Introduction: There are half a million people with cardiac pacemakers in the UK who are denied access to magnetic resonance imaging (MRI) when clinically indicated. Patients are fifty times less likely to be referred and there is a thirty-fold service under provision because provision is logistically difficult – it needs experts in both MRI and cardiology to work together. This has serious consequences (e.g. cancer care and stroke). There is a national shortage of physiologists in the UK and their time is needed to plan scans, review device details. check devices pre- and post MRI and communicate at multiple time points to multiple professional teams.
Methods: Barts developed a unique platform, called PaceMRI, created by healthcare professionals for healthcare professionals with support from medical professional bodies and patient charities. The platform has been designed to facilitate referrals when clinically indicated, identify and explain risjs to patients and referrers, streamline collecting device information and automatically look up MRI protocols based on the scenario and device implanted following UK guidelines. Changes to the platform have been staged with iterative feedback during service use. Paired parametric tests were used to compare data 6 months pre- and post-platform implementation. A questionnaire was given to patients with implanted cardiac devices (bradycardia and tachycardia devices) to assess the requirement and importance of digital device ID cards.
Results: Patient benefits: Patients have benefitted from faster access to clinically vital MRI scans. The median time from a clinical decision that a scan was required to the scan occurring, for outpatients within our trust, reduced to 24 days (inter-quartile range [IQR]: 18–33) from 28 days (IQR 7–60) (p=x) after platform implementation. For all patients, the median time from the referral being received to the scan being performed reduced to 13 days (IQR: 7–20) from 15 days (IQR: 8–32, p=ns). Despite the increased service and logistical demands, this is superior to the average national wait times from referral to scan for general MRI (20 days [NHS diagnostic waiting times, September 2022]). The number of patients waiting for longer than 6 weeks from referral to scan is also lower than the national average for general MRI (14% versus 23.9%).
Service benefits: Utilising PaceMRI has increased service provision and widened access. 385 referrals were received and 129 scans were completed (from 22 centres, 5 of which had not referred previously) over a 6-month period. Referrals increased from 5.6 ± 1.6 to 6.6 ± 2.2 per week (p=0.003), with more external referrals after implementation (53–78%, p<0.05). Most referrals were from Greater London, from non-cardiology referrers (53–64%, p<0.05), with 64% urgent and 16% inpatient requests (pre-implementation: 63% and 23% respectively, p=ns). 29% of scans were requested as part of cancer diagnosis or management (30% pre-implementation, p=ns). The quality of referral also increased; referrers correctly identified device information in 74% of referrals, were unsure in 14% and provided inadequate information in 37% (compared with 37%, 58% and 76% respectively pre-implementation, p<0.05). There were no MRI related device complications despite this increase in service use.
Conclusions: A referrals management platform has demonstrated access to MRI for patients with pacemakers, saves time for referrers and service providers whilst facilitating safe MRI provision. ❑
