Diagnostic stewardship: Driving operational efficiency and cost optimisation

The practice of medicine is constantly evolving, driven by advancements in technology and our understanding of disease. One crucial area demanding our attention is diagnostic stewardship, a concept gaining increasing recognition for its potential to improve patient care and optimise healthcare resource utilisation. This focus is particularly critical given that studies indicate diagnostic errors can occur in 5-20 per cent of physician-patient encounters (1). At its core, diagnostic stewardship encompasses coordinated efforts to ensure appropriate diagnostic testing. In an era of increasingly complex and readily available diagnostic tools, this judicious approach is not just beneficial—it’s essential.

The current landscape of medical diagnostics presents a unique set of challenges. Modern diagnostic tools—from advanced imaging to molecular diagnostics—offer unprecedented insights into patient conditions. However, their overuse can trigger a cascade of unintended consequences. Unnecessary testing can harm patients through radiation exposure, procedural complications, and the anxiety caused by false positives or inconclusive results. Furthermore, it contributes to escalating healthcare costs, straining already limited resources. Beyond the financial implications, over-testing can also lead to diagnostic errors due to the increased probability of incidental findings, which can trigger unnecessary investigations and interventions.

Diagnostic stewardship aims to mitigate these risks by promoting evidence-based testing practices. This involves establishing clear guidelines for ordering tests, ensuring appropriate test selection based on patient presentation and pre-test probability, and interpreting results accurately within the clinical context. It also emphasises the importance of interprofessional collaboration, fostering communication between clinicians, laboratory professionals, and radiologists to optimise the diagnostic process.

A key component of diagnostic stewardship is education. Clinicians need access to up-to-date information on test performance characteristics, including sensitivity, specificity, and predictive values. Understanding these parameters allows for informed decision-making, ensuring that the chosen test is appropriate for the specific clinical question. Educational initiatives should also focus on raising awareness about the potential harms of overtesting and promoting a culture of judicious test utilisation.

Implementing effective diagnostic stewardship programs requires a multi-faceted approach. Healthcare institutions need dedicated stewardship teams that bring together clinicians, laboratory personnel, pharmacists, and other key stakeholders. These teams can develop and implement evidence-based testing guidelines, monitor test utilisation patterns, and provide feedback to clinicians. Leveraging electronic health records (EHRs) can further enhance these efforts by incorporating clinical decision support tools that prompt clinicians to consider appropriate testing strategies based on patient-specific data.

The benefits of diagnostic stewardship extend beyond individual patients. Reducing unnecessary testing frees up valuable resources, enabling better investment in critical areas like preventative care and chronic disease management. Furthermore, a more judicious approach to diagnostics can contribute to antimicrobial stewardship efforts by reducing the inappropriate use of antibiotics in response to false-positives or inconclusive test results.

Diagnostic stewardship is not about restricting access to necessary diagnostic tests. The goal is simple: ensure patients receive appropriate tests when needed and for the right reasons. By embracing this principle, we can improve patient safety, enhance the quality of care, and promote the sustainable use of healthcare resources. In a rapidly evolving medical landscape, diagnostic stewardship is not just a best practice—it’s a necessity. It’s time to prioritise value over volume and ensure that every diagnostic test contributes meaningfully to patient care. The future of healthcare depends on it.

References: 

•  https://www.who.int/news-room/fact-sheets/detail/patient-safety#