title: Significant cost savings achieved by in-sourcing urine drug testing for monitoring medication compliance in pain management.
abstract: BACKGROUND
  Reference laboratory testing can represent a significant component of the laboratory budget. Therefore, most laboratories continually reassess the feasibility of in-sourcing various tests. We describe the transfer of urine drug testing performed for monitoring medication compliance in pain management from a reference laboratory into an academic clinical laboratory.
  
  
  METHODS
  The process of implementing of both screening immunoassays and confirmatory LC-MS/MS testing and the associated cost savings is outlined.
  
  
  RESULTS
  The initial proposal for in-sourcing this testing, which included the tests to be in-sourced, resources required, estimated cost savings and timeline for implementation, was approved in January 2009. All proposed testing was implemented by March 2011.
  
  
  CONCLUSIONS
  Keys to the successful implementation included budgeting adequate resources and developing a realistic timeline, incorporating the changes with the highest budget impact first. We were able to in-source testing in 27 months and save the laboratory approximately $1 million in the first 3 year.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States. semelanson@partners.org
authors.forename: Stacy E F
authors.initials: SE
authors.lastname: Melanson
authors.forename: Milenko J
authors.initials: MJ
authors.lastname: Tanasijevic
authors.forename: Marion L
authors.initials: ML
authors.lastname: Snyder
authors.forename: Alicia
authors.initials: A
authors.lastname: Darragh
authors.forename: Cathleen
authors.initials: C
authors.lastname: Quade
authors.forename: Petr
authors.initials: P
authors.lastname: Jarolim
mesh_terms: D002047:Buprenorphine / Q000652:urine; D002853:Chromatography, Liquid; D017046:Cost Savings; D016903:Drug Monitoring / Q000191:economics*; D005283:Fentanyl / Q000652:urine; D006801:Humans; D009022:Morphine Derivatives / Q000652:urine; D059408:Pain Management / Q000191:economics*; D053719:Tandem Mass Spectrometry; D014147:Tramadol / Q000652:urine; D016482:Urinalysis / Q000191:economics*
chemical_list: D009022:Morphine Derivatives; D014147:Tramadol; D002047:Buprenorphine; C026979:6-O-monoacetylmorphine; D005283:Fentanyl