Abstract
Abstract
Objective:
To investigate clinicians’ rationale for low-value ordering of urine cultures (UC).
Design:
Qualitative descriptive study.
Setting:
A public tertiary acute hospital in New Zealand.
Participants:
Doctors and nurses working in the Emergency Department, General Medicine, and General Surgery.
Methods:
In-depth structured interviews were conducted with 18 doctors and 8 nurses. We analyzed the data using inductive thematic analysis focused on exploring the behavioral and psycho-socio-cultural influences behind ordering of low-value UC.
Results:
We generated four main themes encompassing patient and non-patient factors behind low-value testing. (1)
In the grey zone:
described patient presentations which were considered clinically ambiguous, such as undifferentiated infectious symptoms, delirium, communication challenges, and catheters. (2)
The pressure to act:
illustrated how the fear of uncertainty and expectations of patients and families, colleagues, healthcare systems, and hierarchies impacted clinician decision-making and defensive testing practices. (3)
It depends on who you talk to:
highlighted how inconsistent knowledge, communication, and perceptions of harm between individuals, services, and professions contributed to unnecessary tests. And (4)
It’s just how we do things here:
reflected dogma and inertia behind institutional conditions and a culture of over-testing. An additional theme, (5)
Solutions to change the culture
, explored participants ideas to improve UC ordering behaviors.
Conclusion:
Diagnostic stewardship interventions to reduce low-value UC requests must address the multiple, often compounding, patient and non-patient factors that influence clinicians’ behavior.