Why Diagnostic Stewardship Is Important
By Julia Olff. Julia is a myelofibrosis (MF) patient, certified health educator, patient advocate, and former hospital administrator.
Medical review by Diane B. Francis, PhD
Diagnostic Tests Influence Most Patient Treatment Decisions
In every health care setting – doctor’s office, emergency departments, hospitals – we as patients have diagnostic tests done. Diagnostic tests are used to help figure out what disease or condition a person has. They are used to help plan treatment and to find out how well treatment is working. These tests can also help providers make a prognosis. A prognosis is the likely course of a disease or condition, the chance of recovery or of a disease or condition returning or worsening. There are many different types of diagnostic tests. Examples include laboratory or lab tests such as blood and urine tests, imaging tests such as mammograms and chest x-ray, and diagnostic procedures such as colonoscopy and biopsy.
While Diagnostic Testing Is Evolving Quickly, There Are Many Challenges
An estimated 13 billion lab tests are performed in the U.S. each year. Diagnostic tests are the highest-volume medical activity we experience. And these tests help drive most medical decisions. Rapid diagnostic tests are now more sensitive and specific, providing information faster such as in a few hours or 1 or 2 days. These lab tests may be part of panels of tests done with a single sample, such as one blood draw or nasal swipe. These panels can help a provider know the specific type of bacteria causing a patient’s illness in a shorter time frame. For patients, this means they can be treated more quickly and with the treatment that is best suited for their infection or illness.
Availability and cost are barriers. Rapid diagnostic tests are expensive and only available in some health care settings. Community hospitals may have more limited testing capabilities than those of large academic medical centers. With these new rapid diagnostic tests there is an increased need to have more lab professionals to run and interpret these complex tests. Since the COVID-19 pandemic, labs have faced an increasing volume of tests to run and worsening staffing shortages. Health care facilities that can access these panels - either in their own labs or with outside labs must evaluate and prioritize when to use rapid diagnostics. The data shows patients experiencing urgent or life-threatening illness can benefit the most from rapid diagnostics.
The misuse of antibiotics is an example of the need for diagnostic stewardship.
When it comes to bacterial infections, providers' ability to prescribe antibiotic treatment is limited by the lab tests available to them. Providers may select broad-spectrum antibiotics instead of more targeted ones. Broad-spectrum antibiotics work on a wide range of disease-causing bacteria. Broad spectrum antibiotics may be given when the infection or the specific bacteria causing an infection is not yet confirmed or reported. Patients who are given antibiotics when they don’t have an infection or the wrong type of antibiotic that doesn’t treat the bacteria are at risk for serious side effects. The misuse of antibiotics has also contributed to antibiotic resistance, a serious threat to public health. When antibiotic resistance happens, bacteria develop the ability to defeat the antibiotics designed to kill them.
Examples of antibiotic misuse include:
At least 28 percent of antibiotics prescribed in doctor’s offices and emergency rooms in the U.S. each year are unnecessary.
Although antibiotics don’t work on viruses, a study from the CDC reported more than 30 percent of Medicare recipients received an unnecessary antibiotic for COVID-19 during an outpatient visit.
35,000 Americans die each year because of antibiotic-resistant pathogens
Stewardship Is Critical to Improving Patient Care
Stewardship is supervising or taking care of something. Diagnostic stewardship aims to reduce diagnostic errors by reducing misdiagnosis from the start. The U.S. Centers for Disease Control (CDC) defines diagnostic stewardship as “ordering the right tests for the right patient at the right time to inform and optimize patient care.” An example of diagnostic stewardship is antibiotic stewardship, an effort to measure and improve how antibiotics are prescribed. Antibiotic stewardship aims to improve how antibiotic medicines are prescribed and used to improve patient care and safety and to reduce antibiotic resistance. Stewardship programs perform audits examining how test panel results were used to treat patients and offer feedback on ways to streamline the diagnosis process.
The goal is to have health care providers prescribe antibiotics based on lab tests that confirm the pathogen and select the most effective antibiotic against the pathogen. Studies show that when providers were given antibiotic susceptibility results, they were 3 times more likely to prescribe the recommended antibiotic. This practice, called “nudging,” is one aspect of antibiotic stewardship that supports provider decision-making and better patient outcomes. Diagnostic stewardship can help providers work with patients to choose the right test that fits the patient’s needs and leads to an effective plan of care and better health.
What can you do now?
Become a diagnostic steward for yourself and those you care about.
Review the CDC’s Antibiotics Dos and Don’ts handout to learn more about appropriate antibiotic use and how to take them safely.
Watch this 12-minute TED Talk ‘Antibiotics Just in Case” to learn more about the common medical circumstances antibiotics are prescribed, such as when having dental work. The tips shared can help you be a better self-advocate with your providers.
When prescribed antibiotics about taking them safely. Ask about when they are or aren’t needed as part of your care.
Take the information to your next doctor visit to help you have a more informed conversation with your provider about your diagnostic tests and the results. Check out the Diagnostics 101 Hub to download disease-specific test information.
Call to Action
DHH is expanding and amplifying research on inequities in diagnostic testing. We believe this topic impacts EVERYONE, as tests are the baseline for care and treatment of any health issue or disease. Stay tuned to learn with us, as we continue to report on what you need to know to advocate for yourself and others. Subscribe for the latest.
Sources
https://www.hcplive.com/view/diagnostic-stewardship-emerging-component-treatment-implications
https://www.cdc.gov/antibiotic-use/stewardship-report/current.html
https://infectioncontrol.tips/2021/06/17/antibiotic-stewardship-the-role-medical-laboratories-play/
https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
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