From the 2018 HVPAA National Conference
Jackson Murrey-Ittmann (Michigan Medicine), Raymond Yeow (Michigan Medicine), Jessie King (Michigan Medicine)
Background
MRI imaging plays a crucial role in clinical decision making in the inpatient setting, However, long wait times can limit their use and cause delays in patient care. Since October 2015, Michigan Medicine implemented several initiatives in an attempt to decrease MRI wait times.
Objectives
To determine the effect of various initiatives on MRI wait times in the inpatient setting.
Methods
We conducted a retrospective chart review of 109 inpatient MRIs ordered by the Medicine Facility Service (MFH) at Michigan Medicine from 10/1/17 to 11/26/17. In our review, we examined: 1) median time to exam completion from the initial order; 2) the effects of ordering an exam STAT or needing general/conscious sedation on time to completion; 3) the percentage of exams ordered STAT and the percentage with an appropriate STAT indication; 4) the percentage of exams cancelled; and 5) the median time to completion of the MRI Screening Questionnaire. Data was compared to “baseline” data that was collected by MFH between August and October of 2015.
Results
Median time from initial order to MRI completion was 15.2 hours (hrs), compared to 59.2 hours in 2015. The median time to complete a STAT exam was 6.1 hrs, compared to 59.2 hrs in 2015. 39 of the 109 MRIs (36%) were ordered STAT but only 15 of the 39 (38%) of STAT orders had true STAT indications, as determined by the Department of Radiology at Michigan Medicine. Median time to complete an exam that required general/conscious sedation was 33.9 hrs, compared to 54.1 hrs in 2015. The median time to complete the MRI Screening Questionnaire was 4.7 hours, compared to 3.3 hours in 2015.
Conclusion
Initiatives implemented by Michigan Medicine, which included purchasing another MRI machine, making outpatient MRI machines available on the weekends, and converting the MRI Screening Questionnaire to electronic form, substantially decreased wait times for inpatient MRIs and drastically improved exam completion times for STAT orders. Notably, the vast majority of STAT orders did not have the appropriate indication as defined by Michigan Medicine’s Department of Radiology, which would suggest that further provider education might be warranted.
Implications for the Patient
By demonstrating the effectiveness of quality improvement in decreasing MRI wait times, we hope to encourage future initiatives. We demonstrated STAT exams are now done more quickly than ones ordered routine/urgent which should improve provider trust in the system and thereby encourage providers to use MRIs emergently when indicated.
