Diagnostic Stewardship Guide Targets Testing Overuse and Hospital Cost Pressures

Misordered or overused assays can complicate infection metrics, trigger penalties, and strain laboratory resources. Aligning test selection with clinical need is therefore a priority for quality improvement and patient safety. A new resource outlines how health systems can build an institution-specific business case for diagnostic stewardship.

The Society for Healthcare Epidemiology of America (SHEA) has published “Business Case for Diagnostic Stewardship: A Practical Guide from the Society for Healthcare Epidemiology of America (SHEA) Diagnostic Stewardship Special Interest Group” in Antimicrobial Stewardship & Healthcare Epidemiology (ASHE). The guide provides health care leaders with a framework to develop institution-specific business cases for diagnostic stewardship programs, including financial models for five high‑impact interventions. It is intended to strengthen patient outcomes, improve quality metrics, and reduce health care costs.

The resource defines diagnostic stewardship as ensuring the right test is ordered for the right patient at the right time, with results appropriately interpreted. It details five common opportunities for improvement: optimizing Clostridioides difficile testing, optimizing urine culture use, de‑implementing unnecessary procalcitonin testing, optimizing respiratory pathogen panel use, and optimizing blood culture use. For each area, the guide outlines implementation strategies, projected financial impact, and practical examples that hospitals can adapt to their settings.

As an example of potential value, the authors estimate that a representative 200‑bed community hospital implementing all five interventions could achieve approximately $2.5 million to $2.8 million in annual laboratory and clinical savings. Depending on baseline performance, improved quality metrics could also reduce Centers for Medicare & Medicaid Services (CMS) Hospital‑Acquired Condition penalties by an estimated $200,000 to $600,000. The interventions may additionally improve publicly reported health care–associated infection metrics and hospital reputation.

The publication appears as diagnostic excellence gains national attention. The Centers for Disease Control and Prevention (CDC) Core Elements of Hospital Diagnostic Excellence identify diagnostic stewardship as a key strategy for improving diagnosis while advancing health care quality, safety, and value‑based care. SHEA’s Diagnostic Stewardship Special Interest Group developed the guide to support health care executives, laboratory leaders, infection prevention professionals, antimicrobial stewardship teams, and clinicians.

“Health care leaders know that every investment must improve both patient care and operational performance. This framework helps hospitals evaluate and implement diagnostic stewardship in ways that improve clinical outcomes, strengthen quality metrics and demonstrate measurable value,” said Sarah E. Turbett, M.D., senior author of the paper.

Related Links
The Society for Healthcare Epidemiology of America