LAUSR

Low-value care (LVC) has gained increasing traction over the past few decades, with the Choosing Wisely campaign reaching Australia in 2015. The Royal Australasian College of Physicians, Paediatric and Child Health Division has put forward five ‘not-to-do’ practices, known widely as the Evolve Criteria. The idea that we order unnecessary tests, treatments and procedures can be confronting for clinicians, and drivers are not well understood. At a large tertiary paediatric centre, we surveyed clinicians (medical and nursing) in June 2018 involved in the care of infants with bronchiolitis (one of the five Evolve conditions) about drivers of LVC. We used a 20-question online survey provided by NPS MedicineWise (Available from: https://www.nps.org.au/; accessed 26 February 2019), which we then emailed to all emergency department (ED) and general medical doctors, as well as nursing staff in the ED. A total of 54 individuals responded. Clinicians reported seeing a problem in unnecessary care in pathology (88%), radiology (70%), medications (50%) and surgeries/procedures (25%). Of clinicians, 15% reported being asked for an unnecessary test every day, with 71% asked at least once a week. Major drivers for unnecessary care ordering were identified as diagnostic uncertainty (69%), perceived parental expectation (46%) and fear of litigation (32%). When considering practices of others, 44% reported that their colleagues ordered unnecessary tests several times a week, with 15% seeing this every day. Only 17% of staff reported that they had a high level of influence over changing LVC practices, with 65% reporting some or moderate influence and 18% reporting they had little or no influence. This study was based on a single site, and the views of our clinicians may not be generalised to clinicians working in other hospitals. However, this survey highlights that LVC is not due to a lack of knowledge by clinicians but rather other drivers. Further interrogation on the drivers and tailored interventions are required if we are to reduce LVC in a sustainable manner.