Trends in teaching hospital laboratories

Over the next decade two powerful forces, economics and technology, will reshape teaching hospital laboratories, writes Ross Vining.

Economic

Australia will be forced to spend more on health in the future. But spending growth cannot keep up with the relentless demands for more services, so the economic pressure on everyone in the health system will increase. This will be felt most acutely in the teaching hospitals, which have the most to offer and which are at the cutting edge of what is possible in healthcare intervention.

The future will see new drugs, new diagnostic methods, innovative imaging systems, improved surgical techniques and better prosthetics and, along with these, demands such as ensuring the availability of all the latest tests without a significant increase in resourcing.

Technological

Cellular therapies. Expect growing demands for these emerging techniques over the next 10 years. These techniques are still largely experimental but are showing great promise. Some examples of preliminary success for cellular therapy include regeneration of damaged heart tissue, strengthening of urethral sphincters and neuronal replacement for Alzheimer's disease.

Microbiology. The need for speed has driven innovation in this area, as traditional culture methods for microbial identification are labour intensive (expensive) and slow. New growth-based techniques have potential for automation, are faster than traditional techniques and have already greatly improved blood culture. Expect to see more growth-based micro-techniques soon.

The most active areas in microbiological analysis are in improving the sensitivity and specificity of PCR-based detection systems, but other more esoteric ideas are being explored too. For example: using mass spectrometry to perform rapid speciation and typing of bacteria, cell-based sensors which detect the electrical potentials generated by cells in response to exposure to infectious agents. One thing is certain: the next decade will see changes in the clinical micro lab.

Chemistry. Point-of-care testing (POCT) promises rapid availability of results at the bedside without the costs and delays of sample transport to a remote lab. For 20 years we have been told POCT is 'coming soon'. The key barriers to the use of POCT have been the high consumable cost and data management and quality control/training issues. But now, two-thirds of clinical pathlab testing could be done by technologies currently available in POCT format. Expect to see major decreases in consumable cost for POCT and the widespread use of wireless links to transfer results from POCT to electronic medical record in real time.

Pharmacogenomics. People's sensitivity to drugs can often be predicted from genetic studies, so pharmacogenomics is emerging as a discipline that will become important, allowing more effective drugs for infectious disease therapy to be developed and prescribed, and also allowing adverse drug reactions to be minimised.

Drug monitoring. Tension is increasing between the demands for privacy versus demand for security and safety. But fear of terrorism means it is likely that the demand for security will override demands for personal freedom and privacy. Consequently we will see increasing use of technologies that identify people, such as DNA profiling, and increased use of drug testing of drivers, students and people in the workplace to assess their security risk and personal risk to others.

Dr Ross Vining is acting director of the Institute of Clinical Pathology and Medical Research, based at Westmead, NSW.