Projects per year
Abstract
Introduction: Up to one-third of laboratory tests ordered in the ED for adults presenting with undifferentiated chest pain are generally not indicated by current Australian guidelines. This study set out to undertake a qualitative investigation of clinician perceptions to identify the reasons for variations in pathology requesting.
Methods: For this study, we draw on data from semistructured interviews (n=38) conducted in the EDs and laboratories across three hospitals as part of a larger study on the test result management process from test request to result follow-up. Thematic analysis was conducted to determine what aspects of the clinical routines and environment might contribute to variations in pathology requesting. Informed by the findings from the analysis, targeted questions were developed and further focus groups (n=5) were held with clinicians, hospital management and electronic medical record (eMR) analysts to investigate in more detail the reasons for requesting outside of guidelines.
Results: Participants cited four main reasons for ordering outside of guidelines. Clinicians requested tests outside of guidelines and the ED scope of practice to facilitate the patient journey along the broader continuum of care, including admission to hospital or transfer to another site. Clinicians were also faced with multiple and inconsistent guidelines regarding appropriate test selection. Limited access to in-house specialty and diagnostic services also influenced ordering patterns in smaller non-referral hospitals. Finally, certain features of the current electronic ordering framework within the eMR facilitated overordering and failed to impose any real restrictions on ordering inappropriately or outside of scope of practice.
Conclusion: Beyond the standardisation of pathology requesting advice across electronic decision support, order sets and guidelines, attempts to address issues related to the appropriateness and variation of laboratory test ordering should consider local and systemic factors which also shape the ordering process.
Original language | English |
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Pages (from-to) | 820-824 |
Number of pages | 5 |
Journal | Emergency Medicine Journal |
Volume | 38 |
Issue number | 11 |
Early online date | 2 Sept 2021 |
DOIs | |
Publication status | Published - 1 Nov 2021 |
Keywords
- chest
- clinical assessment
- emergency department
- guidelines
- qualitative research
Fingerprint
Dive into the research topics of 'Why is there variation in test ordering practices for patients presenting to the emergency department with undifferentiated chest pain? A qualitative study'. Together they form a unique fingerprint.Projects
- 1 Finished
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Delivering safe and effective test result communication, management and follow-up
Georgiou, A., Westbrook, J., Greenfield, D., Horvath, A., Wakefield, D., Li, L. & Hillman, K.
1/12/15 → 30/11/21
Project: Research
Activities
- 1 Invited talk
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Diagnostic informatics
Andrew Georgiou (Speaker)
19 Jun 2020Activity: Talk or presentation › Invited talk
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Identifying the mechanisms that contribute to safe and effective electronic test result management systems: a multisite qualitative study
Georgiou, A., Li, J., Thomas, J. & Dahm, M. R., Jan 2022, In: Journal of the American Medical Informatics Association. 29, 1, p. 89-96 8 p.Research output: Contribution to journal › Article › peer-review
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Can patients contribute to enhancing the safety and effectiveness of test-result follow-up? Qualitative outcomes from a health consumer workshop
Thomas, J., Dahm, M. R., Li, J. & Georgiou, A., Apr 2021, In: Health Expectations. 24, 2, p. 222-233 12 p.Research output: Contribution to journal › Article › peer-review
Open AccessFile3 Citations (Scopus)60 Downloads (Pure) -
Diagnostic informatics: the role of digital health in diagnostic stewardship and the achievement of excellence, safety, and value
Georgiou, A., Li, J., Hardie, R-A., Wabe, N., Horvath, A. R., Post, J. J., Eigenstetter, A., Lindeman, R., Lam, Q., Badrick, T. & Pearce, C. M., 10 Jun 2021, In: Frontiers in Digital Health. 3, p. 1-5 5 p., 659652.Research output: Contribution to journal › Article › peer-review
Open AccessFile8 Citations (Scopus)131 Downloads (Pure)