Diagnostic Stewardship

“Modifying the process of ordering, performing, and reporting diagnostic tests to improve the treatment of infections and other conditions”

—JAMA

Diagnostic Stewardship

is the Right Test for the Right Patient prompting the Right Action.

Diagnostic Stewardship: The good, the bad, and how to better define disease

SHEA/CDC Decennial talks from 2021 by Surbhi Leekha, Kaede Ota-Sullivan, Brad Langford & Dan Morgan

Key Definitions

Diagnostic Stewardship

Modifying the process of ordering, performing, and reporting diagnostic tests to improve the treatment of infections and other conditions.

Reflex Testing

Strategy wherein tests are only performed after pre-specified criteria are met. For example, urine cultures are only performed if an antecedent urinalysis indicates the presence inflammation (i.e. pyuria).

Cascade Reporting

Strategy of reporting antibiotic susceptibility in a stepwise fashion when specific criteria are met (e.g. organism resistant to first-line antibiotic agents).

Framing

Presenting choices in a way that highlights positive or negative aspects of a decision, leading to changes in their relative attractiveness.

Nudges

Behavioral interventions to guide decision making through choice architecture while maintaining prescriber autonomy.

Results Suppression

Strategies of reporting only some (or none) of the available result information. For example, not releasing organism identification if multiple organisms present in a urine culture.

Selective Reporting

Strategy of only reporting organism identification or antibiotic susceptibility results when specific criteria are met.

Pre-analytic

The step of ordering tests and collecting samples that occurs before processing in the microbiology laboratory.
Analytic Work or interventions within the laboratory. Analogous to processing.

Post-analytic

The reporting of results and other steps that occur after processing in the microbiology laboratory.

Resources