July 18, 2024
Summer is a time of vacations and weekend adventures. Thanks to AMDA’s Summer Encore Series, it is also a time of learning. This special virtual program offers insights from three of the most acclaimed sessions from PALTC24, including a deeper dive into the issues and opportunities to engage with the presenters. The first session—To Test or Not to Test? Diagnostic Stewardship in PALTC—is set for Wednesday, July 24, from 6:00 to 7:00 PM ET. “This is a great opportunity for those who couldn’t attend the session at the annual conference in San Antonio or those who did but want more,” says Sing Palat, MD, CMD, one of the session presenters.
At its core, diagnostic stewardship seeks to improve all steps of diagnostic testing to optimize patient outcomes. Whether a urinary tract infection (UTI), C. difficile, colitis, pulmonary embolism, or bowel obstruction is suspected, the correct diagnostic test for the right patient at the right time is essential for ensuring appropriate interventions. As newer diagnostic tests become available in PALTC settings, such as molecular testing for diagnosing UTI and soft tissue infections, medical directors and all clinical leaders need to critically evaluate ordering, performing, and reporting of diagnostic tests. Wednesday’s session will explore the steps of diagnostic stewardship that may be applied to PALTC settings to improve testing and patient outcomes.
Dr. Palat observes, “Diagnostic testing is something that, as clinicians, we do every day. But in terms of the concepts that define the right test for the right patient at the right time, we don't often think about that in depth. It’s helpful to take a step back and to put some framework to it. This framework can help us do the right thing daily, as well as help determine what to do when we encounter a new test that we may not be as familiar with. The example we use in our presentation is PCR testing for UTIs. The framework offers some direction on how to evaluate something like that.” Laurent Adler, MD, CMD, the second speaker, adds, “Not only does the idea of diagnostic stewardship help ensure we are doing the right tests at the right time for the right person, but it also helps guide clinicians to identify the next steps in terms of therapy and interventions.” He also observes that diagnostic stewardship is a valuable tool in the world of value-based medicine, where accurate, up-to-date diagnoses are crucial to reimbursement and care planning.
Diagnostic stewardship, the presenters agree, is a team endeavor. As Dr. Adler explains, “The team can apply these principles to change the way they think about testing, order tests, and use these tests to plan and manage care and maximize outcomes.” This is something that the care teams, as well as residents and family members, need to know about to understand why the clinician is ordering various tests and how these tests are important to quality person-centered care. Testing decisions aren’t made in a vacuum, and diagnostic stewardship ensures everyone involved is engaged and on the same page.
The presenters also stress the importance of the connection between pre-testing and post-testing. The pre-test stage of diagnostic stewardship involves understanding what is happening with the patient based on their history and the clinical exam. That information can help identify whether further diagnostic testing is warranted and, if so, the most appropriate test to order.
Drs. Palat and Adler hope their colleagues will leave this program with a better understanding of diagnostic stewardship and the value of formalizing and using this concept in their facilities. They welcome people who missed the session at PALTC24 and those who attended but would like a deeper dive into the topic.
The Summer Encore Series also includes:
Implementation and Use of Diabetes Clinical Practice Guidelines in Daily Practice, Wednesday, August 28, 6:00-7:00 PM ET
Speakers: Barbara Resnick, PhD, CRNP; Naushira Pandya, M.D., CMD, FACP; Edward Davidson, PharmD, MPH
Breaking the Cycle of Psychiatric Medication Whack-A-Mole: A Framework for Successful Deprescribing, Wednesday, September 18, 6:00-7:00 PM ET
Speakers: Jay Tillman, MD; Carrie Brown, RN, BSN; Angela Rudd, PharmD, BCPP