Management of MRI Wait Lists in Canada
Derek J. Emery, Alan J. Forster, Kaveh G. Shojania, Stephanie Magnan, Michelle Tubman and Thomas E. Feasby
Excessive wait times for magnetic resonance imaging (MRI) studies are a major problem in the Canadian healthcare system. To determine how requests for MRI studies are managed, the authors performed a survey of public MRI facilities in Canada. Ninety-six per cent had some method to triage MRI requests. However, only 42% had documented guidelines for prioritization, and none employed quality assurance methods to ensure that guidelines were followed. Target timelines for each prioritization category varied widely. Sixteen per cent of centres were not able to meet their target timelines for any prioritization category, and 45% of centres met target times only for some prioritization categories. Strategies for dealing with wait lists primarily involved attempts to increase capacity. No centres attempted to reduce wait times by decreasing inappropriate requests. There appears to be a need to standardize MRI wait list management given the variation in management practices and wait times observed.
Excessive wait times for some healthcare interventions have caught the attention of governments, providers and the public (Sanmartin et al. 2000). Of particular interest to these groups are cardiac surgery, joint replacement surgery, cancer care and advanced diagnostic imaging, specifically magnetic resonance imaging (MRI). Wait times for diagnostic imaging are particularly important because they may result in delays in definitive treatment.
Efforts to reduce wait times for MRI have focused on increasing the number of diagnostic imaging devices, as Canada lags far behind other countries in this regard. For instance, Japan and the United States have 35.3 and 19.5 MRI units per million population, respectively, whereas Canada has only 4.6. (Stein 2005). The number of MRI scanners in Canada is lower than the median of 6.1 scanners per million for all countries within the Organisation for Economic Co-operation and Development (Stein 2005). The optimal number of MRI machines per capita has not been established, and the number of scanners does not indicate the number of patients scanned; however, it does provide an indication of capacity. While Canadian provinces have recently increased the number of imaging devices, it is unlikely that Canada will have such ready access to imaging as these other countries. Therefore, other approaches to wait time reduction are needed.
Improving the management of wait lists represents another approach to reducing wait times. This strategy might include the development of criteria for determining the appropriateness of imaging requests, which in turn could be used to help triage their relative urgency. A similar approach has been used for cardiac surgery (Naylor et al. 2000). In this setting, these criteria make wait list assignment more objective and equitable while also improving overall efficiency. Although the development of appropriateness criteria for MRI scanning has received some attention (Canadian Association of Radiologists 2005; ACR 2000), there is no evidence that these efforts have had an impact on practice. The role of standardized approaches to triaging requests for MRI has received almost no attention.
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