RESUMO
OBJECTIVE: Develop structured, quality improvement (QI) interventions to achieve a 15%-point reduction in MRIs performed under sedation or general anesthesia (GA) delayed over 15 minutes within a 6-month period. METHODS: A prospective audit of MRIs under sedation or GA from January 2022 to June 2023 was conducted. A multidisciplinary team performed process mapping and root cause analysis for delays. Interventions were developed and implemented over four 'Plan, Do, Study, Act' (PDSA) cycles, targeting workflow standardization, pre-admission patient counselling, reinforcing adherence to scheduled scan times and written consent respectively. Delay times (compared with Kruskal-Wallis and Dunn's tests), delays over 15 minutes and delays of 60 or more minutes at baseline and after each PDSA cycle were recorded. RESULTS: 627 MRIs under sedation or GA were analyzed, comprising 443 at baseline and 184 post-implementation. 556/627 (88.7%) scans were performed under sedation, 22/627 (3.5%) under monitored anesthesia care and 49/627 (7.8%) under GA. At baseline, 71.6% (317/443) scans were delayed over 15 minutes and 28.2% (125/443) scans by 60 or more minutes, with a median delay of 30 minutes. Post-implementation, there was a 34.7%-point reduction in scans delayed over 15 minutes, 17.5%-point reduction in scans delayed by 60 or more minutes and reduced median delay time by 15 minutes (p <0.001). DISCUSSION: Structured interventions significantly reduced delays in MRIs under sedation and GA, potentially improving outcomes for both patients and providers. Key factors included a diversity of perspectives in the study team, continued stakeholder engagement and structured QI tools including PDSA cycles.