Table 1.

Potential targets for enhanced implementation of diagnostic interventions and related effect measurement.

Domain	Variations	Implications	Example
Pre-analytical	Optimizing test utilization Use of LIS data & CDSS	Diagnostic stewardship interventions Prevention of duplicate orders Improved knowledge of intended test use Optimized test utilization	Restricting C. difficile orders to prevent duplicate or unnecessary testing significantly optimizes testing [3]
Post-analytical	Antimicrobial Stewardship PAF CDSS Templated microbiology comments Local contextual factors (e.g., surgery service) Implementation and dissemination science	Optimization of antimicrobial use Evidence-based guideline use at the point of care Provides microbiological expertise that assists with clinical management Conforms interventions to local needs and abilities Uses scientific methods to improve sustainability and adoption of intervention(s)	Templated comments on Candida spp. in urine as normal flora unless high risk was associated with significant decrease in antifungal use [4]
Temporal Changes	Learning curve Changes in standard of care or available treatments	Run-in period before evaluating effects Reassess diagnostic effectiveness with introduction of novel therapies	Performing and plotting interrupted time series analysis of respiratory and CNS testing reflected increasing effectiveness over time [5]

CDSS—clinical decision support system; PAF—prospective audit and feedback.