Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

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Factors leading to over-utilisation of hospital pathology testing: the junior doctor's perspective

William Ericksson , Janine Bothe , Heidi Cheung , Kate Zhang , Simone Kelly


Objective: Pathology over-utilisation is a significant issue affecting the quality and cost of healthcare. As Junior Medical Officers (JMOs) order the majority of pathology tests in the hospital setting, this aim of this research was to identify the main reasons for hospital pathology over-utilisation from the perspective of the JMO. Method: A qualitative method, using the focus group methodology was undertaken. Sixteen JMOs from two hospitals participated in three focus groups. Data were analysed using thematic analysis. Results: Three major themes contributed to over-utilisation. These are the real and perceived expectations of senior colleagues, the level of JMO clinical experience, and strategies to manage JMO workload around clinical systems. Within these themes, twelve subthemes were identified. Conclusions: Over-utilisation of hospital pathology testing occurs when there are high social costs to JMOs for under-ordering, with little cost for over-ordering. Interventions should restore this balance through reframing over-utilisation as both a costly and potentially harmful activity, promoting a supportive culture with regular senior guidance, and addressing clinical systems in which missed tests create an excessive workload.

AH16290  Accepted 30 March 2017

© CSIRO 2017