Objective

The aim of the study was to understand the drivers of low-value diagnostic tests (LVDT) in regional Australian Emergency Medicine (EM) practice to inform de-implementation. 

 

Methods 

A qualitative descriptive study was conducted at Townsville University Hospital Emergency Department. Purposive sampling was used to recruit emergency clinicians as participants. Semi-structured, face-to-face interviews were used to collect data between February 2023 and May 2023. Interviews were audio-recorded and transcribed verbatim. N-Vivo assisted data analysis. Data was analysed through line-by-line and axial coding. Codes were assigned to categories, subthemes, and themes. Themes were further analysed using the behavioural domains of the Theoretical Domains Framework (TDF). Trustworthiness was ensured through reflexivity, data triangulation, thick description, audit trail and member checking.  

 

Results

Twenty-four interviews were conducted between February 2023 and May 2023. Participants had a breadth of EM experience with 19 Emergency Physicians and 5 EM trainees. LVDT were inherently understood and unanimously acknowledged by participants. Six drivers of LVDT emerged: Efficiency, Culture, Resources, Complexity, Consequences and Abilities. Drivers exerted influence at systemic and individual levels by hindering(barriers) or facilitating (enablers) de-implementation. Drivers mapped to 14 behavioural domains of the TDF including environmental resources and context (resources, complexity, efficiency), social influences(culture), belief about consequences(consequences), and beliefs about capabilities(abilities). 

 

Conclusion:

An interconnected web of systemic and individual drivers is influencing emergency clinician behaviour to perform LVDT. De-implementation of LVDT will require behavioural change through contemporaneous navigation of multilevel drivers. Evidence-based, behavioural change theory-informed, co-designed interventions are needed to address the drivers of LVDT.