Diagnostic Stewardship in Viet Nam: Appropriate Testing, Interpretation and Safer Decisions
More diagnostic testing does not always lead to better diagnosis. A patient may undergo several investigations that add little useful information, while another may experience an avoidable delay because an important test was not performed when it was needed. Both situations raise questions about the quality and safety of diagnostic decisions, even when the investigations themselves are technically reliable.
Healthcare professionals face these decisions every day. They need to consider what clinical question they are trying to answer, whether a particular investigation can provide useful information, how its findings should be interpreted, and whether the result is likely to influence subsequent care.
The answers are not always straightforward. A test may perform well under controlled conditions but provide limited clinical value when the likelihood of disease is very low. An abnormal finding may indicate a significant condition, an incidental abnormality, or a variation that does not require intervention. Conversely, a reassuring result may not safely exclude a condition when clinical suspicion remains substantial.
Diagnostic stewardship addresses these challenges by promoting the appropriate selection, performance, interpretation, and use of diagnostic investigations.
For healthcare organizations in Viet Nam, this approach has implications for patient safety, clinical quality, professional collaboration, and the responsible use of healthcare resources. It is relevant to laboratory medicine, diagnostic imaging, pathology, microbiology, and other diagnostic services, although the evidence and practical interventions differ between specialties.
The objective is not simply to perform fewer tests. It is to help patients receive necessary investigations when they are needed, avoid testing that offers little meaningful benefit, and ensure that diagnostic information contributes to appropriate clinical decisions.
Diagnostic Stewardship Is About Better Decisions, Not Fewer Tests
Diagnostic stewardship is an evidence-informed approach to improving how diagnostic investigations are selected, performed, reported, and interpreted so that the information obtained supports better patient care.
The U.S. Centers for Disease Control and Prevention identifies diagnostic stewardship as an important approach within its Core Elements of Hospital Diagnostic Excellence, published in February 2026. The framework emphasizes appropriate test selection, collaboration with diagnostic specialists, improved laboratory utilization and performance, and effective interpretation of results.
These principles build on work developed in clinical microbiology and infectious diseases. In 2023, the Society for Healthcare Epidemiology of America published Principles of Diagnostic Stewardship: A Practical Guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. The guidance focuses on microbiological laboratory testing and examines opportunities to improve test ordering, specimen collection, processing, reporting, and interpretation.
Although its recommendations primarily concern microbiology, the underlying principles of clinical appropriateness, reliable testing, and multidisciplinary collaboration can inform improvement in other diagnostic specialties.
The World Health Organization has also emphasized the importance of appropriate diagnostic practices. During World Patient Safety Day 2024, WHO highlighted the consequences of missed, delayed, incorrect, and poorly communicated diagnoses. Its recommendations for healthcare professionals included selecting and interpreting diagnostic tests according to evidence-based guidance while considering the risks of overdiagnosis and underdiagnosis.
A particularly relevant regional development occurred on June 8, 2026, when the WHO Regional Office for the Western Pacific published Strengthening Clinical Diagnostic Stewardship in the Western Pacific Region: A Practical Manual.
The manual focuses on strengthening diagnostic practices related to bacterial infections and antimicrobial resistance. It provides a practical, facility-oriented approach to selecting tests, obtaining appropriate specimens, interpreting results, and using diagnostic information, with particular relevance to healthcare settings where resources and diagnostic capabilities may be limited.
These international developments reflect a common principle: the value of an investigation depends on how well it addresses a clinical need.
A test may be justified even when it is costly, technically demanding, or unlikely to produce a positive result. Conversely, a readily available investigation may provide little benefit when the clinical indication is weak or the information obtained is unlikely to influence care.
Diagnostic stewardship should therefore be understood as an effort to improve the appropriateness, value, and safety of diagnostic decisions rather than a program primarily intended to restrict testing or reduce expenditure.
The Clinical Question Should Come Before the Test
Appropriate testing begins with a clear understanding of the clinical question.
Before requesting an investigation, healthcare professionals need to consider what condition is being evaluated, what information is already available, and how the possible results could influence the next decision. The same investigation may be useful in one clinical situation and unnecessary or difficult to interpret in another.
