دورية أكاديمية
Quality Improvement of Magnetic Resonance Imaging for Musculoskeletal Infection in Children Results in Decreased Scan Duration and Decreased Contrast Use.
| العنوان: | Quality Improvement of Magnetic Resonance Imaging for Musculoskeletal Infection in Children Results in Decreased Scan Duration and Decreased Contrast Use. |
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| المؤلفون: | Ojeaga PO; University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas., Hammer MR; Departments of Radiology (M.R.H.), Orthopaedic Surgery (L.A.C.), and Pediatrics (L.A.C.), University of Texas Southwestern, Dallas, Texas., Lindsay EA; Department of Orthopaedic Surgery, Children's Health System of Texas, Dallas, Texas., Tareen NG; Department of Orthopaedic Surgery, Children's Health System of Texas, Dallas, Texas., Jo CH; Department of Clinical Orthopaedic Research, Texas Scottish Rite Hospital for Children, Dallas, Texas., Copley LA; Departments of Radiology (M.R.H.), Orthopaedic Surgery (L.A.C.), and Pediatrics (L.A.C.), University of Texas Southwestern, Dallas, Texas. |
| المصدر: | The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2019 Sep 18; Vol. 101 (18), pp. 1679-1688. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Journal of Bone and Joint Surgery Country of Publication: United States NLM ID: 0014030 Publication Model: Print Cited Medium: Internet ISSN: 1535-1386 (Electronic) Linking ISSN: 00219355 NLM ISO Abbreviation: J Bone Joint Surg Am Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Boston, MA : Journal of Bone and Joint Surgery |
| مواضيع طبية MeSH: | Workflow*, Hospitals, Pediatric/*standards , Infections/*diagnostic imaging , Magnetic Resonance Imaging/*standards , Musculoskeletal Diseases/*diagnostic imaging , Quality Improvement/*organization & administration , Tertiary Care Centers/*standards, Adolescent ; Child ; Child, Preschool ; Clinical Protocols ; Contrast Media ; Female ; Hospitals, Pediatric/organization & administration ; Humans ; Infant ; Magnetic Resonance Imaging/methods ; Male ; Registries ; Retrospective Studies ; Tertiary Care Centers/organization & administration ; Texas ; Time Factors ; Young Adult |
| مستخلص: | Background: Magnetic resonance imaging (MRI) is a heavily utilized resource to evaluate children suspected to have a musculoskeletal infection. Complex interdisciplinary workflows are involved with decision-making with regard to indications, anesthesia, contrast use, and procedural timing relative to the scan. This study assesses the impact of a quality improvement endeavor on MRI workflows at a tertiary pediatric medical center. Methods: A registry of consecutively enrolled children for a multidisciplinary musculoskeletal infection program identified those evaluated with MRI from 2012 to 2018. Annual MRI process improvement feedback was provided to the key stakeholders. Demographic characteristics, laboratory parameters, MRI indications, anesthesia use, MRI findings, final diagnoses, scan duration, imaging protocol, surgical intervention following MRI, and length of stay were retrospectively compared between the 3 cohorts (initial, middle, and final) representing 2-year increments to assess the impact of the initiative. Results: There were 526 original MRI scans performed to evaluate 1,845 children with suspected musculoskeletal infection. Anesthesia was used in 401 children (76.2%). When comparing the initial, middle, and final study period cohorts, significant improvement was demonstrated for the number of sequences per scan (7.5 sequences for the initial cohort, 5.8 sequences for the middle cohort, and 4.6 sequences for the final cohort; p < 0.00001), scan duration (73.6 minutes for the initial cohort, 52.1 minutes for the middle cohort, and 34.9 minutes for the final cohort; p < 0.00001), anesthesia duration (94.1 minutes for the initial cohort, 68.9 minutes for the middle cohort, and 53.2 minutes for the final cohort; p < 0.00001), and the rate of contrast use (87.6% for the initial cohort, 67.7% for the middle cohort, and 26.3% for the final cohort; p < 0.00001). There was also a trend toward a higher rate of procedures under continued anesthesia immediately following the MRI (70.2% in the initial cohort, 77.8% in the middle cohort, and 84.6% in the final cohort). During the final 6-month period, the mean scan duration was 24.4 minutes, anesthesia duration was 40.9 minutes, and the rate of contrast administration was 8.5%. Conclusions: Progressive quality improvement through collaborative interdisciplinary communication and workflow redesign led to improved utilization of MRI and minimized contrast use for suspected musculoskeletal infection. There was a high rate of procedural intervention under continued anesthesia for children with confirmed musculoskeletal infection. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| المشرفين على المادة: | 0 (Contrast Media) |
| تواريخ الأحداث: | Date Created: 20191001 Date Completed: 20200217 Latest Revision: 20200217 |
| رمز التحديث: | 20221213 |
| DOI: | 10.2106/JBJS.19.00035 |
| PMID: | 31567805 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1535-1386 |
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| DOI: | 10.2106/JBJS.19.00035 |