title: The national health system: future possibilities for the clinical laboratory.
abstract: BACKGROUND
  The heavy burden of the costs of medical care has brought changes in the public health policy. The changes are partly related to the health management factors, but several cultural, social and environmental factors have also had a significant impact on healthcare. The role of the laboratory is now considered amidst changes that have occurred in the American health model (free-trader) and in the European-Canadian model (universalistic). Moreover, costs and clinical decision-making in laboratories in Italy have also changed in response to the new focus on the pre- and post-analytical phases of the testing process.
  
  
  METHODS
  In the present study, we used the Laboratory Information System (LIS) to evaluate whether the time involved in stages in the turnaround time (TAT) (admission, performance of tests, validation and decision-making for treatment) were reduced following improvements made to the laboratory organization and management of the pre-analytical and post-analytical phases. In particular, an analysis was made of laboratory testing for myocardial markers in patients with acute coronary syndrome.
  
  
  RESULTS
  TAT for myocardial markers in an emergency setting was reduced by 30% following changes made in the laboratory organization and in the management of the pre-analytical and post-analytical phases of the testing process.
  
  
  CONCLUSIONS
  Thanks to changes in healthcare service/system in Italy, laboratory services will now play a crucial role in cultural and socioeconomic changes, particularly where testing processes and techniques are concerned.
authors.affiliation: Patologia Clinica 1, Via Salvatore Matarrese 2/G, Azienda Policlinico, 70124, Bari, Italy. pansini@cimedoc.uniba.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Pansini
mesh_terms: D002170:Canada; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000592:standards / Q000639:trends; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy; D003657:Decision Making; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration / Q000592:standards / Q000639:trends*; D005060:Europe; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics* / Q000458:organization & administration / Q000592:standards / Q000639:trends*; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States