影响白班和夜班急诊科诊断影像决策的因素

IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE
Robert Peter Klein, Gary Velan, Husna Razee, Andrew Coggins, Kevin Lai, Amith Shetty, Noel Young, Michelle Moscova
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引用次数: 0

摘要

背景:医学影像的使用逐渐增加,引发了对其临床影响的讨论。减少低价值成像的干预措施取得了不同程度的成功,因为它们通常不考虑临床环境对决策的影响。影响急诊科(ED)医务人员(MOs)成像命令决策的因素以及这些因素在白班和夜班之间的差异知之甚少。方法:这项混合方法研究于2021年在西悉尼的一家大型三级医院进行。对20个白班和26个夜班临床就诊的ED mo的观察和访谈进行了分析,以了解如何以及为什么做出影像学决定,以及影像学指南的使用。回顾性地从医疗记录中获得人口统计学和临床患者数据(包括患者倾向),以评估影像学的影响。结果:在夜班期间,26例临床观察中有18例使用了诊断成像,而在白班期间,20例临床观察中有12例使用了诊断成像。影响夜班决策的因素包括资源有限、疲劳、对初级ED MOs的支持减少和患者负荷增加。访谈表明,CT更有可能在夜班期间用作加快决策的筛查工具,并作为不可用的成像方式的替代品。相比之下,白班初级执业医师的影像学决定受到需要向高级执业医师证明其决定的影响,促使他们研究主诉和影像学指征。一般来说,在这两个班次中,对成像决策指南的参考很少。结论:不同因素影响白班和夜班ED mo的影像学决策。在设计和实施有针对性的医生支持策略和干预措施以减少低价值成像时,需要考虑到这一点。在修改旨在支持ED夜班期间MO的指导方针/策略时,应考虑资源有限和MO疲劳。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Factors affecting diagnostic imaging decision-making in the emergency department during day and night shifts.

Factors affecting diagnostic imaging decision-making in the emergency department during day and night shifts.

Background: Medical imaging use has increased progressively, prompting discussions about its clinical impact. Interventions to reduce low-value imaging have had varying success, as they generally do not consider the influence of the clinical environment on decision-making. Factors affecting imaging ordering decisions by Emergency Department (ED) medical officers (MOs) and how these factors differ between day and night shifts are poorly understood.

Methodology: This mixed methods study was conducted in 2021 at a major tertiary hospital in Western Sydney. Observations and interviews with ED MOs for 20 day-shift and 26 night-shift clinical encounters were analysed to understand how and why imaging decisions were made, along with usage of imaging guidelines. Demographic and clinical patient data (including patient disposition) were obtained retrospectively from medical records to assess the impact of imaging.

Results: During night shifts, 18 of the 26 observed clinical encounters used diagnostic imaging, compared with 12 of the 20 observed clinical encounters during day shifts. Factors affecting decision-making during night shifts included limited resources, fatigue, reduced support for junior ED MOs and higher patient load. Interviews suggested CT was more likely to be used during night shifts as a screening tool to expedite decisions and as a substitute for unavailable imaging modalities. In contrast, imaging decisions by day shift junior MOs were influenced by the need to justify their decisions to senior MOs, prompting them to research presenting complaints and imaging indications. Generally, there was minimal reference to imaging decision-making guidelines across both shifts.

Conclusion: Differing factors impact imaging decisions by ED MOs during day and night shifts. This needs consideration when designing and implementing targeted physician support strategies and interventions to reduce low-value imaging. Limited resources and MO fatigue should be considered when modifying guidelines/strategies aiming to support MOs during ED night shifts.

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来源期刊
Emergency Medicine Journal
Emergency Medicine Journal 医学-急救医学
CiteScore
4.40
自引率
6.50%
发文量
262
审稿时长
3-8 weeks
期刊介绍: The Emergency Medicine Journal is a leading international journal reporting developments and advances in emergency medicine and acute care. It has relevance to all specialties involved in the management of emergencies in the hospital and prehospital environment. Each issue contains editorials, reviews, original research, evidence based reviews, letters and more.
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