Asch Daniella, Gunabushanam Gowthaman, Cole Kelsey, Holland Christine, Pahade Jay K
Yale University, New Haven, USA.
Yale New Haven Health System, New Haven, USA.
Abdom Radiol (NY). 2025 May 29. doi: 10.1007/s00261-025-05022-7.
Decrease unnecessary abdominal MRI with intravenous contrast with MRCP exams for emergency department and inpatients.
Our institution's two MRCP orders were removed from the electronic medical record (one with intravenous (IV) contrast and the other without), with all providers directed to a new MRCP clinical care pathway containing clinical guidance and links to the appropriate orders based on indication and patient characteristics. Before and after deployment, a random set of MRCP with contrast orders were reviewed for clinical appropriateness of needing IV contrast. A manual tracking of "patient in room" time was performed to compare MRI resource use for MRCP exams with contrast vs. non-contrast. A commercial clinical decision support (CDS) tool was active throughout the study period. Statistical significance was assessed with Chi-square test.
At baseline, 71% (142/200) of MRCP exams were completed with contrast and 29% (58/200) without contrast. After two plan-do-study-act (PDSA) cycles, percentage of MRCPs performed with contrast decreased to 56% (p = 0.003), a 22% relative decrease, and MRCPs performed without contrast increased to 44%, a 53% relative increase. At baseline, contrast use was deemed inappropriate in 54% (29/54) of MRCP studies. Reassessment after PDSA cycle 1 showed a decrease in inappropriate MRCP with contrast orders to 25% (9/36), a 53% relative decrease (p = 0.007). Mean "in room" time was 11.5 min longer for MRCP with contrast exams.
Despite CDS, MRCP with contrast orders were deemed inappropriate 54% of the time at baseline. Redesigning the MRCP ordering process via creation of a pathway with embedded clinical guidance significantly decreased the proportion of contrast-enhanced MRCP exams by 22% and improved relative clinical appropriateness of MRCP with contrast exams by 62%. Properly directing ordering providers to non-contrast MRCP orders can help reduce healthcare costs, reduce unnecessary gadolinium exposure, and improve MR scanner efficiency.
减少急诊科和住院患者在磁共振胰胆管造影（MRCP）检查中使用静脉造影剂进行不必要的腹部磁共振成像（MRI）。
从电子病历中删除了本院的两份MRCP医嘱（一份使用静脉造影剂，另一份未使用），并指导所有医疗服务提供者遵循新的MRCP临床护理路径，该路径包含临床指南以及根据适应症和患者特征链接到适当医嘱的链接。在部署前后，随机抽取一组使用造影剂的MRCP医嘱，审查其使用静脉造影剂的临床适宜性。人工跟踪“患者在检查室”的时间，以比较使用造影剂与不使用造影剂的MRCP检查的MRI资源使用情况。在整个研究期间，一种商业临床决策支持（CDS）工具一直处于启用状态。采用卡方检验评估统计学显著性。
基线时，71%（142/200）的MRCP检查使用了造影剂，29%（58/200）未使用造影剂。经过两个计划-实施-研究-改进（PDSA）循环后，使用造影剂进行的MRCP检查比例降至56%（p = 0.003），相对下降了22%，未使用造影剂的MRCP检查比例增至44%，相对增加了53%。基线时，54%（29/54）的MRCP检查被认为造影剂使用不当。PDSA循环1后的重新评估显示，使用造影剂的不当MRCP医嘱减少至25%（9/36），相对下降了53%（p = 0.007）。使用造影剂的MRCP检查的平均“在检查室”时间长11.5分钟。
尽管有CDS，但基线时54%的使用造影剂的MRCP医嘱被认为是不适当的。通过创建包含嵌入式临床指南的路径重新设计MRCP医嘱流程，显著降低了增强造影MRCP检查的比例22%，并将使用造影剂的MRCP检查的相对临床适宜性提高了62%。正确指导医嘱开具者选择无造影剂的MRCP医嘱有助于降低医疗成本、减少不必要的钆暴露并提高MR扫描仪的效率。
