P0378 - Cardiac MRI Productivity Increases with High-Quality Structured Pre-appointment Telephone Contact

Background

Cardiac MRI is often an essential component for the diagnosis and follow-up of cardiac disease in both children and adults. These studies can be time intensive and often require anesthesia support. Unfilled cardiac MRI appointments therefore unnecessarily delay availability and decrease productivity.

At our institution, we recognized a backlog of cases due to a high number of patients canceling 2-4 days before the appointment during the pre-procedural telephone screening or simply not keeping their appointments. Such late cancelations were often unable to be filled due to a variety of barriers.

This quality improvement project sought to increase the utilization of cardiac MRI by implementing new communication procedures prior the patient’s study.

Methodology

A cardiology nurse was tasked with contacting each scheduled patient 21 days prior to their MRI and requiring confirmation within 7 days that the patient would be able to attend. In cases where a patient was unable to confirm, they were rescheduled, and their spot filled with another patient from the wait list who was able to confirm.

To evaluate this intervention, we tracked service utilization for the 7 months before implementation of this policy, and for 10 months afterwards, up until the routine outpatient service was suspended due to the COVID-19 pandemic. Monthly utilization was charted on a statistical process control X-chart with control limits set at +/- 2.66 moving range averages. Consecutive data points above or below the mean indicated special cause variation, resulting in a shift of the mean line.

Results and Discussion

There was special cause variation associated with the new communication procedure, resulting in a significant increase in the average number of monthly studies from 18 to 24.3. Our utilization of available appointments also increased from 59.4% to 75.3% following the policy change. A second shift back to baseline occurred once our patient backlog was exhausted, though the utilization of available appointments remained slightly higher than baseline at 64.2%.

These results suggest that with this new policy, our cardiac MRI service can be run at a utilization rate which exceeds our current demand. Future directions for improvement may include re-allocating cardiac MRI slots for other services, or adding other types of MRI into our waiting list.

Conclusion

Our policy intervention of calling all patients 21 days prior to their cardiac MRI studies to confirm their appointments, resulted in a significant improvement in service utilization. This persisted until our backlog of cases was exhausted, and suggests that this intervention allows our service to run at a utilization rate which exceeds our current demand.