A Model for Shared Diagnostic Stewardship

Novel technologies are evolving rapidly in the arena of diagnosing infectious disease. Ensuring that patients get the right tests and appropriate clinical management in this environment requires a solid partnership among clinical labs, infectious disease (ID) physicians, and pharmacists, two microbiology experts concluded in a viewpoint published in Clinical Infectious Diseases.

New diagnostic tools aim to reduce antimicrobial resistance by curbing antibiotic use, thus improving patient health outcomes. However, you can’t rely on technology alone to achieve diagnostic stewardship. “Decisions must be made about which new diagnostics are needed, how they will be used, and whether they are worth paying for,” wrote Robin Patel, MD, director of the Mayo Clinic’s Infectious Diseases Research Laboratory in Rochester, Minnesota,

and Ferric C. Fang, MD, a professor of laboratory medicine and microbiology at the University of Washington School of Medicine, Seattle. Some of the newer diagnostic tests are expensive, calling into question whether the value of the test is worth its cost. Overuse is another costly problem with these tests, which can lead to errors in diagnosis and treatment.

“Appropriate use of testing is becoming more challenging as the number of available diagnostic tests increases,” the authors wrote. Labs that partner with the expertise of ID physicians to ensure appropriate testing protocols, interpretation of results, and treatment help promote antimicrobial stewardship and enhance the use of rapid diagnostics, they added.

The authors gave examples of how labs could collaborate with doctors and pharmacists to facilitate diagnostic stewardship, such as expanding their hours or offering real-time consultative support. “ID physicians and pharmacists may be asked to work alongside their laboratorians on diagnostic management teams or clinical microbial sequencing boards that assist clinicians with the interpretation of complex test results in a specific clinical field,” they wrote.

The authors stressed the importance of integrating lab results into electronic medical records (EMR), ensuring that specific comments accompany test results in EMR to better guide treatment decisions. Clinical lab professionals can also partner with doctors on test menu selection. “As new technologies become available, local laboratory methods and a catalog of send-out tests should continually be reassessed to ensure that patients benefit from the latest diagnostic advances; ID clinicians should help ensure that testing is both available and appropriately ordered,” the authors suggested.

Fostering these relationships won’t be easy, as testing methods and clinical guidelines run to keep pace with new diagnostic technologies. Laboratory consolidation has also made it difficult for collaboration to blossom among clinical lab professionals and clinicians. A team-based approach toward stewardship “is a mission for ID specialists and clinical microbiologists to take on together,” the authors observed.

https://www.aacc.org/publications/cln/cln-stat/2018/september/20/a-model-for-shared-diagnostic-stewardship