Improving MRI Access: A framework for optimizing MRI scheduling templates.

INTRODUCTION/BACKGROUND: Within radiology departments, alignment of available imaging capacity with demand across different patient groups helps ensure that all patient populations are receiving timely and equitable care. The objective of the MRI Schedule Optimization project was to implement a 5-step framework to review and update the current MRI schedule templates at the Joint Department of Medical Imaging (JDMI) to ensure optimal alignment with demand across patient populations. METHODS: The project, governed by clinical and clerical stakeholders and operational leadership (Owners), followed a 5-step process: (1) Analysis of baseline data related to MRI demand and current schedule composition (2) Current state assessment of MRI operations via interviews and observations (3) Updating of schedules to align with demand (4) Review of process improvement opportunities (5) Go-live planning and evaluation. RESULTS: Current state analysis revealed that misalignment of the original schedule with demand was as high as 11% for some divisions. Updated MRI schedules were implemented with a maximum variance from demand of 3%. The updated schedules also allocated 27 additional inpatient slots to respond to inpatient demand. In addition, several process improvement opportunities were identified and implemented to streamline scheduling processes, day of exam workflows and inpatient workflow management. DISCUSSION/CONCLUSION: The MRI Schedule Optimization project followed a structured framework to comprehensively review and realign the MRI schedules at JDMI to the needs of our patient population by improving access and identifying process improvement opportunities. This scheduling framework can be applied to perform similar schedule update exercises at any radiology department.

Exploring the impact of diagnostic imaging decision support embedded in an electronic referral solution on the appropriate ordering of magnetic resonance imaging for patients with knee pain: a retrospective chart review.

RATIONAL AND OBJECTIVE: Requests for magnetic resonance imaging (MRI) exams have notably increased in Canada. However, many of these exams may not always be indicated. The Joint Department of Medical Imaging and the eReferral Program have worked collaboratively to embed an integrated clinical decision support (DS) tool within the eReferral process for diagnostic imaging requests. This retrospective chart review aimed to assess the necessity of MRI exams for knee pain patients at the point of referral in relation to the referral method (no DS tools within fax- vs. DS tools within eReferral). METHODS: Seven hundred and seventeen medical charts of routine MRI referral requests to an Ontario Hospital for patients with knee complaints were reviewed during the study period. The necessity of the MRI exams was evaluated using the supporting algorithm and knee pathway appropriateness guidelines. MRI exams were considered necessary if requested for symptoms or signs that align with best-practice standards, complemented with sound clinical assessment or history of a radiography scan before ordering an MRI. RESULTS: In general, MRI requests made through eReferral were 13.289 times more likely to be necessary orders than those made through fax. The likelihood of referring patients for a necessary MRI exam was higher for eReferral than fax for the year 2018/2019 (53.0% vs. 26.8%, P < 0.001) and for the year 2019/2020 (58.5% vs. 16.3%, P < 0.001). In addition, the rate of ordering X-ray as the proper initial imaging scan for patients presenting with knee pain has steadily increased by 10% over the year for users of the eReferral platform compared to a decrease of 7% for those using fax. CONCLUSION: Our findings highlight the positive impact of integrating DS tools at the point of referral in supporting the ordering of necessary MRI scans, suggesting that service re-design and implementation of automated assistive technology services would impact patient care.

Bridging the Gap Between Radiology and Primary Care: Expansion and Sustainability of a Medical Imaging Call Center Model.

OBJECTIVES: The Medical Imaging Call Centre (MICC) was an initiative carried out by a hospital-based academic imaging department with the aim to provide navigational services and radiologist consultations to community-based primary care physicians (PCPs). The strategies used to expand and sustain the initiative over a 3.5-year period after an initial pilot are described. METHODS: The strategy to evolve the MICC had internal and external components. Internally, processes were refined to ensure satisfaction of stakeholders. Externally, a robust engagement strategy focused on recruiting and engaging callers was implemented. Metrics including call volumes, unique callers, and call type were monitored to track utilization and further inform the engagement strategy. A reduction in avoidable use of the emergency department (ED) was determined by tracking pre- and post radiologist consultation decisions reported by callers. RESULTS: During the evaluation period, 2,297 calls were made. There was a 39% increase in the average number of monthly calls in the last 6-month period (61) compared with the first 6 months (44). Call types that involved PCP-to-radiologist communication for patient management consultation also increased over time. A 98% ED avoidance rate (215 of 220) was reported for calls in which PCPs initially indicated that they would be sending their patients to the ED for urgent imaging if the MICC were unavailable. DISCUSSION: The MICC was successful in connecting community-based PCPs with hospital-based subspecialized radiologists. Results indicate that an active engagement strategy is necessary and can lead to changes in patient management that will decrease the burden on other specialists.

Development of nuclear medicine image quality assessment criteria for use in a technologist peer review program.

INTRODUCTION/BACKGROUND: A peer learning program includes the process of peer review, which is the act of performing a secondary review of a peer's work using pre-defined criteria. The Technologist Image Quality Assessment Criteria Project (TIQACP) was initiated to develop and evaluate such criteria for use by technologists for assessment of image quality in Nuclear Medicine (NM). METHODS: A NM clinical expert panel was assembled, comprising 14 technologists, radiologists, and educators from five imaging centres and an academic institution with associated medical imaging training programs. Project design was guided by consensus-based methodology that included three phases: (1) image quality assessment criteria development, based on literature search and expert review (2) image quality assessment criteria refinement, based on consensus-building exercises (panel surveys, discussions, ranking exercise, and time trial) (3) external validation performed via a national survey of NM technologists, facilitated by the Canadian Association of Medical Radiation Technologists. RESULTS: The first phase generated 8 key evidence sources, including textbooks, NM journals and guidelines from professional associations that were reviewed by the expert panel leads and led to a preliminary list of 11 criteria. As part of the second phase, the preliminary list was reviewed via online surveys and panel discussions. Preliminary discussions led to an initial expansion of the list to include 18 criteria. This list required an average of 9 min (range: 7-11 min) for review, which was deemed prohibitive by the panel. A ranking exercise identified 'all required anatomy is clearly identified' as the most relevant criteria and 'Image quality demonstrates no breakdown of the radiopharmaceutical' as the least relevant criteria. Panel discussion also highlighted need to eliminate criteria that were not applicable to all settings. These insights led to an updated list of nine criteria organized into four categories. National validation was supported by 47 NM technologists from across Canada. Respondents were in agreement that the criteria reflected the core elements of image quality in NM (94% agree to strongly agree), were familiar (97%) and were relevant to their current practice setting (88%). The final list was thus not changed based on the survey. DISCUSSION/CONCLUSION: The TIQACP utilized an inclusive process that engaged a range of subject matter experts and the broader NM community to ensure buy-in of the final criteria. These criteria have subsequently been embedded in peer review software that has been implemented into a robust peer learning program for technologists designed to promote a culture of continuous improvement and knowledge sharing amongst front-line staff.