Diagnostic stewardship mechanisms in electronic test results management - a scoping review

Diagnostic stewardship refers to coordinated efforts to ensure timely review and appropriate follow-up of test results. This scoping review aimed to identify the mechanisms, or triggers that create conditions that facilitate the diagnostic stewardship process in the electronic management of test results by clinicians.

Searches for original studies published between January 2013 and 30 April 2024 reporting electronic diagnostic test result management interventions, and the outcomes of these, were conducted in MEDLINE, EMBASE, CINAHL, ProQuest and Scopus. ProQuest and Scopus were searched for grey literature. Identified stewardship mechanisms were categorised using an eight-dimensional sociotechnical model.

Electronic stewardship efforts relied heavily on mechanisms delivered through technical components in order to increase provider awareness of returned results, advise appropriate follow-up actions, and assist with the prioritisation of abnormal test results. Non-technical mechanisms included protected time to accommodate workload, or the extension of responsibility for follow-up tasks to other staff groups. Studies reporting performance feedback in the form of self-audit, education and clarification of expectations for test result follow-up also reported significant improvements in the actioning and follow-up of test results.

Review findings highlight an increasing integration of non-technical mechanisms in stewardship efforts that facilitate the optimal use of digital health.

Success of stewardship interventions depended on integrating social and technical mechanisms. Findings underscore the importance of designing digital health interventions that are not only functional but also contextually aligned with the broader clinical environment.