Objectives: There is a notable rise in patient-initiated imaging requests, with one possible reason being the increased availability of online health information. This study specifically examines the impact of patient-initiated radiological exams on radiologists. Exploring their perspectives on how GPs acquiescing to patients’ medical imaging requests impacts healthcare resources and skew patients’ expectations of the capabilities of radiological studies. The findings of this study are crucial for understanding the evolving dynamics of radiology practice and its challenges. Method: A comprehensive cross-sectional survey was administered to radiologists in private medical centres across Australia between November 2023 and February 2024. The survey included structured and open-ended questions distributed via an intranet platform within the same company and reached a wide range of radiologists. Results: Nearly half of the participants (48%) had over 20 years of experience. The majority of radiologists reported X-rays (27%), ultrasounds (25%), and CT scans (24%) as the most commonly requested non-indicated imaging studies. Radiologists attributed these requests to patients’ exposure to online medical information and their desire for reassurance. Approximately 24% of radiological studies were considered unnecessary, with 30% of radiologists reporting feeling pressured by GPs and patients to expedite report completion. Proposed strategies included patient education, communication, and the establishment of clear guidelines. Conclusions: The study underscores the increasing burden of patient-initiated imaging on radiologists. This burden is further compounded by patients’ unrealistic expectations and lack of understanding of diagnostic imaging’s limitations. Radiologists have stressed the crucial role of the broader healthcare context in collaborating with such requests. Patient education was emphasised to reduce unnecessary imaging and manage patient expectations.

Aim: To examine and understand the work processes of AMS teams across two hospitals that use the same digital intervention, and to identify the challenges and enablers to effective AMS in each setting. Methods: Employing a contextual inquiry approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model, observations and semi-structured interviews were conducted with AMS team members (n=15) in two Australian hospitals. Qualitative data analysis was conducted, mapping themes to the SEIPS framework. Results: Both hospitals utilised similar systems, however, they displayed variations in AMS processes, particularly in post-prescription review, interdepartmental AMS meetings, and the utilisation of digital tools. An antimicrobial dashboard was available at both hospitals but was utilised more at the hospital where the AMS team members were involved in the dashboard’s development, and there were user champions. At the hospital where the dashboard was utilised less, participants were unaware of key features, and interoperability issues were observed. Establishing strong relationships between the AMS team and prescribers emerged as key to effective AMS at both hospitals. However, organisational and cultural differences were found, with one hospital reporting insufficient support from executive leadership, increased prescriber autonomy, and resource constraints. Conclusion: Organisational and cultural elements, such as executive support, resource allocation, and interdepartmental relationships, played a crucial role in achieving AMS goals. System interoperability and user champions further promoted the adoption of digital tools, potentially improving AMS outcomes through increased user engagement and acceptance.

Clinicians, patients, administrators and researchers have become increasingly frustrated by the lack of indication (i.e. problem) information included in prescriptions, despite the obvious benefit this would provide to patients and other healthcare providers [1]. Medication indications are not routinely documented by prescribers, both in inpatient and outpatient settings.[2, 3] Calls have been made to introduce a sixth ‘right’ into the medication management process, whereby the right patient is given the right drug and dose at the right time via the right route for the right indication [4]. Indications-based prescribing has recently gained traction as a potential way forward to facilitate indication documentation [4, 5]. Indications-based prescribing, not currently supported by most electronic prescribing systems (EPSs), describes the scenario where prescribers initially select an indication, not a medication, and the EPS presents the user with suggested medications for addressing the problem. There are clear advantages with this approach, including those associated with guided prescribing (e.g. more appropriate drug selections) and with indication documentation (e.g. improved communication between providers), prompting work to begin on developing EPS functionality in the US to support indications-based prescribing. In a recent usability evaluation of a prototype of this functionality, indications-based prescribing was more efficient to use, resulted in fewer medication errors and in higher usability scores than the traditional EPS functionality [6].