Quality Improvement of Magnetic Resonance Imaging for Musculoskeletal Infection in Children Results in Decreased Scan Duration and Decreased Contrast Use

• Published in: Journal of bone and joint surgery. American volume 2019-09, Vol.101 (18), p.1679-1688
• Main Authors: Ojeaga, Patrick O, Hammer, Matthew R, Lindsay, Eduardo A, Tareen, Naureen G, Jo, Chan Hee, Copley, Lawson A
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Clinical Protocols; Contrast Media; Female; Hospitals, Pediatric - organization & administration; Hospitals, Pediatric - standards; Humans; Infant; Infections - diagnostic imaging; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - standards; Male; Musculoskeletal Diseases - diagnostic imaging; Quality Improvement - organization & administration; Registries; Retrospective Studies; Tertiary Care Centers - organization & administration; Tertiary Care Centers - standards; Texas; Time Factors; Workflow; Young Adult
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.19.00035

BACKGROUND:Magnetic resonance imaging (MRI) is a heavily utilized resource to evaluate children suspected to have a musculoskeletal infection. Complex interdisciplinary workflows are involved with decision-making with regard to indications, anesthesia, contrast use, and procedural timing relative to the scan. This study assesses the impact of a quality improvement endeavor on MRI workflows at a tertiary pediatric medical center. METHODS:A registry of consecutively enrolled children for a multidisciplinary musculoskeletal infection program identified those evaluated with MRI from 2012 to 2018. Annual MRI process improvement feedback was provided to the key stakeholders. Demographic characteristics, laboratory parameters, MRI indications, anesthesia use, MRI findings, final diagnoses, scan duration, imaging protocol, surgical intervention following MRI, and length of stay were retrospectively compared between the 3 cohorts (initial, middle, and final) representing 2-year increments to assess the impact of the initiative. RESULTS:There were 526 original MRI scans performed to evaluate 1,845 children with suspected musculoskeletal infection. Anesthesia was used in 401 children (76.2%). When comparing the initial, middle, and final study period cohorts, significant improvement was demonstrated for the number of sequences per scan (7.5 sequences for the initial cohort, 5.8 sequences for the middle cohort, and 4.6 sequences for the final cohort; p < 0.00001), scan duration (73.6 minutes for the initial cohort, 52.1 minutes for the middle cohort, and 34.9 minutes for the final cohort; p < 0.00001), anesthesia duration (94.1 minutes for the initial cohort, 68.9 minutes for the middle cohort, and 53.2 minutes for the final cohort; p < 0.00001), and the rate of contrast use (87.6% for the initial cohort, 67.7% for the middle cohort, and 26.3% for the final cohort; p < 0.00001). There was also a trend toward a higher rate of procedures under continued anesthesia immediately following the MRI (70.2% in the initial cohort, 77.8% in the middle cohort, and 84.6% in the final cohort). During the final 6-month period, the mean scan duration was 24.4 minutes, anesthesia duration was 40.9 minutes, and the rate of contrast administration was 8.5%. CONCLUSIONS:Progressive quality improvement through collaborative interdisciplinary communication and workflow redesign led to improved utilization of MRI and minimized contrast use for suspected musculoskeletal infection. There was