The increasing number and complexity of diagnostic tests available to clinicians, including molecular genetic testing and next generation sequencing, promises greater precision and personalization in medical decision making. However, this complexity comes at the cost of increasing types of pitfalls in test selection, performance, and interpretation.11,16-19 In many healthcare organizations, a disconnect occurs between clinical decision making at the bedside and the expertise and knowledge resources available to guide appropriate use of diagnostic testing.20
A survey of 1,768 U.S. primary care physicians found that uncertainty about test ordering and interpretation is common. While 53 percent of respondents indicated that asking a lab professional would be “very” or “extremely” helpful to overcoming uncertainty, only 6 percent indicated that they did so at least once a week. Similarly, 75 percent of respondents rated a “curbside consult” as helpful, but only 11 percent used it frequently.21
Ensuring that clinicians are optimally equipped to use tests to inform diagnoses, prognoses, and therapy decisions is consistent with the definition of stewardship: “the careful and responsible management of something entrusted to one’s care.”22 Diagnostic stewardship comprises a variety of interventions to optimize use of testing directly or indirectly through collaborations between clinicians and diagnostic testing experts.
Although for the purpose of this brief we focus on improving diagnosis by optimizing clinical laboratory and anatomic pathology diagnostic services, stewardship can be applied to other types of diagnostic testing. Concurrent initiatives in imaging stewardship, for instance, aim to increase appropriate use of imaging and reduce low-value testing.23-25
