# More Is Actually Less: Practitioners' Perspective of Unnecessary Medical Testing in Saudi Arabian Emergency Departments

## TL;DR

This study explores unnecessary medical testing in Saudi Arabian emergency departments, finding that fear of legal issues drives overuse, and suggests education and staffing as solutions.

## Contribution

The study provides a practitioner-focused analysis of unnecessary testing in Saudi EDs and identifies fear of legal consequences as a key driver.

## Key findings

- CT head for asymptomatic stroke and TBI was the most overused scan (44%).
- Fear of medicolegal proceedings was the most common reason for unnecessary testing (70.9%).
- Continuous education and increased staffing were seen as the top solutions to reduce overuse (70.9% and 67%).

## Abstract

Background

The overuse of medical testing, be it ancillary testing or imaging, has been identified as a problem in all healthcare systems in the world. As the Kingdom of Saudi Arabia marches towards the 2030 vision of healthcare transformation, we have sought to get a perspective on medically unnecessary tests being conducted in Saudi Arabian emergency departments (EDs), the reasons behind this phenomenon, and possible solutions to it.

Methods

This is a cross-sectional survey among emergency medicine physicians (EMPs) working in Saudi Arabian EDs, taken through a self-filled online questionnaire, about their ordering habits, what they believe to be unnecessary testing in their practice, the practice of their colleagues, and other Saudi EMPs as a whole. Subjects have also been asked about the reasons why such practices are occurring and possible solutions to reduce such overuse of unnecessary tests in Saudi EDs.

Results

A total of 182 EMPs were surveyed from the different regions of the Kingdom, and CT head for patients presenting with asymptomatic stroke, and asymptomatic TBI were the most overused scans (both 44%). The most overused advanced body imaging was CT kidney-ureters-bladder (KUB) at 41.5%, while the most overused ancillary tests were complete blood count (CBC) and liver transaminases. The most common reason for the practice was found to be fear of medicolegal proceedings (70.9%). Continuous education of EMPs and increasing ED staffing were found to be the most helpful solutions to reduce unnecessary testing in the ED (70.9% and 67%, respectively).

Conclusion

It is clear from our data that overuse of medical tests and imaging is still a prominent practice. CT head in asymptomatic patients seems to be the most commonly overused imaging in Saudi EDs. Ancillary testing and unnecessary ordering of CBCs and transaminases seem to stem from fear of EMPs from legal consequences. More control over medical test ordering needs to be exercised to reduce these practices.