I have recently been tasked by departmental leadership with the mission of reducing our burgeoning mail out budget. In recent years, we like many others have seen a tremendous growth in the number of tests that are requested by our clinical partners. This growth in numbers of course has been accompanied by a phenomenal growth in cost as well. This has become such a problem for many clinical laboratories that seminars and online presentations that focus on controlling the ever expanding mailed out (reference laboratory) volume are well attended by laboratory medical and administrative directors seeking to learn from the successes of others.

Perhaps at one time the “make vs. buy” decision on whether or not to internalize testing may have been sufficient to control growth; however I would venture to state that for most laboratories another level of effort is needed. In order to realize the full potential of reducing the financial liability of reference laboratory costs control over which tests physicians order is needed. Many if not most of us are trained to serve as consultants to clinicians in guiding test selection and interpretation and review of orders destined for reference laboratories is a natural extension of this activity.

As I am only now beginning to build the review structure here at my facility I would like to ask the Council Chat readership for their thoughts on successful strategies used at their institutions. Do you currently review physician orders as part of your training? Do you review these decisions with a laboratory director prior to making a decision, or is the review done weekly after the fact? How are tests that require review identified, by you and your fellow trainees, by laboratory director, by committee?

As always if you have suggestions for future topics of discussion please forward them to: council@aacc.org