TY - JOUR T1 - Why is there variation in test ordering practices for patients presenting to the emergency department with undifferentiated chest pain? A qualitative study JF - Emergency Medicine Journal JO - Emerg Med J DO - 10.1136/emermed-2020-211075 SP - emermed-2020-211075 AU - Julie Li AU - Maria R Dahm AU - Judith Thomas AU - Nasir Wabe AU - Peter Smith AU - Andrew Georgiou Y1 - 2021/09/02 UR - http://emj.bmj.com/content/early/2021/09/02/emermed-2020-211075.abstract N2 - 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.No data are available. ER -