For example, a test may help distinguish between two plausible diagnoses when the result would lead to different clinical decisions. The same test may add little information when the clinical assessment already provides sufficient evidence for an appropriate plan.
The decision also depends on the patient's condition, the urgency of the situation, previous investigations, and the possible consequences of overlooking a serious disease. In some circumstances, observation or reassessment may be reasonable. In others, delaying a necessary investigation could expose the patient to significant risk.
Diagnostic stewardship must therefore consider both the benefits of testing and the consequences of not testing.
One important concept is pretest probability, which refers to the estimated likelihood that a patient has a particular condition before the result of an investigation is known. This estimate may be informed by symptoms, examination findings, medical history, relevant risk factors, and established clinical evidence.
Pretest probability influences the meaning of a diagnostic result. A positive result does not carry the same clinical significance in every patient, and a negative result does not always provide sufficient reassurance.
When the probability of disease is sufficiently low, even a test with good sensitivity and specificity may produce more false-positive than true-positive findings, depending on its characteristics and the population being tested. These results can lead to additional investigations, unnecessary concern, and potentially avoidable interventions.
When clinical suspicion is substantial, a negative result may not reduce the probability of disease enough to safely conclude the evaluation.
The usefulness of an investigation therefore depends on more than its technical performance. Healthcare professionals need to consider whether testing is indicated, which investigation is most appropriate, and how the result is likely to change the clinical assessment.
Not every appropriate investigation will immediately change treatment. Some tests are needed to exclude serious conditions, establish a baseline, support monitoring, or clarify whether further evaluation is necessary. Their value should be judged according to their intended clinical purpose rather than a narrow expectation that every result must produce an immediate change in management.
The aim is to support sound clinical reasoning rather than replace professional judgment with a rigid rule applied to every patient.
Selecting Investigations According to Their Intended Purpose
Diagnostic investigations serve different purposes. Some are intended to detect or exclude disease, while others support screening, risk assessment, monitoring, or evaluation of response to treatment.
These purposes should not be confused.
A test that is useful for monitoring an established condition may not be appropriate for diagnosing that condition in someone without relevant clinical findings. Similarly, an investigation recommended for screening a defined population may not be the most suitable test for a patient presenting with symptoms.
Understanding the intended use is essential to selecting an appropriate investigation.
Healthcare professionals also need to consider test characteristics, including sensitivity, specificity, predictive values, and the circumstances in which the method was evaluated.
A test validated in a highly selected research population may perform differently in routine clinical practice. Differences in patient characteristics, disease prevalence, disease severity, specimen quality, and clinical setting can influence its usefulness. The supporting evidence should therefore be assessed in relation to the population and purpose for which the investigation is being considered.
This becomes particularly important with newer diagnostic technologies.
Molecular assays, biomarker panels, advanced imaging methods, and genetic investigations may provide valuable information. However, technical sophistication does not automatically establish clinical usefulness.
An investigation should be assessed not only for its ability to detect a biological characteristic or abnormality but also for whether that information can support an appropriate clinical decision.
Some diagnostic strategies involve an initial investigation followed by a more specific confirmatory test. Others may appropriately use a single investigation or a different sequence based on the clinical circumstances.
The choice depends on the clinical question, the limitations of available methods, and the implications of possible findings.
Diagnostic stewardship does not require every patient to undergo the same sequence of investigations. It encourages evidence-informed strategies that are appropriate to the individual clinical situation.
Reliable Results Begin Before Testing
Even when the appropriate investigation has been selected, the reliability of the result depends on what happens before the analysis begins.
In laboratory medicine, the pre-analytical phase includes patient identification, specimen collection, labeling, handling, transport, and preparation. Problems during this phase can compromise the usefulness of a result regardless of how accurately the laboratory instrument performs the analysis.
A specimen assigned to the wrong patient, collected into an unsuitable container, contaminated during collection, or transported under inappropriate conditions may produce misleading information or require the investigation to be repeated.
The CDC's Total Testing Process framework recognizes that reliable laboratory testing begins with the clinical question and extends through test selection, specimen collection, analysis, interpretation, and subsequent clinical decisions.
Diagnostic stewardship therefore involves more than the act of ordering an investigation.
