7 What is needed for diagnostic stewardship?
Organisational aspects of implementing good diagnostic stewardship should begin with a review of existing human, material and financial resources, and an evaluation of the additional requirements.
Cost estimations for each stage of the diagnostic pathway should cover developing and adapting local guidelines and SOPs, and developing and implementing training material, as well as any infrastructure and costs related to efficiently transporting samples, documentation and IT, for example. Table 7 reviews the stages in setting up diagnostic stewardship to the standard expected in GLASS, but can be used for general guidance when GLASS is not the immediate aim.
| Steps | Examples |
|---|---|
| 1. Planning (baseline) | Situation analysis, resources and needs assessment conducted |
| 2. Input (needed resources) | Funding for diagnostic stewardship activities in the surveillance site Local guidelines and SOPs for diagnostic stewardship Trained and capacitated staff on local diagnostic stewardship guidelines Microbiological laboratory facilities with equipment and consumables Communication protocols and facilities |
| 3. Process (activities) | Mobilisation and management of funds Development or adaptation of SOPs Development and implementation of training materials for diagnostic stewardship Implementation of training courses Internal and external quality assurance, regular procurement, and maintenance of equipment and consumables Agreed means and frequency of communication among clinical, laboratory and surveillance staff |
| 4. Output (results) | Sustainable financing and resources available on regular basis Common understanding of protocols for diagnostic stewardship Staff trained and capacitated leading to compliance with local diagnostic stewardship protocols and steps Increase in specimens submitted to the laboratory according to SOPs Good laboratory practices in place resulting in reliable and timely results Patient treatment and surveillance actions are informed in a timely manner |
| 5. Outcome | Patient treatment guided by timely microbiological data resulting in safer and more efficient patient care Accurate and representative AMR surveillance data to inform treatment guidelines and AMR control strategies |
Activity 5: Developing diagnostic stewardship
Watch a six-minute excerpt from Video 1, from 30:03 to 36:00.
If you were to develop a diagnostic stewardship approach appropriate for your healthcare situation, what factors would you need to consider?
Discussion
Any response to this activity will depend on the particular circumstances of your healthcare situation, but you may have thought of:
- costs, in particular the prospective cost
- the availability of sustainable funding
- reimbursement for microbiological diagnostics at your facility
- an appropriate supply chain for consumables and tendering procedures
- available IT systems
- population characteristics – you may need to define the diagnostic approach when there are specific characteristics, which may include a very young or an ageing population, the prevalence of HIV, or the geographical distribution of certain diseases such as malaria, yellow fever or other endemic infections
- AMU in your healthcare facility
- laboratory should establish SOPs for all tests, and each test should be verified or validated before it is introduced
- training and continuous professional development for all staff
- transporting samples between the hospital site and the laboratory
- communication avenues between the hospital site and the laboratory, for example the availability of a clinical microbiologist to visit the wards for discussion with clinicians, and the consistent availability of the laboratory by phone
- awareness among clinical staff of laboratory working hours
- setting up a multidisciplinary team for diagnostic stewardship, in collaboration with infection control and the AMS committee – who should be involved?
This list is not comprehensive; you may have thought of other issues that will affect the implementation of a diagnostic stewardship programme in your healthcare setting.
6 Diagnostic stewardship and GLASS
