Understanding Clinical Decision‐Making in Medical Imaging Referrals: A Cross‐Sectional Study of Public Health Practices in South Australia

Objectives To assess what motivates medical imaging utilisation and to understand what referring clinicians, and those who operationalise these referrals, consider important when making decisions to refer to medical imaging in the South Australia Public Health System. Design, Setting Two cross‐sectional surveys were purpose‐built for online delivery. One was conducted from March–August 2023 for SA Health referring clinicians, and another was conducted from February–July 2023 for South Australia Medical Imaging (SAMI) clinical staff. Participants Two cohorts were surveyed: referring clinicians within SA Health ( n = 138) and SAMI clinical staff ( n = 251), from both metropolitan and regional locations. Main Outcome Measures Two customised survey instruments. Results A range of factors was reported to influence how clinicians' decisions to request medical imaging, including patient‐related, staff‐related and system‐related factors. Both clinicians and SAMI staff agreed that ‘improving overall patient health’ and ‘reassurance or confirmation of disease absence’ were key motivators for requesting medical imaging. However, notable differences emerged in how other motivations were rated, as well as factors clinicians consider important when referring patients for medical imaging. While a small number of clinicians acknowledged over‐requesting, a much larger proportion of SAMI staff perceived over‐requesting as a common issue among referring clinicians. Conclusions This study is the first to explore the perspectives of South Australian clinicians on the factors that motivate medical imaging requests. It highlights a complex array of drivers influencing referral practices and differing perceptions of overuse between those who refer and those who operationalise those referrals. The findings can inform the development of targeted, evidence‐based strategies to optimise medical imaging referrals, improve resource use and enhance healthcare delivery for the South Australian community.