For example, microbiological testing may be affected by contamination during specimen collection. An organism detected in a sample may reflect contamination or colonization rather than the cause of the patient's illness. Without adequate specimen quality and clinical context, a technically accurate laboratory result may still be difficult to interpret correctly.
The analytical phase is equally important. Laboratories need suitable quality management arrangements, appropriate testing methods, competent personnel, equipment maintenance, and relevant quality assessment activities in accordance with applicable requirements.
However, laboratory quality management and diagnostic stewardship should not be treated as identical concepts.
Laboratory quality management focuses on the reliability and quality of the testing process, including compliance with applicable technical requirements. Diagnostic stewardship additionally examines whether the investigation was clinically appropriate and whether its findings are being used meaningfully.
A laboratory can perform an unnecessary test accurately. Conversely, an appropriately indicated test may provide unreliable information if specimen quality or analytical performance is inadequate.
Both clinical appropriateness and technical reliability are necessary for diagnostic excellence.
Interpreting Results in Their Clinical Context
A diagnostic result does not interpret itself. Its meaning depends on the patient's clinical presentation, the reason for testing, the method used, and the limitations of the available evidence.
A result outside a laboratory reference interval does not necessarily establish the presence of disease. Reference intervals generally describe the distribution of results in an appropriately defined reference population. They should be distinguished from clinical decision limits, which are thresholds used to support specific diagnostic or management decisions.
Similarly, a result within a reference interval does not always exclude a clinically important condition.
Interpretation may depend on age, pregnancy, underlying illnesses, medications, specimen timing, and other patient-specific circumstances. In some situations, changes over time are more informative than a single measurement.
Healthcare professionals also need to distinguish between an analytical finding and its clinical significance.
A molecular assay may detect genetic material from a microorganism without establishing that the organism is responsible for active infection. An imaging examination may identify an abnormality unrelated to the symptoms that prompted the investigation.
These findings may still deserve attention, but their meaning requires appropriate clinical assessment.
False-positive and false-negative results introduce further uncertainty. Even reliable diagnostic methods have limitations, and their interpretation depends partly on the probability of disease before testing.
A positive finding in a person with a very low likelihood of disease may warrant a different interpretation from the same finding in a patient with strong clinical evidence of the condition.
The central question is not simply whether a result is positive, negative, normal, or abnormal. It is whether the information supports a clinically justified conclusion.
Diagnostic stewardship encourages cooperation between healthcare professionals requesting investigations and the specialists responsible for providing diagnostic services.
Laboratory physicians, clinical chemists, microbiologists, radiologists, pathologists, and other diagnostic specialists can provide expertise on test performance, limitations, unexpected findings, and the need for further clarification.
Such collaboration is particularly valuable when diagnostic information is complex or when test results and clinical findings appear inconsistent. It can help prevent both unnecessary escalation and inappropriate reassurance.
Balancing Overtesting, Undertesting, and Overdiagnosis
Inappropriate testing can occur in two directions.
Overtesting involves investigations whose expected clinical benefit is insufficient to justify their use. Undertesting occurs when a clinically necessary investigation is omitted or delayed in circumstances where it could reasonably support appropriate care.
Both can affect patient safety.
Unnecessary investigations may produce incidental findings, false-positive results, additional procedures, anxiety, financial costs, and avoidable exposure to procedural risks.
Repeated testing may also consume resources without improving clinical decision-making. However, repeat testing is not inherently inappropriate. Serial measurements may be necessary when a patient's condition changes, when disease evolves, or when interpretation depends on trends over time.
A repeated investigation should be considered potentially low-value only when its expected contribution does not justify its use in the circumstances.
Undertesting presents a different concern. A necessary investigation may not be performed because of limited access, uncertainty about the indication, delays in service availability, or an overly restrictive testing policy.
A program designed to reduce unnecessary testing must avoid creating barriers to investigations that are clinically justified. This is particularly important for time-sensitive conditions, where delayed access to appropriate diagnostic services can affect patient outcomes.
The risks associated with overtesting should also be distinguished from overdiagnosis.
