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Successful practice of clinical pathology depends on a wide variety of laboratory, clinical, and managerial decisions. The skills needed to make these decisions can most effectively be learned by residents and fellows in pathology using a service-oriented on-call approach. We report our experience implementing an oncall system in the clinical chemistry laboratory at the University of Louisville Hospital (Ky). We detail the guidelines used to establish this system and the elements required for its successful implementation. The system emphasizes a laboratory-initiated approach to linking laboratory results to patient care. From inception of the program during late 1990 through 1995, the number of beeper calls (including clinician contacts) steadily increased and is currently 8 to 20 per week. The on-call system is active 24 hours per day, 7 days per week, thus representing activity on all three laboratory shifts. Types of responses were separated into administrative (12%), analytical (42%), clinical (63%), quality control or Quality health care depends on a wide variety of clinical and managerial decisions. Laboratory medicine (ie, clinical pathology) is central to many of these decisions. Thus, establishing and maintaining a strong link between clinical pathology services and patient care and outcome enhances the standard of care. These links are best forged by effective teamwork among laboratorians, clinicians, and the institution in which they practice. As future laboratory directors, pathology fellows and residents must be trained to incorporate such teamwork and to integrate their various skills to solve problems that improve patient care.