Stewardship Standards

Appropriate utilization of clinical laboratory services is important for patient care and requires institutional stewardship. Clinical laboratory stewardship programs are dedicated to improving the ordering, retrieval, and interpretation of appropriate laboratory tests. In addition, these programs focus on developing, maintaining, and improving systems to provide proper financial coverage for medically necessary testing. Overall, clinical laboratory stewardship programs help clinicians improve the quality of patient care while reducing costs to patients, hospitals, and health systems.

The Journal of Applied Laboratory Medicine, Transforming laboratory utilization into laboratory stewardship: Guidelines by the PLUGS® National Committee for Laboratory Stewardship.


National Committee for Laboratory Stewardship (NCLS)


Improve the quality and value of clinical care by establishing national standards for laboratory test utilization.


To promote and enable the highest standards of effective test utilization in every clinical setting.


This effort is led by a multi-institutional committee interested in promoting and formalizing laboratory stewardship:

  • Michael Astion – Seattle Children’s Hospital
  • Robert Carpenter – ARUP Laboratories
  • Jane Dickerson – Seattle Children’s Hospital
  • Andrew Fletcher – ARUP Laboratories
  • Joaquin Garcia – Mayo Medical Laboratories
  • Brian Jackson – ARUP Laboratories
  • Lee Schroeder – University of Michigan
  • Gary Procop – Cleveland Clinic
  • Ila Singh – Texas Children’s Hospital

Four basic elements of laboratory stewardship programs

The Committee has summarized the core elements of successful hospital-based clinical laboratory stewardship programs. These elements are also helpful for independent commercial clinical laboratories.

  1. Governance
  2. Interventions
  3. Data extraction and monitoring
  4. Review and Improve

We are distributing a checklist to help programs identify areas for improvement, advocate for resources, and gain visibility. The following brief survey is intended to provide feedback on the usability of the checklist so that we can improve it. When you open the survey, you will find instructions to complete the checklist and the survey.