Department of Spine, Trauma and Orthopaedics, Queen Elizabeth University Hospital, 1345 Govan Road, Govan, Glasgow, G51 4TF, UK.
Department of Management Science, University of Strathclyde Business School, Glasgow, UK.
Eur Spine J. 2018 Oct;27(10):2436-2441. doi: 10.1007/s00586-018-5578-0. Epub 2018 Apr 10.
To define if MRI scans can accurately be requested based on information provided in the primary care referral and, therefore, streamline the patient journey. 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.
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.
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.
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. These slides can be retrieved under Electronic Supplementary Material.
确定是否可以根据初级保健转诊中提供的信息准确地要求进行 MRI 扫描，从而简化患者的就诊流程。门诊脊柱预约的需求大大超过了我们提供高效、高质量患者护理的能力。目前，在首次就诊后会要求进行脊柱磁共振成像（MRI）检查。
在对初级保健转诊信进行常规审查期间，三位顾问脊柱外科医生记录了他们认为每位患者进行 MRI 扫描的可能性。在接受脊柱服务的首次咨询后，会审查每位患者的记录，以确定是否要求进行 MRI 检查。我们测量了根据初级保健转诊信进行 MRI 扫描的订单的阳性预测值（PPV）、阴性预测值（NPV）、敏感性和特异性。
共纳入 149 名患者[101 名女性，48 名男性，平均年龄 49 岁（16-87 岁）]。有 125 例常规转诊，21 例紧急转诊，3 例“紧急疑似癌症”转诊。在首次就诊前进行 MRI 检查的订单的 PPV 为 84%，NPV 为 56%，敏感性和特异性分别为 82%和 59%。在初始审查期间订购 MRI 可以缩短患者的就诊流程，并带来潜在的社会经济效益。
可以根据初级保健转诊信提供的信息有效地订购 MRI 扫描。在患者就诊流程的早期要求进行 MRI 扫描可以节省大量时间，改善护理，并节省成本。这些幻灯片可以在电子补充材料中检索到。
