Knowledge Lab

By Jennifer Lopez, DVM, MBA, Antech Professional Services Veterinarian

When the question of whether I recommend running blood work in house versus sending it to the reference lab is pitched to me, most people think that I would answer “reference” immediately, since I work for a diagnostic laboratory company who has only just recently started offering in-house analyzer options.

But the question about choosing one or the other isn’t as straightforward as most think. It shouldn’t ever be a “this is better than that” approach either. My answer is always that it depends. The better question to pose to a veterinary clinic struggling with this question is: “Why do you have to pick one? What is right for your clinic and your team?” It’s more a strategic choice rooted in a practice’s goals, purpose in the community, caseload, staffing and workflow.

There are two core decision points that can really help prioritize a clinic’s needs when it comes to in-house and reference lab testing, because let’s be honest, they both have strengths and limitations. The first question to pose is: “Do you have urgency and a need for quick turnaround time with results?” The second question is related closely to the first: “What types of cases will the practice be seeing?”

When you peel back the complexities of these two questions, you will be able to understand that the best solution is not one from a consultant or an accountant you have hired; it’s from your team, the people in the clinic. You will only be able to get this standpoint when you include everyone in the conversation, listen to all perspectives and build a plan together on what you will run in house vs reference, together.

Having a non-judgmental conversation means including everyone—from doctors to technicians to veterinary assistants and yes, the front desk. These decisions affect multiple parts of the practice: the flow of appointments and turning over rooms, the workload of staff and getting timely breaks, client satisfaction, and the even the financial health of the practice. These should all get a voice. For some teams, especially those directly responsible for running samples, this topic can be a sensitive or even personal one. It might get a little heated and controversial. They may have strong feelings based on past experiences, time pressures to get the results, or confidence in certain analyzer technology.

That’s why it’s so important to approach the conversation with openness, not criticism or assumptions. I’ve even heard some clinics allow their technicians to have the final say in what the practice chooses. While it may be tempting to let one group within the practice make the decision about the mix of in-house and reference lab testing, the reality is that this choice impacts everyone. When everyone is invited to voice their opinion and choice, it will create an opportunity to align around shared goals: providing the best patient care, ensuring a smooth and efficient workflow, keeping client expectations realistic and meeting those expectations, and maintaining a healthy bottom line. It’s not about choosing one diagnostic method over another—it’s about creating a strategy that supports the team and respects your non-negotiables, whether those are medical standards, turnaround times, staffing limitations, or budgetary constraints.

Tom Vogel wrote an article published on LinkedIn in September of 2023 titled “Productivity Is The Buzzword, Efficiency Is The True Art.” No cap. In it, he said: “Teams are not a thrown-together set of individuals who all work along their own definitions of productivity, but a bonded group of people working towards shared goals along agreed routines.” Whether you decide to use in-house testing or reference lab, these choices affect everyone. If each role operates in a silo, using different priorities or preferences, it leads to inefficiencies, miscommunications, and inconsistent care. But when diagnostic strategies are built as a team with shared goals, mutual understanding, and clearly defined protocols, that’s when true efficiency happens. The art that Tom Vogel is talking about happens when the tests are run on the correct sample types, results are delivered with confidence showing little to no hemolysis to Fluffy’s owner in the exam room, and everyone knows their role in making it happen. True art.

The second core decision point about diagnostics run is rooted upon what types of cases the clinic is seeing. If we have urgency and quick turnaround time as a requirement, then in-house wins every time for those tests. Those results are going to help us make a decision to prep for surgery or provide critical drug boluses. Faster decision-making can improve patient welfare especially in pre-surgical cases and emergencies.

A case involving vomiting or collapse, a possible plant toxicity, and blocked cats all require immediate data that an in-house CBC, chemistry, and point-of-care electrolyte analyzer can guide; these in-house analyzers can help veterinarians provide life-saving interventions in just minutes. Those results can also help clients better understand and accept things like treatment plans that detail exploratory surgery if necessary, and a compromise of the venous or lymphatic systems that might necessitate hospitalization. However, if there is a need for advanced interpretation, extended panels, or special add-ons, reference labs might win out for those certain non-emergent testing because we can patiently wait for those results.

Case types can also determine diagnostic decisions for some practitioners as we delve further into how it will affect case management, client communication, and clinic flow. Is there relief coverage for the next few days? Is our surgery tech out this week? Is there an owner that wants to wait for the results in the waiting room? Do we have enough staff or time to run all those chemistry panels and thyroid tests in house? How will that affect my flow of appointments? Are we overbooked again? The best practices often blend both a combination—using in-house for rapid insights for emergent cases and reference labs for more in-depth or non-urgent work like wellness and elective surgeries.

For routine wellness, non-urgent chronic disease cases and elective surgeries, sending to the reference labs will provide more comprehensive profiles at lower costs, without tying up your clinic’s staff time and analyzer consumables. In a pinch, same-day testing for surgical elective cases is fine but be sure to have reliable in-house analyzers that can deliver fast and accurate data before the sedation begins.

There has been a noticeable shift in veterinary clinics opting to send out pre-surgical bloodwork to reference labs rather than running it in-house on the day of surgery. I was never a fan of bloodwork on the day of surgery as a technician or a doctor. I was already stressed about the surgery schedule and the allotted time I had. To put in catheters and then have to get blood on everyone and analyze the results took time and attention away from prepping patients. What if there were abnormalities that needed further testing? Canceling dentals and rescheduling was a strain on everyone involved. Think of the client conversation about canceling Fluffy’s dental day of. All the client is really thinking about is that Fluffy didn’t eat that morning, when it was so much more for the team crunched for time. If a CBC, Chemistry, thyroid, and urinalysis had been done prior to surgery, you can get a smoother morning workflow, less stress with staff, and more time to assess abnormalities and adjust scheduling with clients. Maybe even time to drink your coffee?

Reference labs provide certified, highly trained professionals, rigorous quality control, and consistent, validated results across an extensive test menu. This precision is especially important when making surgical or treatment decisions. For many healthy pre-surgical patients, the 12 to 24 hours needed to receive results is a worthwhile trade-off for the broader, more comprehensive profiles available through the reference lab. That turnaround time can also be used productively—such as when you need to assess arterial blood pressure or evaluate exercise tolerance before sedation.

A good diagnostic partner will help standardize preventive protocols, train and empower your team to have better diagnostic conversations with clients by customizing packages that reflect your patient population and your core culture. From customizing panels to automating reports and results, your diagnostic partner should help to refine workflows so diagnostics don’t feel like a burden, but a natural part of care.

One of the most exciting parts about working with a company like Antech is the access to cutting-edge innovations in diagnostics and the partnerships and support that it provides. Remember the ideal diagnostic package isn’t all or nothing, it’s a complementary mix to help you act quickly with your emergencies, but effectively with your non-emergent cases.

We have the solutions for both in-house and reference to support your clinic’s unique needs. I’d love to connect and support you — whether that’s refining your workflow, or just sharing ideas.

Why can’t we have our cake and eat it too?