An audit of elective outpatient magnetic resonance imaging in a tertiary South African public-sector hospital

Abstract

Background: Increasing demand for magnetic resonance imaging (MRI) has resulted in longer waiting times for elective MRI, particularly in resource-limited healthcare environments.However, inappropriate imaging requests may also contribute to prolonged MRI waiting times. At the time of the present study, the waiting time for elective MRI studies at Tygerberg Hospital (TBH), a tertiary-level public-sector healthcare facility in Cape Town (South Africa),was 24 weeks.Objectives: To document the nature and clinical appropriateness of scheduled TBH outpatient MRI examinations.Method: A retrospective analysis of the referral forms of all elective outpatient MRIexaminations scheduled at TBH from 01 June to 30 November 2011 was conducted. Patient age, gender, clinical details, provisional diagnosis, examination requested and referring clinician were recorded on a customised data sheet. Two radiologists independently evaluated the appropriateness of each request by comparing the clinical details and the provisional diagnosis provided with the 2012 American College of Radiology (ACR) guidelines for the appropriate use of MRI.Results: Four hundred and sixty-six patients (median age 42 years; interquartile range 19–55) who had 561 examinations were scheduled in the review period; 70 (15%) were children less than 6 years old. Neurosurgery (n = 164; 35%), orthopaedic (n = 144; 31%),neurology (n = 53; 11%) and paediatric (n = 27; 6%) outpatients accounted for the majority(81%) of referrals; 464 (99.6%) were from specialist clinics. MRIs of the spine (n = 314; 56%),brain (n = 152; 27%) and musculoskeletal system (n = 70, 13%) accounted for more than 95%of the investigations. In 455 cases (98%), the referral was congruent with published ACR guidelines for appropriate MRI utilisation.Conclusion: Scheduled outpatient MRI examinations at TBH reflect optimal clinical use of a limited resource. MRI utilisation is largely confined to traditional neuro-imaging. Any initiative to decrease the elective MRI waiting time should focus on service expansion.

Trends in public sector radiological usage in the Western Cape Province, South Africa: 2009–2019

“…For each new service, appropriate additional radiologist, radiographer and sonographer resources were recruited. 37,38 This study also provides novel insights into the utilisation of WCP radiological services, compared to high-income countries (Figures 1 Similarly, WCP MRI workload during the review period (1.9 vs 2.5 studies/10 3 people; 32% increase) remained, on an average, 26 times lower than the corresponding annual figures for the United States (96 vs 128/10 3 people; 33% increase), Canada (43 vs 55/10 3 people; 28% increase) and Australia (21 vs 51/10 3 people; 143% increase). 13 Local mammography utilisation (15 studies/10 3 women) in the eligible population is approximately 45-times lower than in the United Kingdom.…”

The Cinderellas of the scanner: Magnetic resonance imaging ‘pre-scan’ and ‘post-scan’ times: Their determinants and impact on patient throughput

“…Recent advances in breast, prostate, cardiac and hepatobiliary imaging have contributed to a relentless increase in service requests. 1 , 6 , 7 …”

“…Burgeoning clinical demand in the face of finite equipment resources has resulted in extended MRI waiting times worldwide. This is especially true in the public healthcare services of low- and middle-income countries (LMICs), 5 , 6 including South Africa (SA). On an average, countries of the Organization for Economic Co-operation and Development (OECD) have 70-fold more MRI units per million people than the SA public healthcare sector.…”

“…Throughout the 18 years of the service, there have been sustained efforts to enhance efficiency, extend operating hours and increase patient throughput. 6 These have been successful, to the extent that the annual caseload has increased 147% on a single machine with the same staff complement. Nonetheless, the relentless increase in clinical demand has ensured progressive lengthening of the outpatient waiting time, which reached 128 working days or almost 6 months, at the commencement of the study.…”

Defining the diagnostic divide: an analysis of registered radiological equipment resources in a low-income African country

“…There is a growing appreciation of the need for careful, coordinated strategic healthcare planning at national and international level, to meet burgeoning global service demands and ensure equitable access to care, particularly in the current economic crisis, which is expected to have far-reaching healthcare ramifications for all countries, regardless of economic status [ 31 , 32 ]. There are also increasing pressures to ensure responsible utilization of radiological resources [ 33 ]. Although there is a plethora of documentation outlining appropriate use of imaging services in well-resourced environments, there has been no work on the impact of lack of radiological resources on clinical outcomes and no attempt to define an absolute minimum requirement for imaging in the achievement of health for all.…”