Having standardized care level guidelines can help determine which patients in the MRI suite when their condition escalates, according to findings published September 11 in Academic Radiology.
Hospitals that adopted MRI care level guidelines saw their deterioration of condition events decrease compared to those that did not, wrote a team led by Jonathan Garner from Georgetown University in Washington, D.C. and colleagues.
“We believe that the MRI care levels presented here are generalizable and can be easily adapted to other hospital systems and possibly integrated into other EMRs,” the Garner team wrote.
Deterioration of condition is one of the major safety challenges of inpatient MRI. Inpatients who are often sick and need monitoring before, during, and after scanning, are at risk of experiencing these events during their lengthy stay in the MRI department. The researchers noted that the safety of sick patients in the MRI suite is “underrecognized,” and that managing these patients can affect workflow efficiency.
Caring for these patients requires coordination between MRI technologists and the inpatient care team, with communication failures contributing to safety events.
Garner and colleagues in 2022 implemented standardized MRI care level guidelines and an EMR-integrated dashboard. These guidelines stratify patients into three levels: care level 1 (no risk factors present), care level 2 (additional monitoring during MRI exam), and care level 3 (more likely to have MRIs with lower image quality due to patient motion and higher risk of deterioration of condition).
The Garner team studied the adoption and impact of MRI care level guidelines and an EMR-integrated dashboard on the rate of deterioration of condition events in their hospital system.
It analyzed inpatient MRI orders and safety events recorded between 2020 and 2024 across nine hospitals. From there, it used descriptive statistics to study adoption rates of the EMR-integrated dashboard and to calculate deterioration of condition event rates per 10,000 completed MRI orders before and after implementation.
Five of nine hospitals adopted the care level guidelines, which included one university-affiliated academic hospital and four community hospitals. And 47% of screened orders at participating hospitals were assigned a care level.
Deterioration of condition rates declined at the participating hospitals from 2.11 to 0.45 per 10,000 MRI orders but increased at non-participating sites from 1.31 to 1.49 per 10,000 orders.
Severe deterioration of condition events, such as cardiopulmonary resuscitation, dropped from 0.20 to 0 per 10,000 MRI orders at participating sites while rising from 0.26 to 0.37 per 10,000 orders at non-participating hospitals.
The MRI care levels provide a common language for MRI inpatients that extend toward everyday clinical practice, the study authors wrote.
“Our initiative involving providers from the departments of radiology, nursing, informatics, and quality and safety teams not only produced tangible benefits in the form of new MRI care levels and an EMR dashboard but also positively influenced the safety culture surrounding MRI inpatient safety via collaboration between a diverse group of stakeholders,” they added.
Read the full study here.