Not Just a Test: How One Lab Innovation Saved Millions and Rewrote the Value Equation

In lab medicine, we’re often asked to prove our worth with narrow metrics—cost per test, turnaround time, test volume. But these siloed measures rarely reflect the full impact of what we do.

Over the past few years, I led two studies focused on a single test: the heparin-induced thrombocytopenia (HIT) antibody assay. Both began as practical projects to improve lab performance. But what they revealed went far beyond reagent costs or staffing efficiencies—they told a story about how laboratory decisions can fundamentally shape patient care.

A Cost-Effective Innovation With Big Returns

In the first study, published in Archives of Pathology & Laboratory Medicine, my team and I evaluated the cost-effectiveness and return on investment (ROI) of bringing the HIT antibody test in-house using the HemosIL platform. Like many institutions, we had been sending these tests out, with turnaround times of 2–4 days—delays that often led to empiric use of expensive heparin alternatives like argatroban.

By implementing the assay on existing equipment, we reduced our average turnaround time to just over an hour. That change significantly cut down on unnecessary treatment. We found that the in-house test became cost-effective after as few as 8 tests, and at our institution’s volume, yielded an ROI of up to 298% annually.

Fewer Days in the Hospital—But Only When the Test Is Negative

The second study, published in American Journal of Clinical Pathology, took things further: Could this lab change improve measurable clinical outcomes?

We focused on one critical metric—hospital length of stay (LOS)—and found that patients who had a negative HIT antibody result via in-house testing stayed 3.97 fewer days in the hospital, on average, compared to those with send-out testing. This wasn’t a systemwide trend. There was no decrease in acuity of the patients receiving the test or LOS for the institution as a whole. The reduction was specific to patients with negative test results—those who were able to safely avoid prolonged empiric treatment and be discharged sooner.

It’s a clear example of how rapid, high-quality lab data can directly affect clinical decision-making and resource utilization.

Moving Past Cost-Per-Test

These projects changed how I think about lab value. The traditional cost-per-test model captures only a sliver of the story. It misses what really matters: avoiding harm, reducing overtreatment, shortening stays, saving money systemwide. These are outcomes that matter deeply to patients—and to healthcare systems under strain.

To capture that value, we have to stop viewing labs as isolated cost centers and start recognizing them as engines of clinical efficiency. That means bringing lab leaders to the table in decisions about operations, informatics, and patient flow. It means designing metrics that reflect our role not just in diagnosis, but in care.

A Path Forward

I hope these studies offer a blueprint for others—not just for bringing HIT testing in-house, but for rethinking how we evaluate the success of laboratory innovations altogether. Because when we measure lab value only in terms of cost per test, we ignore everything that happens after the result is released.

We ignore the treatment that’s avoided. The hospital days that are saved. The patient who gets discharged sooner, or doesn’t receive an unnecessary drug. We ignore the confidence we give clinicians to make the right call—and the cascading impact that confidence has across an entire health care system.

Laboratory medicine isn’t just a line item on a budget. It’s an invisible backbone that supports nearly every clinical decision made in modern medicine. When we optimize the lab—not just for throughput, but for clinical integration—we create meaningful improvements in patient care, safety, and efficiency. That’s value. Not in theory, but in outcomes.

It’s time we start telling that story—loudly, clearly, and with data to back it up.

• Raymond C, Dell’Osso L, Golding C, Zahner C.Cost-Effectiveness and Return on Investment Analysis of an In-house HemosIL Heparin-Induced Thrombocytopenia Antibody Assay at a Mid-Sized Institution.Archives of Pathology & Laboratory Medicine. Published online 2023.📄 https://doi.org/10.5858/arpa.2023-0141-OA

• Raymond C, O’Rourke M, Dell’Osso L, Golding C, Zahner C.Analysis of Hospital Length of Stay and Cost Savings With an In-House Heparin-Induced Thrombocytopenia Antibody Assay at a Midsized Institution.American Journal of Clinical Pathology. Published online 2023.📄 https://doi.org/10.1093/ajcp/aqad152