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07/01/26

Diagnostic stewardship of respiratory cultures using clinical decision support in the PICU.

Sick-Samuels, Anna C; Woods-Hill, Charlotte Z; Kelly, Daniel P; Koontz, Danielle W; Elhaissouni, Nora; Kumar, Urmi; Xie, Anping; Richardson, Troy; Dutta, Sreejata; Marsteller, Jill A; Colantuoni, Elizabeth; Milstone, Aaron M; BrighT STAR Respiratory Authorship Group; Aldewereld, Zachary; Auth, Michael J; Banerjee, Ritu; Blumenthal, Jennifer A; Boyle, Katharine; Cecil, Cara; Dallefeld, Samantha; Flaherty, Brian F; Foster, Charles B; Gowda, Keshava M N; Hardy, Kelly A; Hauger, Sarmistha B; Green Hines, Andrea; Hong, Sue J; Hysmith, Nicholas D; Kiragu, Andrew; Kirby, Aileen L; Koutsari, Christina; Larsen, Gitte Y; Naureckas Li, Caitlin; Lin, John C; Marx, Matthew H M; Norton, Bridget M; Priebe, Gregory P; Rapsinski, Glenn J; Same, Rebecca G; Schwenk, Hayden T; Steffen, Katherine M; Tadphale, Sachin D; Toltzis, Philip; Walker, Lorne. JAMA Netw Open.

Collection Topics
Big Three Conditions Business Case for Excellence Culture, Work System, and Implementation Health IT Tests, Screening, and Laboratory Processes Teamwork
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Summary

Unnecessary respiratory cultures can generate misleading results, inappropriate treatment, and diagnostic cascades. This multicenter cohort study evaluates a team-enabled clinical decision support approach designed to promote more appropriate culture ordering in pediatric intensive care. The work illustrates diagnostic stewardship as a practical component of diagnostic excellence: improving diagnosis may depend not only on detecting disease, but also on system enhancement to know when testing is unnecessary to prevent low-value information from driving care.
Read the paper
Sick-Samuels AC, Woods-Hill CZ, Kelly DP, et al. Diagnostic stewardship of respiratory cultures using clinical decision support in the PICU. JAMA Netw Open. 2026;9(7):e2626547.