Magnetic resonance imaging (MRI) of the lumbar spine was selected as the pilot project to test the Appropriateness of Care Framework in 2015-16. Its goal was improving appropriateness of MRI requests related to patients experiencing low back pain. A provincial team of clinical experts (including radiologists, orthopedic surgeons, neurosurgeons, a chiropractor and family practitioners) and patients from Saskatoon and Regina Qu’Appelle Health Regions contributed to the improvement work.
When these experts looked at previous MRI requisitions to determine if appropriateness was an issue for this type of lumbar spine imaging in Saskatchewan, they found that many of the requisitions submitted by physicians did not provide enough information to make this assessment. The team then brainstormed about ways to increase the amount of information provided by referring physicians when requesting an MRI for patients.
A checklist was developed as a clinical decision tool to help referring physicians determine if a lumbar spine MRI is an appropriate test for their patient, and also to provide the radiologist with enhanced information. This checklist is now mandatory for all lumbar spine MRI requisitions. Unlike some other jurisdictions, where up to 30% of lumbar spine MRIs are considered inappropriate, the team found that Saskatchewan has very few lumbar spine MRI requests that do not meet appropriateness criteria.
After a four-month trial period, the checklist was modified based on physicians’ feedback. This finalized version was distributed to physicians and medical imaging offices throughout the province, including the MRI facility in Moose Jaw’s new regional hospital.
This pilot project was successful in large part due to the collaborative efforts of family physicians, specialists, and medical imaging departments in both Saskatoon and Regina Qu’Appelle Health Regions.