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Changing primary care requesting practices for MRI knee: A quality improvement project.

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A new referral pathway significantly reduced inappropriate MRI knee scans in patients over 45 by 42%. This change also decreased the rate of scans without prior X-rays, improving care standards and reducing wait times.

Keywords:
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Area of Science:

  • Radiology
  • Healthcare Management
  • Primary Care Medicine

Background:

  • Knee MRI referrals from primary care are often inappropriate for patients over 45.
  • Inefficient referral practices lead to increased healthcare costs and longer waiting lists.

Purpose of the Study:

  • To analyze primary care MRI knee referral patterns in patients aged 45 and older.
  • To develop and implement a new referral pathway to decrease inappropriate MRI knee requests.
  • To evaluate the impact of the new pathway on referral rates and adherence to guidelines.

Main Methods:

  • Retrospective analysis of primary care MRI knee referrals before and after pathway implementation.
  • Development of a new referral pathway in collaboration with orthopaedic specialists and the Clinical Commissioning Group (CCG).
  • Dissemination of the new pathway through the CCG resource webpage and local education.

Main Results:

  • A 42% reduction in MRI knee acquisitions from primary care referrals was observed post-implementation.
  • Adherence to the new guidelines was 67% among referring physicians.
  • The proportion of patients undergoing MRI knee without a prior plain radiograph decreased from 47% to 20%.

Conclusions:

  • The new referral pathway effectively reduced inappropriate MRI knee acquisitions in older symptomatic patients.
  • The implemented changes align with Royal College of Radiology recommendations and have shortened outpatient waiting lists.
  • Collaborative development with local CCGs is crucial for successful pathway implementation.