A business case for diagnostic stewardship: a practical guide from the Society for Healthcare Epidemiology of America (SHEA) Diagnostic Stewardship Special Interest Group

Objective: We examined five common targets for diagnostic stewardship that have been associated with improved patient outcomes. For each, we estimated the financial and reputational impact of each intervention on a typical 200 bed community hospital. These estimates can be adjusted for individual hospital estimates. Results: We found consistent savings and potential improvements in hospital metrics associated with these different diagnostic stewardship interventions. Clostridioides difficile (CDI) diagnostic stewardship showed ＄125,617 expected savings plus a likely additional 75% reduction in the hospital-acquired condition (HAC) CDI metric. Urine culture stewardship showed ＄34,111–＄92,361 in savings with an additional 30% reduction in the HAC catheter-associated urinary tract infection metric. Procalcitonin de-implementation showed ＄78,938 expected savings from test discontinuation. Expanded respiratory pathogen panel stewardship showed ＄383,650–＄668,000 in savings, depending on degree of reduction and replacement with focused viral testing. Blood culture stewardship showed ＄1,860,800 in savings with an additional 33%–80% reduction in HAC central line associated bloodstream infection and MRSA bacteremia metrics. Conclusions: In total, a 200-bed hospital implementing all five interventions could expect an approximate ＄2,482,616–2,825,216 in laboratory and clinical savings. These interventions would also improve many HAC metrics, providing an additional ＄200,000–＄600,000 in savings, depending on baseline performance. Finally, reputation metrics, such as Leapfrog grades, would also improve.