In an episode recorded live at the ASM Microbe meeting, experts discuss best practices and lessons learned from their own stewardship programs
This summer, our popular Beyond the Result podcast switched things up with a live event at the ASM Microbe meeting in Washington, DC. Our own Angelo Rago hosted and moderated the conversation with three special guests: Allison Chambliss, PhD, director of laboratory stewardship at the University of California, Los Angeles; Linoj Samuel, PhD, head of clinical microbiology at the Henry Ford Health System; and David Gaston, MD PhD, medical director of the molecular infectious disease laboratory at Vanderbilt Medical Laboratories.
The podcast episode, "Enabling Diagnostic Stewardship Through Flexible Syndromic Testing," focuses on lessons learned and advice about implementing and managing diagnostic stewardship initiatives for clinical laboratory testing. While the full recording is worth watching, we’ve highlighted a few key takeaways for those short on time.
Read the highlights below or watch the full podcast now!
Benefits of diagnostic stewardship
While the rationale behind diagnostic stewardship initiatives is straightforward, getting the right test to the right patient at the right time is only part of the story. Diagnostic stewardship also offers additional benefits to patients, physicians, and labs that extend far beyond that goal.
First and foremost: avoiding unnecessarily high laboratory bills for patients. Dr. Samuel mentioned that this is an issue even for insured patients, because they might have policies with high deductibles, and that lab teams have a responsibility to the patient to make sure they get real value from all testing processes.
These initiatives can also help physicians who may be less familiar with selecting the most appropriate test for a given clinical situation. Dr. Gaston recalled an experience during his internal medicine residency when he ordered every possible test for a patient, not because each test was necessary, but because “I had ordered multiple unnecessary tests due to clinical uncertainty as a novice provider,” he said. Diagnostic stewardship programs can offer guidance for physicians getting up to speed, or to those dealing with unusual clinical cases.
Finally, Dr. Chambliss pointed out an important benefit to the lab: diagnostic stewardship helps to “make sure we’re only doing testing that’s necessary,” she said, which frees up much-needed bandwidth to evaluate and bring in new testing technologies. “We don’t have the resources to expand our space or hire more staff,” she added. “We’ve got to be efficient with what we have.”
Demonstrating impact
For many teams who have implemented, or are considering implementing, diagnostic stewardship programs, a considerable challenge is demonstrating how well it’s working for patients and the healthcare system. In some cases, it can even have the opposite effect: Dr. Samuel noted that in the short term, diagnostic stewardship may lead to fewer tests, and overly simplistic analyses could make it appear that each test is actually more expensive. Ongoing monitoring to showcase an improvement in resource utilization is critical to providing a more comprehensive view of the program’s impact.
Dr. Chambliss and Dr. Gaston recommended establishing key outcome measures that are not about test volume. Examples include turnaround time, reduction in follow-up testing or procedures, and overall time in the ICU. For the best results, the metrics selected should align with “what the C-suite is looking for,” Dr. Gaston said.
Guiding physicians
Of course, getting buy-in from the administration doesn’t translate to buy-in from the physicians who ultimately have to rethink how they select and order tests. Every speaker talked about the importance of deploying proven tactics to help guide physicians through this process.
For example, Dr. Gaston said that his team recognizes that physicians don’t have the same awareness of test costs that people in the lab do, so the lab works hard to build logic into their ordering system that checks CPT and other useful codes. Physicians could get a message advising that a test might not be reimbursed, enabling them to make a more informed ordering decision. Meanwhile, Dr. Samuel said his team really likes nudge comments that appear in the ordering process to provide guidance. “We’ve got data to show that comments have a lot of value and actually change behavior,” he said.
Just as important is getting teams and departments on board, one by one. Dr. Chambliss pointed out that each specialty group has its own communication style; one team may like to get updates during in-person meetings, while another prefers seeing it in the electronic medical record system. Dr. Samuel added that nurses often have their own highly effective education methods, so it’s helpful to work closely with them to get diagnostic stewardship programs up and running.
Dr. Gaston recommended using test order data to find groups or even individual physicians who may benefit from additional support around stewardship-driven testing. Lab teams might find that just a few physicians are responsible for a large share of inappropriate orders, making one-on-one education a valuable intervention.
Whenever possible, kick off a diagnostic stewardship program with a quick win, Dr. Chambliss added. Start with one test where the value of this approach really shines through, share that success, get people excited about it, and use it as a foundation to add more tests to the program.
We are so grateful to the speakers who made this live episode of Beyond the Result a hit, and we thank all of the ASM attendees who joined us for a dynamic event. We’re thrilled to be able to share the full podcast now to bring this insightful discussion to a larger audience and to keep an important conversation about diagnostic stewardship going in the broader lab community.