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MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model
  1. Anish N Bhuva1,2,
  2. Patricia Feuchter1,
  3. Angela Hawkins1,
  4. Lizette Cash1,
  5. Redha Boubertakh1,
  6. Jane Evanson3,
  7. Richard Schilling4,
  8. Martin Lowe4,
  9. James C Moon1,2,
  10. Charlotte H Manisty1,2
  1. 1Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
  2. 2Institute of Cardiovascular Sciences, University College London, London, UK
  3. 3Department of Radiology, Barts Health NHS Trust, London, UK
  4. 4Department of Cardiac Electrophysiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Anish N Bhuva, Department of Cardiac Imaging, Barts Health NHS Trust, London E1 1BB, UK; a.bhuva{at}ucl.ac.uk

Abstract

Background Patients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist.

Aim To deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs).

Methods Patients requested a ‘one-stop’ service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this ‘one-stop’ service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed.

Results 215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation.

Conclusion Implementation of a ‘one-stop’ service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.

  • MRI
  • CIED
  • health inequality
  • teamwork
  • Quality improvement

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors All authors were involved in service redesign, delivery and data acquisition. ANB: data gathering, analysis and manuscript preparation. RB, RS, ML, JCM and CHM took part in revising the manuscript. All authors have approved the final manuscript.

  • Funding AB is supported by a doctoral research fellowship from the British Heart Foundation (FS/16/46/32187). JCM and CM are directly and indirectlysupported by the University College London Hospitals, NIHR Biomedical Research Centre and Biomedical Research Unit at Barts Hospital, respectively.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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