Tuxen-Vu Joseph, O'Reilly Gerard, Morphet Julia, Jones Peter, Egerton-Warburton Diana, Wong Anselm, Cameron Peter, Shetty Amith, Craig Simon
Department of Emergency Medicine, Monash Health, Clayton, Victoria, Australia.
School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Emerg Med Australas. 2025 Aug;37(4):e70108. doi: 10.1111/1742-6723.70108.
Quality improvement activities targeting low-value care are important to ensure that scarce healthcare resources are used responsibly. However, there has been little systematic research into what diagnostic testing is considered by emergency department (ED) clinicians to be at risk of unwarranted variation or potentially low value.
This study aimed to determine the views of ED clinicians on which diagnostic tests are highest risk for variation and/or low-value care.
A voluntary electronic survey was distributed to emergency clinicians across Australia and Aotearoa New Zealand. Respondents were asked to identify which investigations were high risk for unwarranted variation and/or low value.
There were 184 responses (75 doctors, 82 nurses, and 27 other) analysed. Investigations identified included D-dimer (42%), venous blood gas (VBG) (39%), C-reactive protein (CRP) (35%), and plain x-rays of the abdomen (35%). Compared to nursing staff, medical staff perceived CRP (51% vs. 24%), urine drug screening (55% vs. 21%), clotting profile (48% vs. 24%), salicylate level (29% vs. 7%), erythrocyte sedimentation rate (41% vs. 10%), and abdominal x-ray (67% vs. 16%) at higher risk. D-dimer and VBG were seen to be high risk by both groups. Routinely ordered tests (e.g., full blood examination) were considered relatively low risk.
Several commonly used investigations are perceived to be at high risk of unwarranted variation or low-value care. These risks are perceived differently by different groups of emergency clinicians. Potential future directions include understanding the reasons for variation and efforts to reduce variation, including audit and feedback.
针对低价值医疗的质量改进活动对于确保合理使用稀缺的医疗资源至关重要。然而，对于急诊科临床医生认为哪些诊断检查存在不必要的差异风险或潜在低价值，目前几乎没有系统的研究。
本研究旨在确定急诊科临床医生对哪些诊断检查存在差异和/或低价值医疗的最高风险的看法。
向澳大利亚和新西兰的急诊临床医生发放了一份自愿电子调查问卷。受访者被要求指出哪些检查存在不必要的差异和/或低价值的高风险。
共分析了184份回复（75名医生、82名护士和27名其他人员）。确定的检查包括D-二聚体（42%）、静脉血气（VBG）（39%）、C反应蛋白（CRP）（35%）和腹部平片（35%）。与护理人员相比，医务人员认为CRP（51%对24%）、尿液药物筛查（55%对21%）、凝血指标（48%对24%）、水杨酸盐水平（29%对7%）、红细胞沉降率（41%对10%）和腹部X线（67%对16%）的风险更高。两组都认为D-二聚体和VBG风险较高。常规开具的检查（如全血细胞检查）被认为风险相对较低。
几项常用检查被认为存在不必要的差异或低价值医疗的高风险。不同组别的急诊临床医生对这些风险的看法不同。未来潜在的方向包括了解差异的原因以及努力减少差异，包括审核和反馈。
