In-Clinic vs. Reference Lab Testing: Cost, Speed and Clinical Fit
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For most veterinary practices, the right answer is not “in-clinic or reference laboratory.” It is a deliberate hybrid: run time-sensitive, sufficiently frequent tests in the clinic and use a reference laboratory for specialized methods, expert review and tests that do not justify in-house complexity.
Where reference laboratories are strongest
Reference laboratories can provide broad menus, high-throughput systems, specialized methodologies, pathology and cytology services, and access to clinical-pathology expertise. They are often the logical choice for low-volume assays, confirmatory testing, complex interpretation and tests requiring methods that would be difficult to maintain in a general practice.
They also shift much of the analyzer maintenance, reagent inventory, quality-control and staffing burden away from the clinic. The trade-off is the time and logistics required to transport the sample and return the result.
Where in-clinic testing adds the most value
Point-of-care testing is most compelling when the result can influence a decision while the patient and client are still present. Common examples include urgent cases, selected pre-anesthetic evaluations, stabilization and monitoring, and high-frequency routine testing.
- Urgent and emergency presentations: rapid chemistry or hematology information may support triage, stabilization and treatment planning.
- Same-day procedures: results may help the veterinarian assess patient-specific risk before proceeding.
- Medication and disease monitoring: same-visit results can reduce callbacks and additional appointments when clinically appropriate.
- Rural, mobile or limited-hours settings: in-clinic capacity can reduce dependence on courier schedules.
Fast results have value only when the test is appropriate, the system is managed correctly and the veterinarian can interpret the result in context.
A practical comparison
| Decision factor | In-clinic testing | Reference laboratory |
|---|---|---|
| Turnaround | Potentially same-visit | Depends on pickup, transport and test schedule |
| Test menu | Focused on the installed platform | Generally broader and more specialized |
| Quality responsibility | Clinic manages staff competency, QC, maintenance and corrective action | Laboratory manages its analytical system; clinic still owns collection and interpretation |
| Economics | Highly sensitive to volume, waste, labor and equipment structure | Usually a defined fee per submitted test or panel |
| Expert support | Depends on vendor and practice resources | May include specialist review or consultation, depending on service |
Compare total turnaround—not just instrument runtime
For in-clinic testing, include collection, sample preparation, queue time, analyzer runtime, review and transfer into the medical record. For send-out testing, include preparation, courier cutoff, transport, laboratory processing and result delivery. The relevant measure is the time from clinical question to an actionable result.
Compare total cost—not only reagent price
The in-clinic cost per reportable result should include:
(equipment + financing + consumables + controls + maintenance + service + labor + connectivity + waste + reruns) ÷ reportable results.
The reference-laboratory comparison should include the submitted-test fee, pickup or shipping costs, staff handling, redraws and any client follow-up created by delayed results. Our article on what diagnostic-equipment quotes often leave out provides a complete cost checklist.
Quality management belongs in the decision
In-clinic testing transfers more operational responsibility to the practice. The American Society for Veterinary Clinical Pathology recommends written procedures, trained personnel, quality control, maintenance records and corrective action for point-of-care testing. A system that is simple to operate still needs a quality plan.
Ask how results will be compared with an appropriate method, how control failures are handled, when a sample should be sent out and when a blood smear or specialist review is required.
Build the hybrid menu
Classify each test into one of three groups:
- Keep in-house: time-sensitive, sufficiently frequent and operationally sustainable.
- Keep at the reference laboratory: specialized, low-volume or interpretation-intensive.
- Evaluate: tests where clinical value is plausible but volume, workflow or economics remain uncertain.
Then validate the “evaluate” group during a defined trial using real cases, actual consumables use and staff time. Do not assume that every test currently sent out should be brought in-house.
Questions to answer before changing your mix
- Which results would change a decision during the current visit?
- How many reportable results would we realistically produce each month?
- Who owns daily QC, maintenance and troubleshooting?
- How will results reach the medical record?
- What is the downtime plan?
- Which tests still require reference-laboratory confirmation or expertise?
Related resources
- How to Evaluate In-Clinic Veterinary Diagnostic Equipment
- Veterinary Hematology Analyzers: What to Compare Before You Buy
- 20 Questions Before You Commit to a Diagnostic Platform
References
- Flatland B, et al. ASVCP quality assurance guidelines for point-of-care testing in veterinary medicine. Veterinary Clinical Pathology. 2013.
- Velayudhan BT, Naikare HK. Point-of-Care Testing in Companion and Food Animal Disease Diagnostics. Frontiers in Veterinary Science. 2022.
- American Society for Veterinary Clinical Pathology. Quality Assurance and Laboratory Standard Guidelines.