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. Author manuscript; available in PMC: 2023 Mar 1.
Published in final edited form as: Infect Dis Clin North Am. 2022 Mar;36(1):203–218. doi: 10.1016/j.idc.2021.11.003

Table 1.

Suggested implementation approach for diagnostic stewardship initiatives in the pediatric intensive care unit

Before Implementation Identify key personnel: a dedicated project champion and a core project team; recommend both an infectious disease and critical care clinician
Identify required data elements (ex: monthly number of endotracheal aspirate cultures)
Examine the unit’s baseline performance of the metric of interest before implementation and establish a system for how to analyze that data in each phase of the project
Understand the current/baseline approach to the test of interest in the unit (the current drivers of testing use, and potential barriers or facilitators to changing practice), via survey, focus groups, or interviews
Reach out to key stakeholders whose perspectives and buy-in will be important for your new approach (e.g., leadership, relevant consultants, nurses, respiratory therapists, advance practice providers).
Create the new tool/algorithm for your stewardship initiative that reflects key drivers/barriers/facilitators and stakeholder perspectives
Establish the balancing metrics and unintended consequences of your practice change and how to monitor for those after implementation
Implementation Develop one or more strategies for disseminating the new tool/algorithm to the appropriate end-users (ie, clinicians, laboratory personnel, etc) in your ICU (e.g., emails, posters, check-lists, educational seminars)
After Implementation Analyze the use of the test of interest on a weekly or monthly basis to monitor progress, using a run or control chart if possible
Share this data with the appropriate end-users that your tool/algorithm targeted, using feedback to help drive behavior change
Monitor for adherence to the new guidelines and for unintended consequences of the practice change
Revise the clinical approach or implementation plan if initial results are suboptimal