Abstract
Objective
To define if MRI scans can accurately be requested based on information provided in the primary care referral and, therefore, streamline the patient journey.
Summary of background data
The demand for outpatient spinal appointments significantly exceeds our services’ ability to provide efficient, high-quality patient care. Currently, magnetic resonance imaging (MRI) of the spine is requested following first consultation.
Methods
During routine vetting of primary care referral letters, three consultant spinal surgeons recorded how likely they thought each patient would be to have an MRI scan. Following the first consultation with the spinal service, the notes of each patient were reviewed to see if an MRI was requested. We measured the positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of ordering MRI scans based on primary care referral letters.
Results
149 patients were included [101 females, 48 males, mean age 49 (16–87)]. There were 125 routine, 21 urgent, and 3 ‘urgent-suspected cancer’ referrals. The PPV of ordering MRIs before first consultation was 84%, NPV was 56% with the sensitivity and specificity being 82 and 59%, respectively. Ordering MRIs during initial vetting could shorten the patient journey with potential socioeconomic benefits.
Conclusions
MRI scans can be effectively ordered based on the information provided by the primary care referral letter. Requesting MRI scans early in the patient journey can save considerable time, improve care, and deliver cost savings.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
(2016) The modern outpatient: a collaborative approach 2017–2020. http://www.gov.scot/Resource/0051/00510930.pdf. Accessed 2 May 2017
Fourney DR, Dettori JR, Hall H et al (2011) A systematic review of clinical pathways for lower back pain and introduction of the Saskatchewan Spine Pathway. Spine 1(36):S164–S171
Kindrachuk DR, Fourney DR (2014) Spine surgery referrals redirected through a multidisciplinary care pathway: effects of nonsurgeon triage including MRI utilization: clinical article. J Neurosurg Spine 20(1):87–92
Wilgenbusch CS, Wu AS, Fourney DR (2014) Triage of spine surgery referrals through a multidisciplinary care pathway: a value-based comparison with conventional referral processes. Spine 39(22S):S129–S135
McEvoy C, Wiles L, Bernhardsson S et al (2015) Triage for patients with spinal complaints: a systematic review of the literature. Physiother Res Int 22(1). https://doi.org/10.1002/pri.1639
(2010) NHS Greater Glasgow and Clyde: pathway for the physiotherapy management of low back pain. http://www.generalpracticemedicine.org/Pathway%20Document%202%201%20.pdf. Accessed 2 May 2017
Wood L, Hendrick P, Boszczyk B et al (2016) A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting. Ann R Coll Surg Engl 98(03):187–191
You JJ, Bederman SS, Symons S et al (2013) Patterns of care after magnetic resonance imaging of the spine in primary care. Spine 38(1):51–59
Gough-Palmer AL, Burnett C, Gedroyc WM (2009) Open access to MRI for general practitioners: 12 years’ experience at one institution—a retrospective analysis. Br J Radiol 82(980):687–690
(2013) National Institute for Health and Clinical Excellence. Low back pain and sciatica in over 16s. NICE guideline (NG 59). https://www.nice.org.uk/guidance/ng59. Accessed 2 May 2017
de Schepper EI, Koes BW, Veldhuizen EF, Oei EH, Bierma-Zeinstra SM, Luijsterburg PA (2015) Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general practice. Fam Pract 33(1):51–56
Remedios D, France B, Alexander M (2017) Making the best value of clinical radiology: iRefer Guidelines. Clin Radiol 72(9):705–707
de Schepper EI, Koes BW, Oei EH, Bierma-Zeinstra SM, Luijsterburg PA (2016) The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study. Eur Spine J 25(4):1234–1241
(2015) National Institute for Health and Clinical Excellence. Suspected cancer: recognition and referral. NICE guideline (NG 12). https://www.nice.org.uk/guidance/ng12. Accessed 2 May 2017
Jenkins PJ, Morton A, Anderson G et al (2016) Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Jt Res 5(2):33–36
McKirdy A, Imbuldeniya AM (2017) The clinical and cost effectiveness of a virtual fracture clinic service. Bone Jt Res 6(5):259–269
Kingsbury SR, Dube B, Thomas CM et al (2016) Is a questionnaire and radiograph-based follow-up model for patients with primary hip and knee arthroplasty a viable alternative to traditional regular outpatient follow-up clinic? Bone Jt J 98(2):201–208
Bhattacharyya R, Jayaram PR, Holliday R et al (2017) The virtual fracture clinic: reducing unnecessary review of clavicle fractures. Injury 48(3):720–723
Jamaludin A, Lootus M, Kadir T, Zisserman A, Urban J, Battié MC, Fairbank J, McCall I (2017) Genodisc Consortium. ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017: automation of reading of radiological features from magnetic resonance images (MRIs) of the lumbar spine without human intervention is comparable with an expert radiologist. Eur Spine J 26(5):1374–1383
Berg HE (2017) Will intelligent machine learning revolutionize orthopedic imaging? Acta Orthop 88(6):577
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No conflict of interest. No funds were received in support of this work. No relevant financial activities outside the submitted work.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Liew, I., Dean, F., Anderson, G. et al. Requesting spinal MRIs effectively from primary care referrals. Eur Spine J 27, 2436–2441 (2018). https://doi.org/10.1007/s00586-018-5578-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5578-0