Overdiagnosis can occur when a genuine condition is detected that would not have caused symptoms or harm during the person's lifetime. It can also arise from expanding disease definitions in ways that classify people as having conditions without sufficient corresponding clinical benefit. It is not the same as a false-positive result, in which an investigation incorrectly indicates the presence of a condition.
Unnecessary testing may contribute to overdiagnosis, but the two concepts are not interchangeable.
Similarly, a reduction in the number of diagnosed conditions does not automatically demonstrate improvement. It might reflect less overdiagnosis, but it could also indicate that clinically important conditions are being missed.
This distinction matters when evaluating testing policies.
Reducing investigation volume or expenditure may have operational benefits, but those reductions should not be regarded as evidence of better diagnostic care without considering clinical appropriateness, access to necessary investigations, and potential patient safety consequences.
The objective is neither maximum testing nor minimum testing. It is testing that is proportionate to clinical need.
Diagnostic Imaging Requires Appropriate Selection and Interpretation
Diagnostic stewardship is not limited to laboratory medicine.
Diagnostic imaging involves decisions about whether imaging is necessary, which modality is appropriate, when it should be performed, and how the expected clinical benefit compares with potential risks.
Ultrasound, radiography, computed tomography, magnetic resonance imaging, and other imaging methods provide different types of information. Their usefulness depends on the clinical question, patient characteristics, availability, and the condition being investigated.
An examination that is appropriate in one clinical situation may provide little value in another.
Some imaging methods involve ionizing radiation, while others introduce different safety considerations, including contrast-agent risks, magnetic resonance safety requirements, contraindications, or difficulties related to patient tolerance.
The World Health Organization emphasizes justification and optimization of radiation protection in medical imaging involving ionizing radiation.
Justification concerns whether the expected benefit of an examination outweighs its associated risks. Optimization of radiation protection concerns obtaining diagnostically adequate information while keeping radiation exposure appropriately minimized for the clinical purpose.
These principles are particularly relevant when more than one imaging method could address the same clinical question. However, decisions about ultrasound or magnetic resonance imaging require consideration of their own benefits, limitations, and safety issues rather than application of radiation-dose principles intended for ionizing radiation.
Appropriateness also involves considering previous imaging information and avoiding unnecessary duplication.
Repeated imaging should not be restricted through an inflexible rule. A new examination may be justified when symptoms change, the previous investigation was inadequate, or new findings warrant reassessment.
Incidental findings present another stewardship challenge.
Modern imaging techniques can identify abnormalities unrelated to the clinical question being investigated. Some require further evaluation, while others may have little clinical significance.
Determining which findings warrant additional assessment requires professional judgment and consideration of the available evidence.
Unnecessary escalation may expose patients to additional procedures, costs, and anxiety. Dismissing a clinically important finding can create a different safety risk.
Radiologists and referring clinicians therefore have complementary roles in supporting appropriate imaging decisions.
Evidence-based imaging referral criteria can assist with modality selection and help reduce inappropriate investigations. Their application, however, should reflect the patient's circumstances, clinical indications, and relevant professional standards.
The goal is to support appropriate access to necessary imaging while reducing examinations unlikely to improve care.
Microbiology Demonstrates the Importance of Clinical Context
Clinical microbiology provides some of the clearest examples of diagnostic stewardship in practice.
Tests for suspected infection can generate essential information about microorganisms, antimicrobial susceptibility, and other findings relevant to diagnosis and treatment. However, detecting a microorganism does not always establish that it is responsible for a patient's illness.
Some organisms may be present as colonizers, while others may appear because of specimen contamination. Molecular tests may detect microbial genetic material without necessarily demonstrating active infection.
The significance of a result depends on symptoms, examination findings, specimen quality, the method used, and the broader clinical context.
The Society for Healthcare Epidemiology of America's 2023 guidance addresses these challenges through a coordinated approach to ordering, collecting, processing, reporting, and interpreting microbiological investigations.
The CDC's 2026 diagnostic excellence framework also identifies microbiological testing as an important area for stewardship improvement. Its examples include urine cultures, blood cultures, respiratory cultures, Clostridioides difficile testing, and multiplex molecular diagnostic panels.
These examples illustrate why appropriate test selection and interpretation matter.
