Quality Improvement (QI) Campaign Improved Utilization of Rapid Sequence MRI (rsMRI) for Diagnosis of Pediatric Appendicitis | QI campaign (May 2021) | Mixed methods study | 2016 - 2022 | Appendicitis patients | MRI protocol: | ≥7 years with suspected appendicitis and equivocal ultrasound or negative | If abscess is present CT should be use instead | RESULTS | Conclusion: | Significant ↓ in rate of CTs & ↑ in rate of rsMRIs performed | (p < 0.0001) | Their QI project lead to less CT scan and more MRI with similar diagnostic results and less radiation. | https://www.jpedsurg.org/article/S0022-3468(23)00344-5/ | Source: Lyttle BD et. al. | General Surgery, Department of Surgery, University of Colorado School of Medicine, USA | @StayCurrentMD | @gigenace | Cincinnati Children's | Journal of Pediatric Surgery
Quality Improvement Campaign Improved Utilization of Rapid Sequence MRI for Diagnosis of Pediatric Appendicitis
Infographic · Mar 2024 · 1 min read
In brief
In brief
Quality improvement campaign successfully shifted pediatric appendicitis imaging from CT to rapid-sequence MRI, reducing CT use by 60% while increasing MRI use 9.5-fold. Stakeholder interviews and targeted interventions overcame barriers to MRI adoption, demonstrating radiation reduction without compromising diagnostic accuracy.
- CT was overused for pediatric appendicitis despite available MRI, exposing children to unnecessary radiation.
- Stakeholder-informed QI campaign reduced CT use by 60% and increased rapid-sequence MRI use 9.5-fold.
- Rapid-sequence MRI protocols can replace CT for equivocal ultrasound findings when institutional barriers are addressed.
- Quality improvement interventions can successfully shift imaging practices toward radiation-free modalities in pediatric surgery.
- Midway feedback surveys during QI campaigns help identify and overcome provider adoption barriers.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with a timeline spanning 2016-2022, marked by a lightning bolt icon at May 2021 indicating the QI campaign intervention. Icons include a calendar with clock, intestine illustration, and hospital logo. Results are displayed with large red down arrow and green up arrow showing opposing trends in CT versus MRI utilization.
New infographic you should know from Journal of Pediatric Surgery by Cecilia Gigena
"Quality Improvement Campaign Improved Utilization of Rapid Sequence MRI for Diagnosis of Pediatric Appendicitis"
Authors: Bailey D. Lyttle, Marina L. Reppucci, Connor Prendergast, Ioannis A. Ziogas, Suhong Tong, Shannon N. Acker, Sarah Milla, Jeffrey J. Tutman, Amanda Rutherford, Jonathan Orsborn, Tellen D. Bennett, Lisa DeCamp, Jose L. Diaz-Miron
Full article: https://gcmd.co/3wFqtMo
Introduction
Appendicitis is the most common indication for emergency general surgery in the pediatric population. Computed tomography (CT) or magnetic resonance imaging (MRI) may be used for diagnosis when ultrasound findings are equivocal. However, CT involves unnecessary radiation exposure if MRI is available. After introducing a rapid sequence MRI (rsMRI) appendicitis protocol at our institution, CT was still preferentially used. We therefore implemented a quality improvement (QI) campaign to reduce the rate of CTs and increase the rate of rsMRI. Here, we assess the effectiveness of the QI campaign while evaluating potential barriers to using rsMRI.
Methods
We conducted a mixed methods study, first performing stakeholder interviews which informed the design of a QI campaign initiated in May 2021 and a midway feedback survey in December 2021. A retrospective cohort study was then performed of children evaluated for appendicitis at our institution between January 1, 2016, and April 30, 2022. CT and rsMRI rates were compared before and after QI campaign implementation.
Results
There was a significant decrease in rate of CTs and increase in rate of rsMRIs performed following the initiation of the QI campaign (p < 0.0001). The rate of CT scans decreased by a factor of 0.4 while the rate of rsMRI increased by a factor of 9.5.
Conclusion
A successful QI campaign was initiated at our institution, resulting in decreased utilization of CT and increased use of rsMRI for the evaluation of suspected appendicitis. These results highlight the potential impact of QI projects.