Laboratory Stewardship: Improving Quality of Care by Linking Clinical Outcomes to Appropriate Test Utilization in Clinical Chemistry Laboratories

Stewardship of laboratory services aims to ensure appropriate test utilization and improve patient outcomes. However, clinical chemistry initiatives have largely focused on reducing test volumes and costs rather than linking interventions to clinical outcomes. This review examines stewardship strategies for clinical chemistry tests using an outcome-based framework developed by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on Outcome Studies in Laboratory Medicine (TF-OSLM), which classifies outcomes into seven categories: change in patient management, clinical outcomes, economics, operational efficiencies, patient-centeredness, safety, and guide policy making. We review stewardship evidence for three high-impact targets: erythrocyte sedimentation rate/C-reactive protein co-ordering, cardiac troponin with legacy markers, and vitamin D testing. For each target, we summarize the clinical context, intervention strategies, and outcomes mapped to the TF-OSLM framework. Across all three targets, strong evidence supports reductions in test volume and associated cost savings at the institutional and national levels. However, a consistent gap emerges: direct evidence linking these interventions to patient-level clinical outcomes, such as mortality or diagnostic trajectories, remains limited. Safety data remain limited to retrospective observations, and most evidence stems from large academic centers. Public demand for testing, driven by media and wellness culture, poses an additional challenge that can undermine even robust policy interventions. The TF-OSLM framework is readily transferable to other high-volume clinical chemistry tests, and stewardship programs should incorporate prospective evaluation of clinical outcomes alongside utilization metrics to build a comprehensive evidence base for outcome-based quality in laboratory medicine.