Title : Service evaluation of urgent spinal MRI requests for back pain patients in an orthopaedic department
Abstract:
Background and Rationale: There has been a significant rise in urgent spinal MRI scan requests for patients presenting with back pain during on-call sessions within the orthopaedic department. The increase in these requests not only burdens hospital resources but may offer limited clinical benefit. This service evaluation aims to review the departmental practices for requesting urgent spinal MRI scans and align them with national guidelines to ensure optimal care and resource utilization.
Aims and Objectives:
1. Quantify the number of urgent spinal MRI scan referrals for back pain.
2. Assess the appropriateness of these requests by comparing them to national guidelines.
3. Review MRI scan results and their clinical impact.
4. Investigate discussions with the spinal team regarding patient care.
5. Estimate the financial implications of current MRI usage and propose recommendations for future practice.
Methodology: Data was collected retrospectively on 285 patients presenting with non-traumatic spinal concerns between 01/07/2023 and 31/12/2023. Patient data, including demographic information, referral reasons, and MRI results, were gathered from trauma lists and analyzed using Excel. This was compared against national standards for cauda equina syndrome (CES) and other spinal pathologies.
Results: The evaluation reveals a substantial overuse of urgent MRI scans, resulting in significant financial implications for the Trust. A preliminary analysis of the MRI data demonstrates a discrepancy between the number of referrals and the presence of red flags, with only 53% of referred patients identified as having red flag symptoms. Despite this, 63% of referred patients underwent MRI scans. The findings were as follows: 55% of the scans revealed disc bulge or prolapse, 20% were normal, 9% showed degenerative changes, and 5% confirmed cauda equina syndrome (CES).
Conclusion and Recommendations: A more selective approach to MRI scan requests is essential to ensure alignment with national guidelines, reduce unnecessary imaging, and lower costs. Future actions will involve revising departmental protocols, improving documentation practices, and providing staff training on appropriate MRI referral criteria. Additionally, a decrease in the number of positive CES diagnoses on MRI, coupled with an increase in the incidence of CES, is indicative of improved access to MRI scanning.
