If you work in practice, you will be familiar with the regular phone calls from worried clients waiting for their pet’s test results. Even when clients have been reasonably informed of the average turnaround time, it is not uncommon for them to phone in, hoping that the results have come back sooner than anticipated. From the client’s perspective, these results are hugely important – they might mean a change in their pet’s medication, a new health condition to come to terms with, a less favourable prognosis, or even that it is time for them to say their final goodbye. Understanding this, as veterinary professionals, we naturally want to do all we can to give diagnostic results as quickly as possible, while ensuring accuracy and reliability. But are in-house diagnostic methods comparable to the technology used in external laboratories? This article outlines recent advances in in-house diagnostics and compares their performance and reliability with those of external reference laboratories.
What are the recent advancements in in-house diagnostics?
Range of testing
Gone are the days when PCV, total solids, a basic biochemistry profile, a urine dipstick and a trusty microscope were the extent of in-house testing. Instead, it is now common for practices to run extensive blood counts, biochemistry profiles and snap tests to get rapid results for whether a patient has lungworm, parvovirus, leptospirosis or another infectious disease. In-house thyroid hormone, cortisol, and fructosamine testing means a quicker diagnosis and more convenient monitoring of endocrine diseases, and phenobarbital assays facilitate the monitoring of epileptic patients. New technology also suggests that we can take a step back from the microscope, with diagnostic equipment now able to analyse blood smears, urine sediment, faeces samples and cytology from swabs and fine needle aspirates.
Speed of results
With couriers collecting samples promptly and delivering them to external laboratories, and results becoming available via an online portal, there’s no disputing that it’s become more efficient to send samples away. However, technological advances, especially in AI, mean that in-house equipment can also give results more quickly than previously. In-house testing now replaces the need for human interpretation, for example, the Vetscan Imagyst can analyse urine sediment in minutes (Zoetis Services, 2024). Not only does this reduce the time spent waiting for results, but it also frees up veterinary staff to perform other tasks.
Reliability and accuracy
Perhaps more important than speed, though, is accuracy. After all, clinicians must trust the reliability of the results they receive if they are the basis of important treatment decisions. Previously, the accuracy of in-house diagnostic equipment has not been comparable to reference laboratories, and it’s been favourable to send samples externally. This is particularly true of haematology, where unreliable results have meant vets and vet nurses may take a cautious approach, checking blood smears manually or sending samples away to confirm in-house results. However, quality control and calibration protocols are now more advanced (Godfrey, 2024), allowing in-house equipment to stand up against reference laboratory equipment in terms of accuracy (IDEXX, 2023; Heska, 2024).
Availability of experts
Along with in-house diagnostic equipment becoming more reliable, some providers also have experts, including board-certified pathologists, available to offer support or review results. Considering the increasing use of AI, this human touch provides reassurance. Additionally, the availability of experts allows discussion of specific cases and means that samples can be analysed by remote specialists, avoiding the delay associated with sending samples away.
What are the benefits of testing in-house?
One of the main benefits of testing in-house is the speed. Quick results reduce client stress (Giger, 2010), improving the client’s relationship with the veterinary team, reducing the likelihood of complaints, and improving client compliance (Fender, 2020). Of course, it’s not only the client that benefits from quick results ‒ their pet will also. Having more information about a patient’s condition at the point where decisions need to be made will help to ensure early intervention with appropriate treatment, therefore improving patient outcomes (Mandray, 2019; Velayudhan and Naikare, 2022).
The ability to run diagnostic tests in-house and get rapid, reliable results provides convenience and facilitates the most streamlined and efficient journey to a definitive diagnosis. For instance, a patient could present to the vet and the results of further investigation could be available within an hour or two, meaning the patient could proceed to surgery or be discharged on medication as early as possible, reducing the length of hospital stays and reducing client frustration from delayed next steps.
As well as the client and the patient, in-house testing also benefits the practice as a business. In-house diagnostics bring in revenue, and there is even more potential. At present, only 30% of sick animals presenting to vets in the UK undergo further testing in the form of blood sampling, compared to 70% of sick animals in the US (Mandray, 2019). Similarly, in the UK, only 10% of animals who present for wellness checks undergo blood tests, compared to 50% in the US (Mandray, 2019).
What are the limitations?
While calibration protocols have improved the accuracy of in-house testing (Zoetis Services, 2024), there are still concerns regarding the quality and reliability of results compared to reference laboratory equipment (Velayudhan and Naikare, 2022). This primarily stems from a lack of regulation (Velayudhan and Naikare, 2022) within the sector and the inability of small companies to perform quality control (Urbina, 2023). The use of AI is relatively new and doubt remains about its infallibility. However, the availability of experts to review results goes a long way to counteract this.
Another limitation is cost. Depending on the size of the practice, a fully equipped diagnostic suite may not be financially viable. However, since single machines can often perform multiple diagnostic tests, in-house diagnostic equipment is becoming more affordable.
Conclusions
Improvements in the speed, accuracy, and diversity of in-house diagnostics positively impact patient care and the client-vet bond, as well as increase revenue for vet practices. In some cases, in-house testing provides results with comparable accuracy to external reference laboratories. For instances where the accuracy is in doubt, some manufacturers have remote specialists available as part of the service.
While these new technologies may not be within reach for every veterinary practice, their affordability should improve over time, and, in the long term, they may be considered a worthwhile investment.