Should you build an in house clinical lab instead of sending tests out when clinics order blood work?

Clinics and healthcare operators often reach a turning point. The questions start simple. Results feel slow. Patients call back. Providers wait to make decisions. Costs feel harder to predict. That is when the idea appears: should we keep sending tests out, or should we build an in house clinical laboratory?

USALCS is a consulting and implementation partner, not a lab testing provider. We do not run patient tests. We help organizations plan, design, build, and operationalize clinical laboratories through workflow design, space planning, equipment strategy, staffing support, documentation systems, and launch readiness.

This decision is not about ego or owning a lab. It is about choosing an operating model that matches your volume, your care pathway, and your ability to run a quality driven environment.

The two models in plain language

Model A: Send out testing to a reference lab

You collect the specimen, package it, and send it to an outside partner. The partner runs the test and returns results.

When this model is the best fit

• Your test volume is low or inconsistent

• You need a wide menu, including specialty assays

• You want minimal startup effort and fewer operational commitments

• You do not want to manage lab staffing, QC routines, and day to day lab operations

Model B: Build an in house clinical laboratory

You run a defined test menu under your organization’s control.

When this model is the best fit

• Routine test volume is high and predictable

• Your care pathway depends on faster turnaround

• You want stronger control over quality and exception handling

• You are ready for staffing, documentation, and operational oversight

Most organizations do not choose one model forever. A strong long term strategy is often hybrid: keep specialty or low volume assays with lab testing companies, while bringing high volume routine testing in house.

What send out testing really costs beyond the invoice

Send out testing looks simple because it is priced per test. But operational cost is not only money. It is also time, friction, and patient experience.

Turnaround time becomes a clinical problem

When results come back later than your care pathway needs, follow up becomes messy. Patients wait longer. Providers delay decisions. Your staff spends more time on calls, updates, and rechecks.

You lose control when something goes wrong

Specimen issues, missing details, reruns, and delays can happen in any system. When the process sits outside your walls, fixing root causes and prioritizing urgent cases becomes harder.

Preanalytical risk increases with every handoff

Collection, labeling, storage, transport, and receiving are all points where errors can occur. The longer the chain, the more room there is for rework and delays.

Growth can punish you over time

As volume rises, per test pricing may become expensive compared to running a focused menu internally. That is often when leaders start exploring an in house model.

What building your own lab really demands

Owning a lab can create speed and control, but it also creates responsibility. The lab is not just instruments. It is a full operating system.

You will need to plan for

• Space and workflow that reduce mix ups and rework

• Staffing coverage, training, and competency tracking

• Standard operating procedures and documentation discipline

• Quality control schedules and maintenance routines

• Result reporting workflows and data integrity expectations

• Supply planning and downtime risk management

A common failure pattern is buying equipment first, then trying to design operations around it. Strong labs do the opposite: design the workflow first, then select equipment that fits the workflow and volume.

The best decision is usually which tests, not all tests

A smart approach is to start focused and scale safely:

• Keep specialty and low volume assays with lab testing companies

• Bring high volume routine assays in house

• Expand only after operations are stable and repeatable

This reduces risk and gives you a path to scale without chaos.

Decision checklist for order blood work volume, speed needs, and long term cost

Use this checklist to decide whether an in house lab is worth it for your organization.

Volume reality

• Do you run the same routine tests daily or weekly at stable volume?

• Is demand consistent enough to justify staffing and supplies?

Clinical urgency

• Do providers frequently need faster results to make decisions?

• Are delays causing repeat visits, extra calls, or patient dissatisfaction?

Operational readiness

• Can you recruit and retain qualified personnel?

• Can you maintain consistent QC, maintenance, and documentation routines?

Quality discipline

• Are you prepared to run a strict, repeatable process every day?

• Can you standardize workflows and enforce consistency across staff?

Financial clarity

• Have you modeled the full cost, not only the analyzer price?

• Include staffing, reagents, controls, calibrators, service contracts, waste handling, and system upkeep.

If you check many of these boxes, building a focused in house lab can be a strong move.

Common mistakes that make labs fail early

Mistake 1: Starting with equipment instead of workflow

Workflow should lead equipment choices. Poor workflow creates errors, delays, and staff burnout.

Mistake 2: Trying to run too many tests on day one

A wide menu looks impressive but can break a new operation. Start with a tight menu that matches real demand.

Mistake 3: Treating documentation like optional admin work

Documentation is how the lab stays consistent, trainable, and audit ready.

Mistake 4: Underestimating staffing coverage

A lab is not one person and one machine. You need coverage plans, cross training, and continuity.

How USALCS helps without being a laboratory

USALCS does not perform patient testing. We help you build the lab operation itself so it is realistic, efficient, and scalable.

Typical support includes

• Feasibility planning and cost modeling based on your volume and goals

• Test menu strategy with a phased rollout plan

• Workflow and layout planning to reduce errors and improve speed

• Equipment planning aligned with throughput and operational design

• Staffing guidance, onboarding structure, and competency framework

• SOP structure and operational documentation system setup

• Launch planning so you go live with control, not confusion

USALCS can help you map your test menu, space, staffing, and launch plan so you avoid expensive rework and build a lab designed to run smoothly from day one.

Which path fits your lab strategy?

Choose send out testing when volume is low, the menu needs to stay broad, or you want to avoid building operational overhead early. Choose an in house model when routine volume is stable, speed matters to care decisions, and you are ready to run a quality driven operation.

The best move is not choosing a side. The best move is choosing a strategy that matches your reality, then building it with discipline.