Toward smarter testing: Diagnostic stewardship in healthcare systems

Diagnostic stewardship (DxS) is an emerging paradigm in healthcare that emphasizes the appropriate use of diagnostic tests to improve patient outcomes, reduce unnecessary treatments, and optimize resource utilization. This narrative review explores the principles, applications, and challenges of DxS across various clinical and global health settings. It highlights the critical role of DxS in combating antimicrobial resistance by reducing overdiagnoses/misdiagnoses and facilitating targeted therapy through evidence-based diagnostic practices. The review discusses the integration of DxS with antimicrobial stewardship programs and its potential to transform clinical decision-making by leveraging advancements such as rapid diagnostic tests and machine learning tools. In addition, it addresses barriers to implementation, including limited resources, clinician resistance, and systemic inefficiencies, particularly in low- and middle-income countries. The global health implications of DxS are explored, with an emphasis on equitable access to diagnostics and improved infectious disease surveillance. There is a need for a multidisciplinary approach to overcome the challenges in implementing DxS, including investments in infrastructure, education, and the development of evidence-based protocols. By fostering a culture of precision and accountability, DxS has the potential to transform healthcare delivery, improve patient safety, and advance global health equity. Analyzing current evidence and providing a roadmap for future research and policy initiatives, this review underscores the transformative potential of DxS in achieving sustainable, high-quality healthcare, and mitigating global health challenges.