Enhancing Inpatient MRI Safety and Workflow Using Standardized MRI Care Level Guidelines and Electronic Medical...

Inpatient magnetic resonance imaging (MRI) presents safety challenges, with deterioration of condition (DOC) as the most serious MRI-related safety event in our health system. To address these risks, standardized MRI Care Level (CL) guidelines and an Electronic Medical Record (EMR)-integrated dashboard were implemented in November, 2022. The CL guidelines stratify patients into three levels, with CL3 patients at highest risk of DOC events. This study evaluates the adoption and impact of MRI Care Level guidelines and an EMR-integrated dashboard on the rate of DOC events in the hospital system.

Inpatient MRI orders and safety events were analyzed from June 01, 2020 to April 30, 2024 across nine hospitals. Descriptive statistics were used to assess adoption rates of the EMR-integrated dashboard and to calculate DOC event rates per 10,000 completed MRI orders before and after implementation.

Five of nine hospitals adopted CL guidelines (participating hospitals); one university-affiliated academic (AH) and four community (CH). 47% of screened orders at participating hospitals were assigned a CL. In AH, 58.5% CL1, 25.1% CL2, 16.4% CL3; in CH, 75.5% CL1, 20.6% CL2, 3.9% CL3. Post-implementation, DOC rates per 10,000 MRIs decreased at participating sites (2.11 to 0.45) but increased at non-participating sites (1.31 to 1.49). Similarly, severe DOC (Cardiopulmonary Resuscitation (CPR)/death) dropped from 0.20 to 0 at participating sites while rising from 0.26 to 0.37 at non-participating hospitals.

Implementation of standardized CL guidelines was followed by a reduction of DOC events at hospitals that have adopted the new MRI Dashboard and safety measures.