Table 1.

A roadmap to implementing diagnostic stewardship for resident physicians.

1. Understanding the Concept:

-Diagnostic stewardship (DS) is a coordinated approach to patient care that involves the judicious use of diagnostic tests. It is essential to understand that DS is not just about ordering tests, but about making informed decisions that lead to better patient outcomes;

-DS principles include ordering the right tests for the right patient at the right time, understanding the performance characteristics of different tests, and considering the pre-test probability of the suspected disease/result.

2. Pre-Analytical Stage:

-Before ordering a test, consider its appropriateness for the patient’s condition and the pre-test probability of the suspected disease. This can prevent unnecessary testing and reduce healthcare costs;

-Implement enhanced or targeted specimen collection techniques to ensure the quality of the sample. Poorly collected samples can lead to inaccurate results;

-Ensure optimal preparation and timely transport of the specimen to the laboratory to minimize potential contamination and maximize its quality;

-Pre-test probability is the likelihood of a patient having a disease before a diagnostic test result is known. Understanding this concept is crucial for interpreting test results and making informed clinical decisions.

3. Analytical Stage:

-This involves the actual execution and performance of diagnostic tests. Understanding how tests are performed can help you interpret the results and make informed clinical decisions;

-A reflex testing strategy involves performing certain tests only if pre-specified criteria are met. This can prevent unnecessary testing and ensure that tests are used appropriately;

-Selective testing involves not testing for a particular pathogen–drug combination on bacteria suspected of being a contaminant. Selective reporting involves only reporting some part of the results or none of them (suppression of results). Both strategies can prevent overdiagnosis and unnecessary treatment;

-Novel molecular diagnostics, such as PCR methods and next-generation sequencing, can provide rapid and accurate results. However, they should be used judiciously considering their cost and the need for specialized equipment and expertise.

4. Post-Analytical Stage:

-Effective communication of test results is crucial for patient care. This involves not only delivering accurate results in a timely manner but also explaining the results to the patient and discussing the next steps;

-Clinical decision support systems (CDSS) can aid in the interpretation of test results and guide clinical decision making. Templated microbiology comments can provide standardized interpretations of common test results;

-Regularly evaluate and adjust the criteria for DS based on emerging potential risks or if the realized benefits do not align with initial expectations. This ensures that DS remains relevant and effective in changing healthcare environments.

5. Continuous Education:

-Stay updated on the latest developments in diagnostic testing methods, diagnostic algorithms, and diagnostic guidelines. This ensures that you are providing the best possible care to your patients;

-Bayesian reasoning is a statistical method that involves updating the probability of a hypothesis as more evidence becomes available. It is a fundamental concept in medicine that can aid in the interpretation of test results and clinical decision making;

-Learn how to interpret test results correctly and evaluate them properly based on evidence-based principles and practices. This can prevent misdiagnosis and ensure appropriate treatment.

6. Collaboration:

-DS is a team effort that involves clinicians, laboratories, administrators, and policymakers. Collaboration ensures that DS principles are effectively incorporated into clinical practice and that patient care is optimized;

-Be open to feedback from your colleagues and be ready to adapt to changes in diagnostic practices. This can help you to improve your DS skills and provide better patient care.

7. Patient-Centered Care:

-Always consider the patient’s individual characteristics and needs when making diagnostic decisions. This ensures that the care provided is personalized and effective;

-Remember that the ultimate goal of DS is to improve patient outcomes and optimize patient care. All DS activities should be guided by this goal.