Improved Magnetic Resonance Imaging Utilization for Children with Musculoskeletal Infection

• Published in: Journal of bone and joint surgery. American volume Vol. 97; no. 22; p. 1869
• Main Authors: Mueller, Andrew J, Kwon, Jeannie K, Steiner, Jeffrey W, Mittal, Vineeta S, Fernandes, Neil J, Jo, Chan-Hee, Lindsay, Eduardo A, Copley, Lawson A B
• Format: Journal Article
• Language: English
• Published: United States 18.11.2015
• Subjects: Adolescent; Child; Child, Preschool; Female; Guideline Adherence - statistics & numerical data; Humans; Infant; Infection - diagnosis; Magnetic Resonance Imaging - statistics & numerical data; Magnetic Resonance Imaging - utilization; Male; Musculoskeletal Diseases - diagnosis; Practice Guidelines as Topic; Process Assessment (Health Care); Quality Improvement; Texas; Texas
• ISSN: 1535-1386
• DOI: 10.2106/JBJS.O.00403

Magnetic resonance imaging (MRI) with sedation is an important resource used to evaluate children with musculoskeletal infection. This study assesses the impact of multidisciplinary guidelines and continuous process improvement on MRI utilization at a tertiary pediatric medical center. A multidisciplinary team developed a guideline for MRI with sedation, and it was implemented at our institution. Scan duration, anatomic regions imaged, sequences performed, timing of surgical intervention, length of hospital stay, and readmissions for these children were compared with these measures among a cohort of similar children who had been treated prior to guideline implementation. Comparative data were gathered for the subsequent cohort to determine any impact of the continued process improvement program on MRI utilization. Statistical comparison was performed to determine significant differences between groups. Children evaluated prior to the guideline implementation had 9.0 MRI sequences per scan, an MRI scan duration of 111.6 minutes, and a hospital stay of 7.5 days. In comparison, children in the initial MRI guideline cohort had 7.5 sequences per scan, a scan duration of 76.1 minutes, and a hospital stay of 5.4 days. Children in the subsequent guideline cohort had 6.5 sequences per scan, a scan duration of 56.3 minutes, and a hospital stay of 5.0 days. The rate of immediate surgical procedure under continued anesthesia was 16.7% prior to the guideline, 50.5% among children in the initial guideline cohort, and 64% among children in the subsequent guideline cohort. Differences between cohorts were significant (p < 0.0001). In aggregate, 264 hours of MRI scan time and 809 hospital bed-days were conserved for more than thirty months. This initiative promoted improvement in diagnostic efficiency, therapeutic consistency, and patient safety for children with musculoskeletal infection. The findings of this study illustrate the beneficial impact of interdisciplinary coordination of care on clinical outcomes for children with musculoskeletal infection. Tangible improvements occurred for both length of stay and resource utilization.