Combined lumbar spine MRI and CT appropriateness checklist: a quality improvement project in Saskatchewan, Canada

Maryam Madani Larijani; Amir Azizian; Tracey Carr; Scott J Adams; Gary Groot

doi:10.1093/intqhc/mzab120

Combined lumbar spine MRI and CT appropriateness checklist: a quality improvement project in Saskatchewan, Canada

Int J Qual Health Care. 2021 Aug 28;33(3):mzab120. doi: 10.1093/intqhc/mzab120.

Authors

Maryam Madani Larijani¹, Amir Azizian², Tracey Carr¹, Scott J Adams³, Gary Groot¹

Affiliations

¹ Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada.
² Saskatchewan Health Quality Council, Innovation Place, The Atrium, 111 Research Drive, Saskatoon, SK S7N 3R2, Canada.
³ Department of Medical Imaging, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.

Abstract

Background: As rates of advanced imaging for lower back pain (LBP) continue to increase, there is a need to ensure the appropriateness of imaging.

Objective: The goal of this project was to reduce the number of inappropriate magnetic resonance imaging (MRI) and computed tomography (CT) requests for LBP patients and facilitate appropriate imaging by developing a combined imaging appropriateness checklist for lumbar spine MRI and CT.

Methods: In prior work, we developed and adopted individual evidence-based lumbar spine MRI and CT checklists into the radiology requisition process. In the current project, a combined checklist was developed and trialed in one of the former Saskatchewan health regions (Five Hills) beginning in May 2018. Using statistical process control, control charts compared the monthly number of imaging requests pre-checklist implementation and post-checklist implementation from May 2017 to February 2020. The monthly number of lumbar spine MRI and CT requisitions in the nearby former Saskatchewan Regina Qu'Appelle Health Region, in which the combined checklist was not trialed, was also plotted and compared as a balancing measure.

Results: In Five Hills, a shift (decrease) was observed in the monthly number of lumbar spine MRI requisitions 7 months following the implementation of the combined checklist. However, the monthly number of lumbar spine CT requisitions did not change significantly. In the Regina Qu'Appelle Health Region, there was a shift (increase) in the monthly number of lumbar spine MRI requisitions, while the monthly number of lumbar spine CT requests decreased after the implementation of the combined checklist.

Conclusions: The combined checklist with evidence-based indications for lumbar spine MRI and CT imaging in LBP patients appeared to reduce the complexity associated with two previous individual checklists and facilitate imaging appropriateness. Accountable benefits may include the reduction of radiation exposure as a result of unnecessary and repeated imaging and reduction in wait times for CT and/or MRI.

Keywords: checklist; computed tomography; imaging order appropriateness; lower back pain; magnetic resonance imaging; quality improvement.

MeSH terms

Checklist*
Humans
Magnetic Resonance Imaging
Quality Improvement*
Referral and Consultation
Saskatchewan
Tomography, X-Ray Computed