Emergency MRI Three Tiered Prioritization

Publication date: Available online 17 May 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Juan E. Small, Stacey Sullivan-Richard, Lisa A. Kingsley Rocker, Jacob J. Kim, Jennifer C. Broder
Background/PurposeTraditional methods for prioritization are limited and insufficient for today′s Magnetic Resonance Imaging (MRI) demands. In particular, the discrepancy in urgency of the heterogeneous emergency department (ED) patient population necessitates risk stratification to meet different degrees of urgency. The purpose of this study was to more effectively prioritize the MRI imaging needs of ED patients commensurate with the severity of their presenting illness.MethodsA three-level tiered classification system (Tier 1: Critical, Tier 2: Emergent, Tier 3: Urgent) of ED patients with unambiguous hierarchically defined numerical classifications was implemented to replace a traditional method of MRI orders. Each tier was accompanied by guiding consensus-driven clinical definitions and common qualifying examples. Lastly, each tier imaging order was tied to a specific target 'order to imaging start time′ (OTST). After implementation, a month by month one-year retrospective analysis of ED MRI imaging order volume was conducted in order to assess the percentage distribution of each category. In addition, a month by month one-year retrospective analysis of the OTST for each tier was conducted. The OTST outcome measure was used in order to monitor the ability of the system to meet tier target times based on severity.ResultsThe system effectively prioritized ED patients into three tiers based on acuity. An inverse relationship existed between ED MRI OTST and the tier severity into which the patient was stratified. We found that only 4% of the ED specific volume is truly critical (Tier 1). In addition, Tier 3 MRI examinations constituted 75% of the ED volume. Month by month quality assurance analysis demonstrated consistent completion of examinations under or close to the target times tied to each tier. The average overall wait time from order time to begin scan time for all ED MRIs decreased from 245 minutes (4.1 hours) at baseline to under 136 minutes (2.7 hours).ConclusionsWe implemented and evaluated a three-tiered system of ED MRI imaging orders based on patient severity. The system was unambiguous due to its numerical hierarchy and each of three tiers was accompanied by explicit guiding definitions for each category. A quality assurance process following implementation allowed us to monitor the ability of the system to meet target times tied to each tier. Our current ability to accurately predict a target performance time allows us to set accurate expectations for both providers and patients.



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