ArticleEmergency medicine journal : EMJ2025
Drivers of low-value diagnostic tests in emergency medicine practice: a qualitative descriptive study.
Article in Emergency medicine journal : EMJ, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Co-Design of a Theory-Informed, Multicomponent, Intervention for Diagnostic Stewardship in a Major-Referral Emergency Department: A Qualitative Descriptive Study.Emergency medicine Australasia : EMA · 2026Article
- 'Communication Is Crucial': A Qualitative Study of Patient Expectations of Diagnostic Tests in Emergency Medicine Practice.Health expectations : an international journal of public participation in health care and health policy · 2026Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionLow-value diagnostic tests harm patients and healthcare systems. Elucidation of determinants of low-value tests is essential for their de-implementation. The aim of this study was to understand the drivers of low-value tests in emergency medicine (EM) practice.
methodsA qualitative descriptive study was conducted at an Australian academic ED. Purposive sampling was used to recruit participants. Semistructured interviews were used to collect data between February 2023 and May 2023. Interviews were audio-recorded, transcribed verbatim and uploaded to NVivo. Data were thematically analysed through line-by-line and axial coding. Codes were assigned to categories, subthemes and themes. Themes were further analysed using the behavioural domains of the Theoretical Domains Framework. Trustworthiness was ensured through reflexivity, data triangulation, thick description, audit trail and member checking.
resultsTwenty-four interviews were conducted with participants who had a breadth of EM experience: 19 senior EM doctors and 5 doctors in EM training. Low-value tests were inherently understood and unanimously acknowledged by participants. Six drivers of low-value tests emerged: efficiency, culture, resources, complexity, consequences and abilities. Drivers exerted influence at systemic and individual levels by hindering (barriers) or facilitating (enablers) de-implementation of low-value tests. Drivers mapped to the following behavioural domains of the Theoretical Domains Framework: environmental resources and context (resources, complexity, efficiency), social influences (culture), belief about consequences (consequences), and beliefs about capabilities (abilities).
conclusionAn interconnected web of systemic and individual drivers is influencing emergency doctors' behaviour to perform low-value tests. De-implementation of low-value tests will require behavioural change through contemporaneous navigation of multilevel drivers. Behavioural change theories like the Theoretical Domains Framework provide a robust framework to navigate change in collaboration with multidisciplinary clinicians and community. Evidence-based, theory-informed, co-designed interventions are needed to address the drivers of low-value tests.
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