining the patient, performing lab work, and discussing results and treatment with the client during the initial 30-minute exam. In-house diagnostics save you time and protect your sanity.

10. Better profits

Clients will pay more for better, faster service. And, on the flip side, a poly-pharmacy approach can eventually cost clients more money, and—more important—result in a patient's misdiagnosis.

When used optimally, preanesthetic testing and in-clinic diagnostics improve the quality of medicine you practice and generate monthly practice income. And, even better, test results give you a trustworthy way to document treatment success.

Less guesswork. Better patient care. More satisfied clients. Improved profitability. In-house diagnostics give you the tools to achieve all these benefits—and practice a level of medicine that offers clients and patients convenience and compassion.

Dr. Fred Metzger

Veterinary Economics Editorial Advisory Board member Dr. Fred Metzger, Dipl. ABVP, owns Metzger Animal Hospital in State College, Pa., a 1998 Practice of Excellence. Send questions or comments to ve@advanstar.com.