Assessing context and readiness of emergency medicine physicians to promote evidence-based imaging referral guidelines: a mixed-methods study.

Background: Assessment of context and readiness to change are key components in the implementation of imaging referral guidelines.

Purpose: In line with JBI's (formerly known as the Joanna Briggs Institute) approach to evidence implementation, the aim of this study was to apply a mixed-methods study design to assess the context and readiness of physicians to use evidence-based imaging and referral guidelines, in tandem with associated opportunities and barriers.

Methods: A survey was administered to physicians in an emergency department (ED) in Singapore, followed by virtual focus group sessions with physicians who volunteered. Mann-Whitney U test was used to evaluate differences in specialist and non-specialist responses. Braun and Clarke's reflexive thematic analysis was followed for data engagement, coding, and theme development.

Results: Fourteen physicians responded to the survey, and 16 physicians participated in the focus groups. All physicians agreed that imaging utilization will increase in the coming decade, and most agree that overuse is a problem in the ED, especially conventional radiography (CR). Physicians gave a median score of 4 out of 5 to most questions evaluating their knowledge, skills, and attitude. There was no statistical difference in the scores between non-specialists and specialists, except for their preference for imaging guidelines that provide evidence to enhance clinical judgement (P = .03), where specialists had a higher mean rank. Key themes generated were workplace culture and factors influencing imaging referrals.

Conclusion: Imaging overutilization in the ED, especially CR, is a problem. While physicians have the readiness, awareness, knowledge, skills, and attitude to change practice, factors such as workplace culture, medico-legal landscape, and interdisciplinary relationships impede such changes. The development of institutional guidelines coupled with targeted strategies and efforts involving key stakeholders is necessary to bridge the evidence-to-practice gap.