A microbiological investigation requested without a suitable indication may produce a positive finding that is difficult to interpret and could contribute to unnecessary antimicrobial treatment.
Conversely, failure to perform an indicated investigation may delay recognition of an important infection or limit the information available to guide subsequent care.
Specimen quality is equally relevant. Contamination can make results misleading, while inappropriate collection or processing can compromise the usefulness of an otherwise suitable investigation.
The WHO Western Pacific manual published in June 2026 provides a practical regional perspective on these issues. It emphasizes appropriate test selection, specimen quality, interpretation, and the use of diagnostic information to support better management of bacterial infections and antimicrobial resistance.
Diagnostic stewardship and antimicrobial stewardship are closely connected, but they are not identical.
Diagnostic stewardship concerns the appropriate use of investigations and diagnostic information. Antimicrobial stewardship concerns the appropriate use of antimicrobial medicines. Reliable diagnostic information can support antimicrobial decisions, but the two approaches have different primary objectives and responsibilities.
The timing of investigations also requires clinical judgment. When microbiological samples are clinically indicated, timely collection may improve their diagnostic usefulness.
However, diagnostic stewardship should not be used as a justification for delaying urgent, clinically indicated treatment while awaiting test results.
The broader lesson is that microbiological information becomes most valuable when it is obtained appropriately, interpreted in context, and used to support sound clinical decisions.
New Diagnostic Technologies Need Evidence of Clinical Value
Healthcare organizations increasingly encounter new molecular assays, biomarker panels, genetic investigations, advanced imaging methods, and other diagnostic technologies.
These innovations may improve diagnostic capabilities or provide information that was previously unavailable. Nevertheless, introducing a new diagnostic investigation requires more than demonstrating technical performance.
For many new biomarkers, molecular assays, and related technologies, three concepts are particularly important: analytical validity, clinical validity, and clinical utility.
Analytical validity concerns whether the method reliably measures or detects what it is intended to measure or detect.
Clinical validity concerns whether the finding is meaningfully associated with the condition or clinical characteristic being investigated in the intended population.
Clinical utility concerns whether using the information can improve clinically relevant decisions or outcomes.
A test may demonstrate strong analytical performance without sufficient evidence that its use will improve patient care in routine practice.
Healthcare organizations should therefore consider the supporting evidence, intended population, clinical indications, limitations, resource requirements, and consequences for subsequent care before introducing new investigations.
This includes assessing whether healthcare professionals have the necessary expertise to request the test appropriately, interpret the findings, and explain their significance.
Tests developed or evaluated in other populations may also require further assessment before their performance and clinical usefulness can be assumed to apply in Viet Nam.
Clinical utility may depend on factors beyond the test itself, including the availability of confirmatory investigations, specialist services, and appropriate management options.
A test that identifies a clinically relevant condition may have limited practical value if the organization cannot establish a suitable way to use that information in patient care.
New diagnostic technologies should therefore complement professional judgment and established quality management processes rather than bypass them.
Their adoption should be guided by credible evidence of benefit and suitability for the intended setting, not simply by novelty, technical complexity, or commercial availability.
Helping Patients Understand the Purpose of Testing
Diagnostic stewardship also has an important patient-centered dimension.
Patients may understandably believe that more investigations will provide greater certainty. Some may feel reassured when several tests are performed, while others may be concerned when a healthcare professional recommends observation or reassessment without immediate additional investigations.
These expectations deserve respectful discussion.
Healthcare professionals should explain why an investigation is recommended, what information it may provide, and how the possible results could influence care.
When testing is not clinically indicated, patients may benefit from understanding why its expected value is limited and what circumstances could justify reassessment.
Communication is particularly important when an investigation may produce uncertain findings or lead to further procedures. Relevant risks, limitations, and alternatives should be discussed according to the clinical circumstances and applicable consent requirements.
Financial considerations may also affect access to testing, especially when investigations involve substantial out-of-pocket expenses or require travel to another healthcare facility.
However, financial cost should not be the sole measure of diagnostic value. An expensive investigation may be necessary and appropriate, while a low-cost test may still provide little meaningful benefit.
Patient preferences and circumstances should be considered alongside clinical evidence and professional judgment.
