Hospitals Could Save Millions Through Smarter Diagnostic Testing, New Guide Shows

Arlington, Va. – A practical new guide from the Society for Healthcare Epidemiology of America (SHEA) is making the case that better diagnostic testing is not just good medicine—it is a serious financial opportunity for hospitals. The resource, titled Business Case for Diagnostic Stewardship: A Practical Guide from the Society for Healthcare Epidemiology of America (SHEA) Diagnostic Stewardship Special Interest Group, was published in the journal Antimicrobial Stewardship and Healthcare Epidemiology. It offers healthcare leaders a detailed framework for building institution-specific business cases for diagnostic stewardship programs, complete with financial models for five high-impact interventions that hospitals can adapt to their own operational settings.

The core financial argument is striking. According to the authors’ estimates, a representative 200-bed community hospital that implements all five interventions could generate approximately $2.5 million to $2.8 million in annual laboratory and clinical savings. Beyond those direct savings, hospitals that improve their baseline performance on quality metrics could reduce penalties under the Centers for Medicare and Medicaid Services Hospital-Acquired Condition program by an estimated $200,000 to $600,000. The interventions may also improve publicly reported healthcare-associated infection metrics and strengthen hospital reputation, benefits that carry real competitive weight in an era when patients and payers increasingly scrutinize quality data.

Diagnostic stewardship, at its heart, is about ensuring the right test is ordered for the right patient at the right time—and that results are interpreted appropriately once they return. It is a discipline aimed at eliminating the cascade of harm that follows unnecessary or poorly targeted testing: false-positive results that trigger unneeded antibiotics, incidental findings that lead to invasive follow-up procedures, prolonged hospital stays, and wasted laboratory resources. Unlike efforts to restrict care, diagnostic stewardship refines decision-making at the moment a test is considered, making it an attractive target for both clinicians and administrators seeking measurable improvement.

The guide examines five common opportunities for improvement that recur across hospital settings. The first is optimizing testing for Clostridioides difficile, the bacterium responsible for severe, sometimes life-threatening diarrheal infections in healthcare settings. Because molecular assays can detect the organism in patients who are merely colonized rather than truly infected, testing unformed stools indiscriminately inflates infection rates and drives unnecessary treatment and isolation. The second and third targets are optimizing urine culture use and de-implementing unnecessary procalcitonin testing. Urine cultures ordered in patients without symptoms frequently reveal asymptomatic bacteriuria, a common finding that is often inappropriately treated with antibiotics, fueling resistance and adverse drug events. Procalcitonin, a biomarker sometimes used to guide antibiotic decisions, is frequently ordered in situations where the result will not change management, consuming resources without benefiting patients.

The remaining two interventions address the explosive growth of multiplex diagnostics. Optimizing respiratory pathogen panel use tackles panels that test for dozens of viruses and bacteria simultaneously in patients whose care would change little based on the full results, encouraging clinicians instead to select narrower panels or targeted tests matched to the clinical question. Optimizing blood culture use rounds out the list, addressing the widespread practice of drawing blood cultures from patients with low pretest probability of bloodstream infection or from indwelling lines where contamination is likely. Each unnecessary culture carries costs in laboratory processing, false-positive contamination that prompts additional testing and antibiotics, and extended lengths of stay when ambiguous results are reflexively treated.

For each of the five interventions, the authors lay out implementation strategies, projected financial impact, and practical examples that hospitals can adapt to their own circumstances. The financial models are designed to translate clinical improvements into the language of hospital administration: avoided laboratory costs, reduced antibiotic expenditures, shortened lengths of stay, and improved quality measure performance. That translation matters, because diagnostic stewardship programs typically require upfront investment in education, electronic health record modifications, and personnel time, and program champions must often justify those costs to budget-conscious executives before any savings are realized.

Senior author Sarah E. Turbett, MD, framed the resource as a bridge between clinical value and operational performance. Healthcare leaders know that every investment must improve both patient care and operational performance, she noted, and this framework helps hospitals evaluate and implement diagnostic stewardship in ways that improve clinical outcomes, strengthen quality metrics, and demonstrate measurable value. The emphasis on measurable value reflects a growing recognition that programs perceived as purely clinical initiatives often struggle to survive budget cycles, while those with robust business cases secure sustained institutional support.

The publication arrives at a moment when diagnostic excellence is receiving increasing national attention. The Centers for Disease Control and Prevention’s Core Elements of Hospital Diagnostic Excellence identifies diagnostic stewardship as a key strategy for improving diagnosis while advancing healthcare quality, safety, and value-based care. By aligning its guidance with that national framework, SHEA positions diagnostic stewardship as a central pillar of hospital quality improvement rather than a niche laboratory concern, giving infection preventionists, laboratory directors, and antimicrobial stewardship teams a shared vocabulary for engaging executive leadership.

The guide was developed by SHEA’s Diagnostic Stewardship Special Interest Group, a body convened specifically to advance this field, and it is aimed at a broad professional audience: healthcare executives, laboratory leaders, infection prevention professionals, antimicrobial stewardship teams, and frontline clinicians. Each of these groups plays a distinct role in making diagnostic stewardship succeed. Executives control the resources, laboratory leaders understand the technical nuances of test performance and utilization, infection prevention teams track the downstream effects on healthcare-associated infection metrics, stewardship programs connect testing behavior to antibiotic use, and clinicians ultimately decide which tests to order and how to interpret them.

For hospitals weighing whether to act, the combined figures offer a compelling bottom line. Direct savings of $2.5 million to $2.8 million annually, plus up to $600,000 in avoided CMS penalties, represent the kind of return that few quality initiatives can match—achieved largely by doing fewer, better-targeted tests rather than buying new technology. The authors emphasize that actual results will vary with each hospital’s baseline performance, patient population, and existing stewardship infrastructure, which is precisely why the guide insists on institution-specific business cases rather than one-size-fits-all projections. What the resource makes clear is that diagnostic stewardship has matured from a conceptual ideal into an operational discipline with documented strategies, modeled financial impact, and demonstrated potential to improve patient care, healthcare quality, and hospital finances simultaneously. As pressure mounts to deliver safer, higher-value care, the guide suggests that one of the most powerful tools available to hospitals may be simply ordering the right test, for the right patient, at the right time.

Subject of Research: Building hospital business cases for diagnostic stewardship interventions to improve patient care and reduce costs

Article Title: SHEA publishes resource to help hospitals build the business case for diagnostic stewardship

Article References: SHEA publishes resource to help hospitals build the business case for diagnostic stewardship. (n.d.). Original publication

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Keywords: diagnostic stewardship, SHEA, hospital savings, Clostridioides difficile testing, urine culture, procalcitonin, respiratory pathogen panels, blood culture, antimicrobial stewardship, CMS penalties, healthcare quality, infection prevention