Laboratory structure and function

Laboratory tests have been a part of medical care at least as long ago as the time when Hippocrates practiced, around 300 BC. The first clinical laboratories were established late in the nineteenth century. The results of clinical laboratory tests are used to diagnose disease, determine appropriate therapies, detect toxins, monitor therapeutic drug concentrations, and assess overall health. Laboratory tests consume a very small fraction of total healthcare spending, but have great influence over medical decisions. There is little doubt that laboratory services are essential to adequate healthcare, and their role is certain to increase as clinical applications of new technologies such as proteomics and molecular diagnostics expand. Clinical laboratory services are provided in a variety of settings: physicians’ offices, clinics, hospitals, and regional and national referral centers. Each of these settings has unique requirements for diagnostic laboratory services; therefore the design of laboratory services depends highly on the environment in which it operates. Virtually every consideration in clinical laboratory design and function-personnel, equipment, automation, consolidation, test menu, location, etc.-is influenced by the type of services the laboratory needs to provide. The greatest challenges in clinical laboratory design and function are faced by hospital laboratories because they serve the most diverse set of laboratory needs: inpatient, outpatient, critical, routine, referral, and outreach. A well-designed laboratory service is an asset to the institution it serves, providing timely laboratory results that are used to improve patient care. In addition, prudent choices for equipment and personnel, and attention to designing efficient processes that do not waste time or resources, benefit the institution by producing an essential service at a competitive cost. In some circumstances, a greater investment results in long-term savings. Also, assigning laboratory-related services such as phlebotomy and POC testing to supervision by laboratory staff has potential benefits for both the laboratory and institution.