TABLE 4

Major Reasons Described by Providers for Obtaining RVT

ThemesRepresentative Quotes
RVT is obtained by or directed by other clinicians• “[I]f it’s the hospitalist asking, or 1 of the units asking for this test, I just do it. I don’t fight back” (ED physician 3).
• “[T]he biggest area where this gets ordered is either in the ER or by trainees on the floor” (hospitalist 1).
• “I think a lot of times when I talk to the outside emergency departments, they’re mostly adult providers. And so they always have some kind of uncertainty as to what is actually going on. So I find that they feel justified in getting that test” (hospitalist 8).
• “…attendings. They just like to know” (resident 8).
RVT provides reassurance or validation of a diagnosis and assuages provider self-doubt• “A typical benefit I see is just validating what you see clinically” (ED physician 2).
• “I guess it’s a reassurance more than anything” (resident 12).
• “Outside EDs…have immediate gratification on the answer, and then when they call to admit the patient, they’ve got the diagnosis” (hospitalist 11).
Ordering RVT is easy and provides the perception of doing something• “I remember when I was early in training…this child has X, Y, Z. Let’s order, this, this, this, and this. It’s very easy to do because you can” (ED physician 10).
• “I think it’s very difficult to not send a test that you know that you can to find out what’s wrong with the patient. …There’s a test available for the illness, why not use it?” (hospitalist 11).
• “Sometimes it’s not as well thought out—won’t change anything—but [there’s] a lot of self-anxiety…[and] doing something is better than doing nothing” (resident 7).
RVT could change medical managementa• “I guess a lot of people tend to order the viral panel, saying, ‘It makes myself feel better that I can withdraw all the antibacterial therapies’” (resident 8).
• “People will empirically slap on antibiotics and when they get that viral testing, it kind of reassures them that maybe they can stop the antibiotics or stop them sooner” (hospitalist 10).
• “If there is suspicion for influenza, [you] would be more likely to test because if you document influenza, you’d be more likely to treat” (resident 10).
Uncertainty regarding institutional policies on cohorting• “If the resident isn’t the one requesting it, it might be the charge nurse who’s telling us they need it for cohorting. But I don’t know. Maybe it’s an urban legend. Maybe they actually don’t need it” (ED physician 5).
• “The contact precautions thing, I don’t think we actually know super well, but some of the policies it sounds like people interpret differently” (resident 9).
• “Do you actually use it for cohorting…?” (ED physician 7).
Parental desire to have a viral label• “Most of the time, if you explain to them [parents] why it’s not being done, they’re fine with not having it done if it doesn’t change anything” (resident 11).
• “I feel like I can explain to them why we’re not doing it and usually talk them out of wanting it once they understand that it’s painful and it’s not going to change the management” (hospitalist 11).
• “If a parent really wants it…I don’t think it’s a battle worth fighting. I would just order it in that case, which does happen on occasion” (hospitalist 11).
  • ED, emergency department.

  • a Medical management reasons for RVT were later refuted during the focus group discussions (see text).