Diagnostic Stewardship 101

The purpose of diagnostic stewardship is to improve the overall process of diagnosing diseases. But, as any healthcare professional knows, the diagnostic process is often complex and difficult.

Diagnostic stewardship represents an opportunity for a more holistic approach. It brings together all relevant healthcare teams in a joint effort to improve patient and resource management at all stages of the diagnostic process. Thoughtfully implementing new diagnostic tools—including syndromic infectious diseases testing—can help diagnostic stewardship programs succeed.

What is Diagnostic Stewardship?

New diagnostic tools and technologies are constantly being innovated with the primary goal of improving and saving the lives of patients. But these tools can’t achieve this goal without the efforts of healthcare professionals from all facets of the healthcare system. The term diagnostic stewardship encapsulates the combined efforts of these healthcare teams to improve the overall process of diagnosing patients. These efforts begin with determining and implementing the most effective ways to diagnose patients so they can be appropriately treated.

Diagnostic stewardship also includes reevaluating how resources are used, such as radiological procedures and laboratory tests. It involves collecting and analyzing data, as well as researching, onboarding, and effectively utilizing new tools and technologies. And, on top of all of that, diagnostic stewardship requires developing and implementing an effective financial strategy.

These efforts can help improve patient management and outcomes, but they can also help the infectious disease diagnostics industry decide which innovations to prioritize next, and how to better improve the accuracy and accessibility of diagnostic tools already on the market.

Why Does Diagnostic Stewardship Matter?

There are many reasons why diagnosing and treating infectious diseases can be so difficult. First of all, patients frequently present with non-specific symptoms, which means healthcare providers often rely on guesswork and serial laboratory tests, some of which don’t provide actionable answers for days. This approach often forces healthcare providers to make important patient management decisions before receiving a definitive lab result. From there, determining the best treatment, and allocating limited manpower and resources, must be configured on a case-by-case basis—even if a pathogen-specific result never materializes.

Simply put, the infectious disease diagnostic process is extremely complicated and can look different in every scenario. And while there is an increasing number of new and improved diagnostic tools available on the market, studies have shown that these tools only improve clinical outcomes when they are implemented as part of an effective diagnostic stewardship program.¹

In tandem with new diagnostic tools, a diagnostic stewardship program endeavors to combat the macro threats of misdiagnoses, infection transmission, antimicrobial resistance, and the ineffective allocation of limited or expensive resources. Overcoming such obstacles can empower physicians to more confidently focus on patient management and face new and emerging threats.

Diagnostic Stewardship and Antimicrobial Stewardship

There are many elements under the umbrella of patient management—including diagnosis, treatment, and infection prevention. Currently, one of the biggest pieces of this puzzle is antibiotic resistance, which is why antimicrobial stewardship programs are more important than ever when it comes to patient management and diagnostic stewardship.

Antimicrobial stewardship refers to the systemic efforts to combat antimicrobial resistance. An antimicrobial stewardship program (ASP) typically aims to optimize the use of antimicrobial medications by avoiding unnecessary and inappropriate prescriptions in order to slow the development of resistance and improve patient outcomes with better targeted treatment.

Diagnostic stewardship solutions for antimicrobial resistance, like providing accurate diagnostic test results more quickly, can mean that physicians have the actionable information they need to select the most appropriate antibiotics, if any, for their patients. It also means they can better reduce the risk of transmission within healthcare facilities by utilizing isolation resources more effectively.²

Facing Infectious Disease Threats with Diagnostic Stewardship

Unfortunately, antibiotic resistance is far from the only obstacle facing diagnostic stewardship efforts. SARS-CoV-2 remains a critical and complex issue worldwide, especially during the respiratory season months.

The COVID-19 pandemic has negatively impacted antimicrobial resistance but, as a result, positively impacted the implementation of antimicrobial stewardship programs in healthcare facilities. Sepsis, of course, is a deadly threat that is always top-of-mind for healthcare providers, particularly in emergency departments and hospitals. The availability of fast and accurate diagnostic solutions is the key to treating patients with dangerous viral or bacterial infections without sacrificing antibiotic stewardship efforts.

Because the long-term threat of antimicrobial resistance often overlaps with seemingly more urgent threats, effective diagnostic stewardship is more complex—and more important—than ever.

Factors that can Impact Diagnostic Effectiveness

A recent review of the literature demonstrates that “factors beyond the analytical performance of a diagnostic can impact the effectiveness of a diagnostic test on clinical outcomes.”³ For that reason, interdisciplinary collaborations can help suggest and implement modifications that may improve the effectiveness of a diagnostic. For example, addressing diagnostic underutilization, clinical decision support interventions, conforming interventions to local needs and abilities, and antimicrobial stewardship may all contribute to improved diagnostic effectiveness.³

An interdisciplinary diagnostic stewardship effort that focuses on optimizing diagnostic effectiveness can have a real impact on antimicrobial utilization and patient care.

How Does the Syndromic Approach Support Diagnostic Stewardship?

Getting actionable laboratory results into the hands of healthcare providers faster can lead to better patient management decisions, including diagnosis and treatment decisions. Syndromic testing with the BioFire^® FilmArray^® System can empower diagnostic stewards to choose the right test, the first time.

When patients present with infectious diseases with nonspecific symptoms, syndromic testing optimizes the initial evaluation and may help avoid the additional testing that comes with individual and serial tests. Instead of relying on culture, the BioFire System uses multiplex PCR testing to target a comprehensive grouping of possible causes of infection and antimicrobial resistance genes.

A syndromic approach to infectious disease testing provides pathogen-specific results in about an hour, which can facilitate targeted, rather than broad-spectrum, antibiotic treatment sooner. Identifying antimicrobial resistance genes can also help promote antibiotic stewardship when it matters most. Additionally, in collaboration with BioFire System tests in the United States, BioFire ^® Syndromic Trends collects pathogen-specific data that can help healthcare facilities make data-driven diagnostic stewardship plans.

As the need for effective diagnostic stewardship only becomes more critical and more urgent, the good news is that the diagnostic tools and technologies, as well as the innovative institutional practices, that are available to healthcare providers are improving by the day.

Additional Diagnostic Stewardship Resources

Learn more about how multiplex PCR diagnostic testing works, and how the BioFire System can help institutions streamline and simplify the process of infectious disease diagnostics.

Request a free demo of the BioFire System to see how your institution’s diagnostic stewardship plan could benefit from syndromic testing. Our team is ready to answer all your questions.

References

Patel R, et al. Clin Infect Dis. 2018;67(5):799-801. https://doi.org/10.1093/cid/ciy077.
Diagnostic stewardship: a guide to implementation in antimicrobial resistance in surveillance sites. 2016. Accessed 25 Apr 2022. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/251553/WHO-DGO-AMR-2016.3-eng.pdf
Hueth KD, et al. Antibiotics. 2022;11(250).