Whether a clinic uses reference laboratories exclusively or combines them with in-house diagnostics, there’s no denying the benefits testing advances have brought to the industry, patients and clients.
Results in about 15 minutes for in-house tests and next-day results on most reference laboratory tests mean faster diagnosis and treatment options as well as expediting the identification of zoonotic, contagious and emerging diseases.
Board-certified veterinarians with advanced training in diagnostic work in reference labs along with medical technologists and specially trained veterinary technicians. The expertise of reference laboratory staff makes outside labs an appealing option to many practitioners.
But manufacturers of in-house laboratory equipment note that accuracy is their priority and their machines are accurate, easy to use and maintain.
“The design and capabilities of newer technologies have resulted in overall improvements and enhancements to the work flow and streamlining of laboratory processes,” says Liz Whitney, DVM, a technical writer and industry outreach coordinator for Heska Corp. of Loveland, Colo.
“Newer productivity features, such as integration with practice management software programs, help to improve the processes of the diagnostic team, save time and reduce operational costs.”
Dr. Whitney says the ability to customize panels based on individual patient needs, process multiple patient samples simultaneously and automate dilutions, along with the advantage of getting accurate results with smaller sample volume, all significantly increase the level of service a clinic can deliver.
The benefits of in-house laboratories often lead owners of the equipment to say they wouldn’t want to practice without it.
“Perception is reality,” Whitney notes. “Once in-house protocols are accepted and in place, it is easy to justify their effectiveness. Ultimately the focus is to bring value to the pet owner, improving or enhancing a clinic’s ability to diagnose, treat and successfully manage patient care.”
Incorporating certain diagnostic tests as a standard of care in wellness exams can detect diseases before clinical symptoms are apparent, speeding treatment and making better medical outcomes.
“When a patient is presented for wellness or illness, the ability to obtain rapid in-clinic results for blood chemistry with electrolytes, hematology and blood gas parameters is crucial to detection of early changes, identification of rule-outs and diagnosis of disease leading to more timely procession to additional testing or to accurate treatment,” Whitney says.
“The continued development and availability of point-of-care tests such as for heartworm disease, viral diseases and early renal damage have also made a big difference in regard to rapid detection and definitive diagnosis of some diseases, as well as for identification of early changes suggestive of disease that may warrant further investigation.”
Veterinarians’ education of clients on the importance of blood work with wellness exams is key, experts say, in the success of a program.
Being able to cite examples of cases where wellness exam blood work helped an animal’s treatment can be motivational, and clients involved in these successful cases are often willing to give permission to use their pets’ stories. Running wellness blood work also allows veterinarians to track changes over time for individual patients.
Emerging diseases such as H1N1 influenza have been reported through reference lab testing. Idexx of Westbrook, Maine, reported the second 2011 confirmed case in a domestic cat located in Wisconsin in February, helping to chart the path of diagnosed cases.
“Reference laboratories probably play a larger role in early emerging-disease detection than in hospital testing because of the depth and breadth of testing offered,” says Darin Nelson, senior vice president of business development for VCA Antech Inc. of Los Angeles.
Laboratory equipment manufacturers say having fast access to in-house diagnostic testing means the difference between life and death for many emergency veterinary hospital patients.
Tammi Lesser, LVT, director of marketing for Idexx VetLab, says because of the variety of reasons veterinarians use diagnostic tests and diagnostic equipment, Idexx seats veterinarians and industry thought leaders on an advisory board for feedback that weighs heavily in the direction of future technologies.
“We’ve found that veterinarians consider accuracy, speed to result, maintenance and ease of use as the most important features of in-house analyzers,” Lesser says. “Having these instruments at the practice allows veterinarians to provide real-time care to patients and give clients results before they leave. Compliance on blood work recommendations is improved because there’s no need for a callback or a recheck to start treatment.”
Lesser says analyzer manufacturers support veterinarians to maximize compliance.
Despite vast commonalities, a divide exists within the industry regarding the accuracy of inhouse analyzers compared to that of reference laboratories. Companies often debate the cost difference and which offers the best return on investment.
Both sides offer convincing arguments as to which is best, but at the end of the discussion an agreement from both sides can typically be made: While reference laboratories work best in some cases, there are also examples in which having analyzers and other diagnostics in-house have saved lives and money.
“Having in-office equipment supplements the needs of most practices,” VCA’s Nelson says. “In our experience, the top quality practices do about 75 percent with a reference lab and 25 percent in their practices. This seems to be a rational balance.”
But the in-house laboratory proponents have another viewpoint: It’s never better to wait for results.
“A good analogy to how veterinarians who use in-house analyzers is the use of a cellphone,” Lesser says.
“When cellphones first came out, people thought they’d use them for emergencies only, but then with such easy access, you use them much more frequently and for many different reasons. Once you have this available, you don’t want to go without it.”
About 70 percent of veterinarians have at least one in-house analyzer, says Craig Tockman, DVM, director of professional services for Abaxis North American Animal Health of Union City, Calif.
“We recently launched an in-house parvo test and a second giardia test,” Dr. Tockman says. “In-house testing helps improve customer service, which is an area that needs improving, according to the recent Bayer Animal Health study [on declining veterinary visits]. Clients cited the stress of a veterinary visit as one of their reasons for fewer visits. In-house diagnostics allows for fewer visits and faster treatment.”
Tockman says in-house diagnostics ROI can be boosted by packaging blood testing with other services. A profit can be made while still giving clients a discount.
“With these options, routine blood work should be our industry’s standard of care.”
Another component to diagnostics is the expert “lifeline” offered by multiple reference labs and equipment manufacturers for veterinarians who use on-site analyzers.
“A consultant feature means veterinarians can call for expert advice even if the blood work is run in house,” Lesser says. “Especially with the down economy, vets are looking for ways to provide better client care and stand out from the competition. In-house analyzers often allow for a distinction.”
Diagnostics can also prevent problems.
“TiterCHEK is not used primarily on dogs with past vaccination reactions,” says Chris Wang, senior manager for global marketing service with Synbiotics Corp. of Kansas City, Mo. “The trend is to proactively avoid potential vaccine (distemper and parvo) reactions in healthy dogs.
“In addition, because pet owners are more aware now about the possibility of avoiding unnecessary medicines and procedures, they want to know if a vaccine is really necessary. The test provides veterinarians an indication of the titer or the potential for protective immunity. This helps the vet make decisions about revaccinations and also about the dog’s immune status in general.”