Shared decision-making does not mean that every requested investigation must be performed. Nor does it mean that a clinically necessary test can always be omitted without potential consequences.
It involves helping patients understand reasonable options and participate in decisions while maintaining appropriate professional responsibilities.
Patient-centered diagnostic stewardship should support informed choices without creating unnecessary fear about testing or discouraging patients from seeking necessary medical evaluation.
Applying Diagnostic Stewardship in Viet Nam
The practical application of diagnostic stewardship in Viet Nam needs to reflect differences in healthcare settings, clinical capabilities, workforce arrangements, and access to diagnostic services.
Large hospitals may operate specialized laboratories, advanced imaging departments, electronic medical records, and multidisciplinary clinical teams. Smaller healthcare facilities may depend on external diagnostic providers or have limited access to specialist consultation.
These differences influence both testing decisions and the interventions that can be implemented.
A large hospital may have opportunities to review frequently requested laboratory panels, repeated investigations, or the use of expensive diagnostic procedures. A smaller facility may need to prioritize access to essential investigations, reliable specimen collection, appropriate referral arrangements, and support for interpreting results.
In both settings, the objective should remain clinical appropriateness rather than simply reducing utilization.
The WHO Western Pacific manual provides a useful resource for facility-level discussions, particularly in microbiology and infectious diseases. Its practical orientation may be valuable where diagnostic capabilities and resources vary.
However, the manual should not be treated as a comprehensive standard for all diagnostic laboratory services, imaging, pathology, or other specialist investigations.
The application of international guidance also needs to consider local clinical practices, professional competencies, patient needs, and the regulatory framework governing healthcare services in Viet Nam.
Testing restrictions or utilization targets developed in another country should not be adopted automatically without assessing their suitability.
A policy that works in a highly specialized hospital may be inappropriate in a smaller facility with different diagnostic and referral capabilities.
Differences in data quality, reimbursement arrangements, access to specialist care, and the availability of investigations may also influence what constitutes a practical stewardship intervention.
The objective is to adapt evidence-informed principles to the realities of local healthcare delivery rather than reproduce international models without sufficient evaluation.
Governance, Collaboration, and Responsible Implementation
Diagnostic stewardship depends on cooperation between clinicians, diagnostic specialists, and healthcare leaders.
Laboratory professionals may identify repeated investigations that appear to provide limited additional value, while treating clinicians can explain whether changes in the patient's condition justified the testing.
Radiologists may identify opportunities to improve imaging selection, while referring clinicians can clarify the clinical questions and operational circumstances influencing their requests.
Microbiologists may recognize testing patterns associated with contamination or difficult-to-interpret findings, while clinical and antimicrobial stewardship teams can contribute expertise on how those results influence care.
These perspectives are most useful when brought together through constructive professional discussion.
Healthcare leaders should establish clear arrangements for identifying stewardship priorities, reviewing proposed interventions, assigning responsibilities, and evaluating their effects.
A practical starting point may be a specific testing practice where inappropriate use, inadequate access, or unreliable interpretation could affect patient safety.
The organization can examine relevant evidence, review local utilization patterns, discuss representative clinical cases, and identify the factors influencing current practice.
Possible improvements may include clearer clinical indications, education on test limitations, changes to ordering processes, better specimen collection practices, or more accessible consultation with diagnostic specialists.
Interventions involving restrictions should be introduced cautiously.
An electronic ordering barrier or mandatory approval process may reduce unnecessary requests, but it could also delay a necessary investigation if the policy is poorly designed.
Appropriately justified exceptions and timely access to necessary testing should remain part of the intervention design.
Evaluation should examine whether an intervention improved clinical appropriateness, not simply whether fewer investigations were performed.
A reduction in test volume may reflect less unnecessary testing. It may also result from restricted access, delayed care, or unmet diagnostic needs.
For this reason, organizations should consider relevant measures of clinical appropriateness, access, quality, and potential unintended consequences.
The choice of measures should reflect the specific intervention, available data, and clinical setting. No single indicator can establish the overall quality of diagnostic stewardship across every healthcare service.
Recent international research also offers useful perspectives on the organizational value of stewardship.
