We once had a research fellow studying this: it is an extremely complex
and poorly understood subject.
Some topics we found to be relevant
Economy of scale
Specialised equipment
Specialised knowledge... and a common good in concentrating expertise in
rare conditions
Laboratories trying to maintain their existence, position, status and
sense of self by not referring
Turnaround time
Historical accidents of funding
.... I'll try and find the documentation
My view:
Laboratories should offer whatever clinical service is needed by their
clinicians
Laboratories should decide whether to assay in house or refer*
Bad things happen when clinicians send specimens directly: our deal is
that we will pay for the referred analysis if the request goes out
through us and the report comes back through us: that seems to do the
trick in most cases
Laboratories should actively decide whether to refer any particular
assay or not: probably annually
With this policy we are a much larger outward referrer and a much
smaller inward recipient than most other laboratories in our Newchurch
benchmarking group of "Teaching Hospital Laboratories"
* Not Regions, Strategic Health Authorities or anyone else.
Dr Jonathan Kay
On Wednesday, March 6, 2002, at 08:52 , [log in to unmask] wrote:
> What determines where one sends a sample to for an assay that one's lab
> doesn't
> carry out?
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