8 The diagnostic stewardship committee and its role
Managing a patient with an infectious disease requires:
- infection control
- diagnostic stewardship
- antibiotic stewardship.
It is addressed by integrating these three elements, ensuring they are given equal priority. A single committee in charge of all three areas may decide on appropriate sub-structures. Figure 6 shows the close relationship between different stewardship programmes.
Managing diagnostic stewardship in the hospital or healthcare facility requires a multidisciplinary collaboration between clinical staff, microbiology laboratory staff and surveillance/epidemiological staff. Other staff, such as pharmacists and hospital administration, may also need to be involved.
Although (as mentioned earlier) it might be optimal to combine the different stewardship roles because of the significant overlap, the WHO outlines the role of the diagnostic stewardship committee as follows:
- Development, adoption and implementation of quality management practices including local guidelines and SOPs for specimen selection, collection, transport, laboratory testing and reporting.
- Review and oversight of training needs and activities, including supportive supervision for diagnostic stewardship at the surveillance site.
- Promotion of good diagnostic stewardship at referral sites (particularly if one laboratory in one facility serves several surveillance sites).
- Monitoring of progress of the diagnostic stewardship activities.
- Convening of regular team meetings to (i) present and discuss laboratory results and related issues, (ii) present progress in implementation, (iii) identify and address administrative, technical, operational and logistic issues.
- Establishment of links with the antibiotic stewardship programme, infection and prevention programme, and drug committee.
- Participation in local surveillance data management for reporting and development of local treatment guidelines.
- Key areas of responsibility for each of the different professionals.
Activity 6: Reflecting on how to improve diagnostic stewardship
After studying this module, what are your priorities for improving diagnostic stewardship at your healthcare facility?
Discussion
Your priorities will depend on your role, but options include:
- using posters in wards to illustrate the correct procedure for collecting specimens
- listing information on laboratory working hours and appropriate times for sample delivery in a prominent place in the wards, together with the laboratory phone number
- providing the list of laboratory tests, and brief information on the validation results of new tests that are introduced
- providing short summaries about the purpose of the tests, and their sensitivity and specificity
- introducing regular ward rounds at hospital facilities for the clinical microbiologist, if available, to accompany the clinician
- raising awareness of the local and regional laboratories/hospitals, as well as the local and national governments about the potential for cost savings and improved health outcomes from investing in diagnostic testing and stewardship
- creating guidelines on antimicrobial treatment
- providing periodic information on AMR trends at hospital, ward and patient levels.
This list is by no means comprehensive and the improvements may be simple and specific or more substantial, depending on your role and situation!
7 What is needed for diagnostic stewardship?