In September 2026, researchers associated with the Society for Healthcare Epidemiology of America published A Business Case for Diagnostic Stewardship: A Practical Guide from the Society for Healthcare Epidemiology of America (SHEA) Diagnostic Stewardship Special Interest Group.
The analysis examined five commonly targeted diagnostic stewardship interventions and estimated their potential financial and operational effects using assumptions for a representative 200-bed community hospital in the United States.
The findings illustrate how more appropriate microbiological testing and related diagnostic practices may reduce unnecessary laboratory activity and associated healthcare costs while supporting selected hospital quality objectives.
However, the estimates are modeled rather than guaranteed savings observed in every hospital. They depend on assumptions about U.S. healthcare operations, costs, reimbursement arrangements, and baseline performance.
They should not be applied directly to healthcare organizations in Viet Nam without institution-specific evaluation.
Financial efficiency may be a valuable consequence of stewardship, but the primary objective should remain safer and more appropriate diagnostic care.
A well-governed program should support evidence-informed decisions while preserving appropriate professional judgment and access to necessary investigations.
Legal and Professional Considerations in Viet Nam
Diagnostic stewardship activities must operate within the legal and professional framework governing healthcare services in Viet Nam.
The Law on Medical Examination and Treatment No. 15/2023/QH15 and Decree No. 96/2023/ND-CP provide important provisions concerning healthcare practice, professional responsibilities, licensing, and the organization of medical examination and treatment services.
Healthcare organizations considering changes to diagnostic services should ensure that the activities remain within their authorized professional scope, permitted technical capabilities, and applicable professional requirements.
Laboratory quality management is also governed by specific Ministry of Health regulations.
Circular No. 01/2013/TT-BYT provides guidance on implementing laboratory quality management in healthcare facilities.
Circular No. 25/2026/TT-BYT, issued on June 30, 2026, and generally effective from August 15, 2026, amends provisions of Circular No. 01/2013/TT-BYT and other healthcare regulations, including Circular No. 32/2023/TT-BYT and Circular No. 23/2024/TT-BYT. Certain provisions concerning the latter two circulars took effect earlier, on July 1, 2026.
In relation to laboratory quality management, Circular No. 25/2026/TT-BYT revises Clause 5 of Article 5 of Circular No. 01/2013/TT-BYT. The amended provision encourages healthcare facilities to participate in specialty-specific external quality assessment programs in accordance with the Ministry of Health's arrangements for laboratory quality assurance, as well as internationally recognized external quality assessment programs.
This amendment concerns laboratory quality management and external quality assessment. It does not establish a general legal requirement for every healthcare organization to implement a diagnostic stewardship program based on an international model.
Other applicable legal, professional, or institutional requirements concerning laboratory quality must still be considered independently.
Similarly, diagnostic stewardship recommendations developed by WHO, CDC, SHEA, or other international organizations do not replace Vietnamese legislation, Ministry of Health regulations, or applicable professional and technical standards.
Healthcare organizations introducing new testing policies, modifying diagnostic procedures, or adopting new technologies should assess the implications for professional responsibilities, patient safety, and regulatory compliance.
Particular care is needed when interventions could restrict access to investigations that healthcare professionals consider clinically necessary.
The use of patient-level diagnostic information for utilization review, quality improvement, or research also requires attention to confidentiality and personal data protection.
Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/ND-CP, both effective January 1, 2026, form part of the applicable legal framework for personal data processing, including health-related information.
Healthcare organizations should assess the legal basis and purposes of data processing, access permissions, security safeguards, retention requirements, and other relevant obligations.
The use of aggregated or appropriately de-identified information may reduce privacy risks, but it does not automatically eliminate all legal obligations, particularly where individuals may still be identifiable.
Additional ethical or regulatory requirements may apply when activities constitute research or involve sharing information with external organizations.
International evidence should be used to inform professional judgment and organizational improvement, not to create the impression that a particular international recommendation has automatically become a binding Vietnamese standard.
Building a More Balanced Approach to Diagnostic Testing
Diagnostic stewardship offers healthcare organizations a way to improve diagnostic care without assuming that more testing is always better or that fewer investigations necessarily indicate higher quality.
Its value lies in connecting clinical questions with appropriate investigations, reliable test performance, meaningful interpretation, and decisions that reflect the patient's circumstances.
