ArticleBMJ open2026
How the introduction of a new patient pathway impacts diagnosis and treatment of acute abdominal pain in the emergency department: a qualitative study based on expert interviews.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
7 authors.
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Abstract
objectiveThis study aimed to explore (1) facilitating and inhibiting factors influencing the implementation of the Abdominal Pain Unit (APU) process, (2) physicians' acceptance of the pathway and (3) typical experiential patterns and professional rationales emerging in clinical practice.
designWithin a mixed-method framework, a qualitative evaluation study was conducted. Semi-structured expert interviews were conducted. SETTING,
participants36 physicians experienced in emergency care from 10 different emergency departments (EDs) involved in treating APU patients were interviewed. Years of work experience and professional status guided the selection.
resultsSeven major themes emerged: (1) physicians' understanding of APU as a complex symptom associated with diagnostic uncertainties, (2) changes in clinical routines, (3) diagnostic certainty, (4) influence of professional experience, (5) the role of the digital APU application, (6) interdisciplinary cooperation and (7) obstacles to broad implementation. Overall, physicians perceived APU as beneficial for structuring clinical routines and standardising care, particularly for less experienced physicians. The pathway prompted more systematic documentation, repeated pain scoring and greater diagnostic reflection. The digital application was largely seen as intuitive, though its integration into existing IT systems and workflows posed challenges. No substantial changes were reported in interdisciplinary cooperation. Barriers to large-scale implementation included concerns about overdiagnosis, loss of clinical autonomy and additional documentation effort.
conclusionThe APU pathway supports the structured care of acute abdominal pain (AAP) in the ED. Its successful integration requires alignment with clinical routines, IT infrastructure and professional cultures. Balancing standardisation with clinical autonomy is key for sustainable implementation.
trial registrationDRKS00021052.
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