Safely Shifting MRIs for Seizure Evaluation to the Outpatient Setting

Area of Science:

• Neurology
• Radiology
• Healthcare Management

Background:

• Inpatient brain MRIs for seizure evaluation are costly, with low yield (2%).
• A 20% increase in inpatient MRIs for seizures occurred from 2018-2020.
• Current practices show significant provider variability in MRI ordering.

Purpose of the Study:

• To decrease inpatient brain MRIs for seizure evaluation from 50% to 40%.
• To safely shift MRI utilization to the outpatient setting within 6 months.
• To standardize MRI ordering and utilization protocols.

Main Methods:

• Analyzed provider variability in MRI ordering practices.
• Developed a local guideline to standardize MRI utilization.
• Created a process map to identify and overcome barriers to outpatient MRIs.
• Implemented a streamlined, automated process for outpatient MRI referrals.

Main Results:

• Inpatient MRIs for seizure evaluation decreased from 50% to 26% post-implementation.
• Significant reductions observed across various seizure types (febrile, provoked, unprovoked).
• Guideline adherence reached 93% in the final 12 months.
• No readmissions for acute findings occurred in patients undergoing outpatient MRI.

Conclusions:

• A clinical guideline and standardized process effectively and safely reduced inpatient MRI utilization for seizure evaluations.
• The implemented changes optimized resource allocation and patient management.
• Successful shift of MRIs to outpatient settings improved efficiency without compromising patient safety.