Changing primary care requesting practices for MRI knee: A quality improvement project

Objectives: The objectives of this work were first to examine referral practices from primary care for MRI knee in patients >= 45 years old and then to develop a new referral pathway to reduce the number of inappropriate MRI knee referrals. Following this, the aim was to re-assess the effect of the intervention and identify further areas for improvement. Methods: A baseline retrospective analysis of knee MRIs requested from primary care in symptomatic patients >= 45years over a two-month period was undertaken. A new referral pathway was implemented in consensus with orthopaedic specialists and the clinical commissioning group (CCG), via the CCG resource webpage and local education. Following implementation, a repeat data analysis was undertaken. Results: The number of MRI knees acquired from primary care referrals reduced by 42% after the new pathway was implemented. 67% (46/69) were compliant with the new guidelines. The number of pa-tients having an MRI knee without a prior plain radiograph was 14/69 (20%) compared to 55/118 (47%) prior the pathway changes. Conclusion: The new referral pathway reduced the number of knee MRI acquisitions in primary care patients >= 45 years by 42%. Changing the pathway has decreased the number of patients undergoing MRI knee without a prior radiograph from 47% to 20%. These outcomes bring our standards towards the evidence-based recommendations of the Royal College of Radiology and have reduced our outpatient waiting list for MRI knee. Implications for practice: Implementing a new referral pathway with the local CCG can successfully reduce the number of inappropriate MRI knee acquisitions from primary care referrals in older symptomatic patients.(c) 2023 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.