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Inter-relationship between diagnostic stewardship and antimicrobial stewardship
The right antibiotic for the right indication at the right dose and duration
Diagnosis and treatment
Antimicrobial stewardship
Rapid diagnostic test results reported
Patient Lab
Adapted from ref 9
Clinical evaluation
Diagnostic stewardship
The right test for the right patient at the right time
Rapid diagnostic test ordered origin , and the correct identification of the causative pathogen would therefore reduce the use of inadequate or unnecessary antibiotics . The value of molecular diagnostic assays using syndromic panels was summarised in a metaanalysis that considered the role of testing for influenza and other respiratory viruses . Pooling the results , the authors found that molecular diagnostic testing had an overall sensitivity of 90.9 % and a specificity of 96.1 %. While the authors noted that the impact of such testing on patient outcomes was mixed , they still suggested that molecular diagnostic testing should be implemented in the hospital setting . 10
Clinical decision support systems Although clinicians should be aware of clinical decision support systems ( CDSS ), they might be less familiar with the major developments that have occurred in recent years . Today , CDSS are designed to be used at the point of care , allowing the clinician to utilise the output from CDSS , together with their own clinical acumen , to improve the delivery of health care . In fact , the scope of CDSS is vast and encompasses not only diagnostics but also disease management , through enhancement of compliance with clinical guidelines . CDDS can improve clinical practice through automatic provision of decision support and recommendations as opposed to mere assessment . CDDS can also provide clinicians with treatment reminders and prescribing support in an effort to minimise the risk of medication errors . In a systematic review by Jenkins et al , 11 CDDS in the hospital setting reduced overall requests for imaging by 36.8 % and provided targeted reminders to primary care physicians on the appropriate indications for imaging . CDDS have also been shown to be of value in the decision-making process according to a patient ’ s clinical need . This was examined in a study in which the CDDS simulated the role of the urologist in the follow-up of stable patients with prostate cancer . The study showed a high level of agreement between the CDSS and two specialists for the identification of patients with potential disease progression , and subsequent referral to urology care . 12
In the context of AMS , a systematic review of studies assessing the effectiveness of CDSSs at reducing antibiotic prescribing confirmed improvements in clinical and economic outcomes and in the implementation of appropriate antimicrobial therapy , through increased adherence with practice guidelines or susceptibility test results . However , the review also revealed the availability of limited data on the impact of CDSS specifically on primary care . 13 In another study , the implementation of an ASP supported by a computerised CDSS reduced antimicrobial use and spending , non-compliance with prescribing guidelines , and hospital length of stay . 14
In the laboratory setting , CDSS play an