Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
Institute of Cardiovascular Sciences, University College London, London, UK.
BMJ Qual Saf. 2019 Oct;28(10):853-858. doi: 10.1136/bmjqs-2018-009079. Epub 2019 Feb 13.
Patients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist.
To deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs).
Patients requested a 'one-stop' service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this 'one-stop' service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed.
215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation.
Implementation of a 'one-stop' service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.
由于心脏起搏器和除颤器患者获取磁共振成像（MRI）扫描的机会有限，导致他们往往无法得到及时诊断，尤其是癌症和神经疾病，这种情况并不少见。如今，结合新技术和经过验证的方案，此类患者可安全地进行 MRI 扫描，但仍存在一些实际操作方面的障碍。
建立一个流程简化、可持续的服务体系，为心脏植入式电子设备（CIED）患者提供及时的 MRI 扫描。
我们为患者提供了一站式 MRI 服务，即患者可在同一地点和就诊过程中对设备进行重新编程和扫描。为了提供这项“一站式”服务，我们培训了一支由行政人员、医生、心脏生理学家和放射技师组成的团队。我们使用标准方案来防止不必要的申请被拒绝以及预约流程被延误。我们分析了服务模式改变前后 6 个月和 2 年的服务量、等待时间和安全性。我们还分析了内部和外部住院患者转诊的等待时间以及癌症患者的治疗时间。
在两年内共进行了 215 次 MRI 扫描。在服务模式改变后，MRI 检查次数增加了六倍，达到全国平均水平的 20 倍，同时将等待时间从 60 天缩短至 15 天，并且没有出现不良事件。该部门的流程效率保持不变。85 次（40%）转诊来自外部。41 名（19%）住院患者接受了扫描，内部转诊患者的住院时间减少了 3 天。24 次（11%）扫描用于疑似癌症患者，83%的患者可在国家规定的 62 天内接受治疗。此前，无论是住院患者还是疑似癌症患者都没有相应的服务。
为 CIED 患者实施“一站式”服务模式以提供 MRI 检查是安全、简化、可扩展的，同时减少了延误，具有经济和临床意义。mrimypacemaker.com 上提供了方案和检查表。
