Simple intervention can reduce unnecessary inpatient MRI orders
Prompting physicians to answer questions regarding the necessity of inpatient MRI exams could save institutions time and money by reducing unnecessary utilization.
At one large academic center, reviewing a questionnaire related to body MRI orders—mainly MRI/MRA abdomen and (nonmusculoskeletal) MRI/MRA pelvis studies—resulted in many ordering providers doing an about-face regarding the necessity of their inpatient request. Answers to the questionnaire also highlighted trends in how these orders originate.
Insight from the intervention was detailed recently in the journal Current Problems in Diagnostic Radiology.
“MRI utilization in the United States is relatively higher than in other parts of the world and inpatient MRI utilization is particularly difficult to manage given the lack of direct reimbursement,” corresponding author of the paper Christopher G. Roth MD, with the department of radiology at Sidney Kimmel Medical College, Thomas Jefferson University, and colleagues noted. “Body MRI studies present an opportunity to reduce inpatient MRI utilization since they are generally the least emergent.”
Acknowledging that inpatient MRI orders are especially prevalent at their institution, the authors devised a nine-item questionnaire about the urgency of such requisitions. A link to the questionnaire was on MRI workstation computers and was reviewed with residents and fellows on their first day rotating on the service.
The questions touched on topics like how MRI results would affect management of the patient’s condition, specific clinical questions that would impact patient care, whether other tests had already been completed, who recommended the MRI, whether it could be safely completed on an outpatient basis and more.
Nearly 24% of respondents could not provide information about the specific clinical question they were seeking to answer with the exam. These often came from advanced practice practitioners (APPs) who had been told by their attending to submit an order. In terms of who requested the exams, nonradiology providers asked for almost 70% of the orders, while16% were recommended in patients' other radiology reports.
The final question prompted respondents to provide information on their decision after answering each of the prompts. That question revealed that, although the respondents felt that 17% of their orders were outpatient appropriate and another 23% were likely suitable for outpatient settings, under 5% were changed from inpatient, while 4% were canceled altogether.
“The decision-making is fragmented usually originating from a consulting service to the primary service and delegated to house staff or APPs,” the group explained. “Having a scripted dialogue between radiology and the ordering clinician provides the opportunity to identify the urgent, inpatient-worthy clinical indications that might be missing or not understood.”
The authors acknowledged that their method, which required providers to voluntarily click on the link and complete the questionnaire, is resource- and time-intensive. However, integrating similar prompts on urgency into an EMR could streamline the process and prioritize inpatient MRIs for those who need them most urgently.
The study abstract is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.