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  • Factors influencing variation in investigations after a negative CT brain scan in suspected subarachnoid haemorrhage: a qualitative study

    Author(s)
    Chu, Kevin
    Windsor, Carol
    Fox, Jennifer
    Howell, Tegwen
    Keijzers, Gerben
    Eley, Robert
    Kinnear, Frances
    Furyk, Jeremy
    Thom, Ogilvie
    Brown, Nathan J
    Brown, Anthony FT
    Griffith University Author(s)
    Keijzers, Gerben
    Thom, Ogilvie
    Year published
    2019
    Metadata
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    Abstract
    Introduction Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians’ decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH. Methods We conducted an interview-based qualitative study informed by social constructionist theory. Fifteen emergency physicians from six EDs across Queensland, Australia, underwent individual face-to-face or telephone interviews. Content analysis was performed whereby transcripts were examined ...
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    Introduction Variation in the approach to the patient with a possible subarachnoid haemorrhage (SAH) has been previously documented. The purpose of this study was to identify factors that influence emergency physicians’ decisions about diagnostic testing after a normal CT brain scan for ED patients with a headache suspicious of a SAH. Methods We conducted an interview-based qualitative study informed by social constructionist theory. Fifteen emergency physicians from six EDs across Queensland, Australia, underwent individual face-to-face or telephone interviews. Content analysis was performed whereby transcripts were examined and coded independently by two co-investigators, who then jointly agreed on the influencing factors. Results Six categories of influencing factors were identified. Patient interaction was at the forefront of the identified factors. This shared decision-making process incorporated ‘what the patient wants’ but may be biased by how the clinician communicates the benefits and harms of the diagnostic options to the patient. Patient risk profile, practice evidence and guidelines were also important. Other influencing factors included experiential factors of the clinician, consultation with colleagues and external influences where practice location and work processes impose constraints on test ordering external to the preferences of the clinician or patient. The six categories were organised within a conceptual framework comprising four components: the context, the evidence, the experience and the decision. Conclusions When clinicians are faced with a diagnostic challenge, such as the workup of a patient with suspected SAH, there are a number of influencing factors that can result in a variation in approach. These need to be considered in approaches to improve the appropriateness and consistency of medical care.
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    Journal Title
    EMERGENCY MEDICINE JOURNAL
    Volume
    36
    Issue
    2
    DOI
    https://doi.org/10.1136/emermed-2018-207876
    Subject
    Clinical sciences
    Nursing
    Health services and systems
    Public health
    Publication URI
    http://hdl.handle.net/10072/384314
    Collection
    • Journal articles

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