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dc.contributor.authorChu, Kevin
dc.contributor.authorWindsor, Carol
dc.contributor.authorFox, Jennifer
dc.contributor.authorHowell, Tegwen
dc.contributor.authorKeijzers, Gerben
dc.contributor.authorEley, Robert
dc.contributor.authorKinnear, Frances
dc.contributor.authorFuryk, Jeremy
dc.contributor.authorThom, Ogilvie
dc.contributor.authorBrown, Nathan J
dc.contributor.authorBrown, Anthony FT
dc.date.accessioned2019-07-04T12:33:37Z
dc.date.available2019-07-04T12:33:37Z
dc.date.issued2019
dc.identifier.issn1472-0205
dc.identifier.doi10.1136/emermed-2018-207876
dc.identifier.urihttp://hdl.handle.net/10072/384314
dc.description.abstractIntroduction 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.
dc.description.peerreviewedYes
dc.languageEnglish
dc.publisherBMJ PUBLISHING GROUP
dc.relation.ispartofpagefrom72
dc.relation.ispartofpageto+
dc.relation.ispartofissue2
dc.relation.ispartofjournalEMERGENCY MEDICINE JOURNAL
dc.relation.ispartofvolume36
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchNursing
dc.subject.fieldofresearchPublic Health and Health Services
dc.subject.fieldofresearchcode1103
dc.subject.fieldofresearchcode1110
dc.subject.fieldofresearchcode1117
dc.titleFactors influencing variation in investigations after a negative CT brain scan in suspected subarachnoid haemorrhage: a qualitative study
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.hasfulltextNo Full Text
gro.griffith.authorKeijzers, Gerben


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