Unnecessary testing may expose patients to false-positive findings, incidental abnormalities, avoidable procedures, and financial burdens. Insufficient or delayed testing may leave important clinical questions unanswered and postpone necessary care.
Poor specimen quality, inappropriate methods, or misinterpretation can undermine the usefulness of an investigation even when it was appropriately requested.
These risks cannot be addressed through restrictions on testing alone.
Healthcare organizations need clinical expertise, reliable diagnostic services, multidisciplinary cooperation, and a willingness to examine how testing decisions are made in everyday practice.
The international guidance available in 2026 provides an increasingly useful foundation for this work. The CDC's diagnostic excellence framework places diagnostic stewardship alongside improvements to diagnostic systems and learning from safety events. The WHO Western Pacific manual offers practical direction for strengthening microbiological diagnosis and supporting the response to antimicrobial resistance.
For healthcare organizations in Viet Nam, the opportunity is to adapt these principles to different healthcare settings, with attention to clinical priorities, available resources, professional responsibilities, and patient safety.
Diagnostic stewardship is not about performing the fewest tests. It is about making better decisions about when to test, which investigation to use, how to interpret the findings, and what that information means for the patient's care.
A high-quality diagnostic system needs both appropriate access to necessary investigations and the professional judgment to avoid testing unlikely to improve care.
Strengthening that balance is an important part of advancing diagnostic quality, safety, and excellence in Viet Nam.
Evidence and Policy Context
This article draws on international evidence and professional guidance, including the World Health Organization's World Patient Safety Day 2024 materials on improving diagnosis for patient safety; the U.S. Centers for Disease Control and Prevention's Diagnostic Excellence Initiative and Core Elements of Hospital Diagnostic Excellence (2026); the Society for Healthcare Epidemiology of America's Principles of Diagnostic Stewardship: A Practical Guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force (2023); and the WHO Regional Office for the Western Pacific's Strengthening Clinical Diagnostic Stewardship in the Western Pacific Region: A Practical Manual (2026).
The discussion also considers WHO guidance on justification and optimization of radiation protection in medical imaging, the scientific literature on diagnostic test selection and interpretation, and the September 2026 publication A Business Case for Diagnostic Stewardship: A Practical Guide from the Society for Healthcare Epidemiology of America (SHEA) Diagnostic Stewardship Special Interest Group.
These materials provide evidence and practical perspectives on clinical appropriateness, analytical quality, clinical validity, clinical utility, overtesting, undertesting, and the safe use of diagnostic information. Their scope and strength of evidence differ, and findings from specific populations or healthcare systems should not be assumed to apply directly to Viet Nam.
The Vietnamese legal context includes the Law on Medical Examination and Treatment No. 15/2023/QH15; Decree No. 96/2023/ND-CP; Circular No. 01/2013/TT-BYT on laboratory quality management, as amended; Circular No. 25/2026/TT-BYT; the Law on Personal Data Protection No. 91/2025/QH15; and Decree No. 356/2025/ND-CP.
International diagnostic stewardship frameworks are presented as sources of evidence-informed improvement principles. They should not be interpreted as mandatory Vietnamese diagnostic protocols, universal test-ordering restrictions, or substitutes for applicable laws, professional standards, and institutional responsibilities.
Professional Scope and Disclaimer
This article is published by Diagnostic Excellence Vietnam (DxEx.vn) for professional education, knowledge-sharing, and general information. It examines diagnostic stewardship from the perspectives of diagnostic quality, patient safety, clinical appropriateness, governance, risk management, and systems-based improvement.
The content does not constitute individualized medical advice, clinical diagnosis, treatment recommendations, test-ordering instructions for individual patients, legal advice, or a legally binding interpretation of Vietnamese regulations. Diagnostic Excellence Vietnam (DxEx.vn) is not a healthcare provider, regulatory authority, or accreditation or certification body.
Decisions concerning diagnostic testing, clinical interpretation, treatment, professional practice, and organizational implementation remain the responsibility of appropriately qualified healthcare professionals and authorized healthcare organizations, subject to applicable Vietnamese laws, professional standards, institutional requirements, and individual patient circumstances.