Targeting Missed Care Opportunities Using Modern Communication Methods: A Quality Improvement Initiative to Improve Access to CT and MRI Appointments.

PURPOSE: To evaluate the impact of automated text and phone call reminder systems on CT (computed tomography) and MRI (magnetic resonance imaging) missed care opportunities. METHODS: This was an IRB (institutional review board) exempt prospective interventional quality improvement study. The proportion of missed care opportunities (appointment made, no imaging performed) related to scheduled CT and MRI examinations were evaluated over 2 months (Month 1: reminder phone calls by staff 48-96 hours prior and mailed letter 1-2 weeks prior; Month 2: no manual call or letter, automated text message 24 hours prior, automated phone call 72 hours prior, automated patient portal message 7 days prior). The proportion of missed care opportunities was calculated in aggregate and by modality. Process control p-charts were generated. An a priori power analysis was performed. Chi-squared tests were performed. p-value < 0.017 was considered significant after Bonferroni correction. RESULTS: Missed care opportunities occurred for 2.82% (292/10348; 95% CI: 2.51-3.16) of all CT and MRI appointments using traditional communication and 2.44% (262/10719; 95% CI: 2.16-2.75) using automated communication (p = 0.09). Automated messaging did not significantly change the proportion of missed care opportunities for CT (traditional: 2.62% [95% CI: 2.23-3.06] vs. automated: 2.06% [95% CI: 1.70-2.48], p = 0.05) or MRI (traditional: 3.1% [95% CI: 2.60-3.66] vs. automated: 2.83% [95% CI: 2.40-3.30], p = 0.43). Process control p-charts showed dominance of common cause variation. CONCLUSION: Automated messaging did not meaningfully change the overall proportion of missed care opportunities compared to traditional human-initiated phone calls. Automated communications may reduce cost and improve efficiency without adversely affecting access to care.

Improving Breast MR Wait Times: A Model for Transitioning Newly Implemented Diagnostic Imaging Procedures into Routine Clinical Operation.

PURPOSE: The purpose of this quality improvement (QI) initiative was to increase patient access to breast MR while maintaining diagnostic image quality. METHODS: Institutional review board approval was waived for this HIPAA-compliant QI initiative, which was conducted from December 2014 through March 2016. Breast MR wait times, scheduling grids, and staffing models were reviewed to identify root causes of elevated wait times. Breast MR wait times were tracked on a biweekly basis as root causes were identified and action plans were implemented. Patient recall rates for repeat MR imaging were tracked. A retrospective analysis of image quality was performed in a randomly selected sample (20 per month; total: 320 examinations). Wait time and image quality data were analyzed with statistical process control charts and logistic regression. RESULTS: In all, 798 breast MR examinations were performed during the study period. Monthly volume increased from 23 in December 2014 to 50 in March 2016 (range: 23-64). Wait time for a routine breast MRI fell from 101 days before implementation to 5 days at study completion. The technical recall rate was 0.5% (4 of 798); no recall was performed for a technologist-related error or scan quality concern. The proportion of examinations with minor (31% [99 of 320]) or major (3% [9 of 320]) image quality impairments did not significantly change during the study period (P = .69-.70). CONCLUSION: A specialized MR examination was transitioned into routine clinical operation while maintaining image quality. This model may be useful for transitioning other specialized diagnostic imaging examinations into routine clinical practice.