title: Acute spinal cord compression: CQI framework increases resource efficiency while promoting delivery of high-quality care.
abstract: OBJECTIVE
  Literature reports indicate that advanced imaging is overutilized, especially in the emergency setting. At our institution, stat spinal MRI for suspected acute spinal cord compression (ASCC) was perceived to be excessively utilized. A continuous quality improvement process was employed to investigate this trend and improve the efficiency of this diagnosis.
  
  
  METHODS
  Spine imaging in patients with suspected ASCC was retrospectively evaluated for appropriateness of indications and quality of imaging. Based on the results, a new institutional policy for ordering MR for suspected ASCC was implemented, concurrent with development of a new screening spine MRI protocol. Subsequently, indications, efficacy, and imaging utilization of the new strategy were analyzed for improved operational effectiveness.
  
  
  RESULTS
  The initial retrospective study demonstrated only a 1.4% positive rate of ASCC as well as image-quality degradation due to patient motion resulting from prolonged scan times. Based on these results, a new institutional policy for ordering stat ASCC spine MRI was instituted with an updated screening MRI protocol. This policy resulted in a positive rate of ASCC of 4.4%, and decreased scan time by 50%-70%, while preserving diagnostic image quality and decreasing resource utilization.
  
  
  CONCLUSIONS
  As suspected, stat spinal MRI for ASCC was excessively utilized at our institution. The study demonstrated that systemic improvements regarding this issue can be achieved by using a multidisciplinary approach and following a continuous quality improvement methodology. A new MRI protocol for identification of ASCC was found to preserve image quality and diagnostic confidence, while simultaneously decreasing scan time and use of valuable health care resources.
authors.affiliation: Department of Radiology, University of Chicago Medicine, Section of Neuroradiology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. Electronic address: potigailo@gmail.com.
authors.forename: Valeria L
authors.initials: VL
authors.lastname: Potigailo
authors.affiliation: Department of Radiology, University of Chicago Medicine, Section of Neuroradiology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Christoforidis
authors.affiliation: Department of Radiology, University of Chicago Medicine, Section of Neuroradiology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Katzman
mesh_terms: D000208:Acute Disease; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000592:standards / Q000706:statistics & numerical data*; D006293:Health Promotion; D006300:Health Services Misuse / Q000517:prevention & control* / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois; D008279:Magnetic Resonance Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000592:standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000473:pathology*
keywords: Cord compression; continuous quality improvement