Purpose
An interdepartmental audit of acute MRI imaging in neurologically compromised patients identified a greater than 24hour average delay for this vulnerable group of patients.
The reason cited by our radiology department were the number of routine referrals from primary care overloading the capacity available.
Approach
A multi-disciplinary group was formed which would utilise the principles of prudent healthcare to secure clinical “buy in” and included Consultant Orthopaedic Surgeons, Consultant Radiologist, Senior MSK physiotherapists, radiographers, members of the service improvement team and primary care, so that all parts of the MSK pathway were represented.
A review of the scrutinising process of MRI referrals was undertaken only to find no formal process and referrals were being “rubber stamped”. There were also no referral guidelines in place with the Health Boards.
Referral and imaging criteria were formulated according to advice of specialist societies.
Initial review of referrals identified that >80% of referrals were inappropriate, predominantly due to paucity of clinical information provided or incorrect investigation being requested.
The MDT group met on a weekly basis to scrutinise all referrals. The decision of the group was communicated to each referrer with an explanation of the refusal to undertake the imaging request.
Outcomes
Over the 9 months during which the group met, over 1100 imaging requests were scrutinised and there was a 70% decrease in the number of MRI scans performed.
Only 50% of referrals were deemed inappropriate compared with the initial review that identified greater than 80% of referrals deemed inappropriate.
With appropriate Guidelines, adequate time to triage MRI requests there is strong evidence of change in referral behaviour, with referrers more often adhering to referral criteria and improvement in clinical information.
Re-audit of acute neurologically compromised patients requiring imaging revealed an average waiting time of less than 12 hours from MRI.
Implications
Health board guidelines for MSK MRI referrals enable referrers to reduce inappropriate referrals, thus reducing demand.
Appropriate time to triage MSK MRI requests using health board guidelines ensures referral requests are appropriate, and with appropriate clinical information prioritising scan can be made.
Funding acknowledgements
No funding required.
Additional notes
This work was presented at Physiotherapy UK 2019. |