Effect of team training on improving MRI study completion rates and no-show rates

Harnessing ChatGPT dialogues to address claustrophobia in MRI - A radiographers' education perspective

INTRODUCTION

The healthcare sector invests significantly in communication skills training, but not always with satisfactory results. Recently, generative Large Language Models, have shown promising results in medical education. This study aims to use ChatGPT to simulate radiographer-patient conversations about the critical moment of claustrophobia management during MRI, exploring how Artificial Intelligence can improve radiographers' communication skills.

METHODS

This study exploits specifically designed prompts on ChatGPT-3.5 and ChatGPT-4 to generate simulated conversations between virtual claustrophobic patients and six radiographers with varying levels of work experience focusing on their differences in model size and language generation capabilities. Success rates and responses were analysed. The methods of radiographers in convincing virtual patients to undergo MRI despite claustrophobia were also evaluated.

RESULTS

A total of 60 simulations were conducted, achieving a success rate of 96.7% (58/60). ChatGPT-3.5 exhibited errors in 40% (12/30) of the simulations, while ChatGPT-4 showed no errors. In terms of radiographers' communication during the simulations, out of 164 responses, 70.2% (115/164) were categorized as "Supportive Instructions," followed by "Music Therapy" at 18.3% (30/164). Experts mainly used "Supportive Instructions" (82.2%, 51/62) and "Breathing Techniques" (9.7%, 6/62). Intermediate participants favoured "Music Therapy" (26%, 13/50), while Beginner participants frequently utilized "Mild Sedation" (15.4%, 8/52).

CONCLUSION

The simulation of clinical scenarios via ChatGPT proves valuable in assessing and testing radiographers' communication skills, especially in managing claustrophobic patients during MRI. This pilot study highlights the potential of ChatGPT in preclinical training, recognizing different training needs at different levels of professional experience.

IMPLICATIONS FOR PRACTICE

This study is relevant in radiography practice, where AI is increasingly widespread, as it explores a new way to improve the training of radiographers.

The Psychological, Physiological, and Behavioral Responses of Patients to Magnetic Resonance Imaging (MRI): A Systematic Review and Meta-Analysis

BACKGROUND

MRI is generally well-tolerated although it may induce physiological stress responses and anxiety in patients.

PURPOSE

Investigate the psychological, physiological, and behavioral responses of patients to MRI, their evolution over time, and influencing factors.

STUDY TYPE

Systematic review with meta-analysis.

POPULATION

181,371 adult patients from 44 studies undergoing clinical MRI.

ASSESSMENT

Pubmed, PsycInfo, Web of Science, and Scopus were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality appraisal was conducted with the Joanna Briggs Institute critical appraisal tools. Meta-analysis was conducted via Meta-Essentials workbooks when five studies were available for an outcome. Psychological and behavioral outcomes could be analyzed. Psychological outcomes were anxiety (State-Trait-Anxiety Inventory, STAI-S; 37) and willingness to undergo MRI again. Behavioral outcomes included unexpected behaviors: No shows, sedation, failed scans, and motion artifacts. Year of publication, sex, age, and positioning were examined as moderators.

STATISTICAL TESTS

Meta-analysis, Hedge's g. A P value <0.05 was considered to indicate statistical significance.

RESULTS

Of 12,755 initial studies, 104 studies were included in methodological review and 44 (181,371 patients) in meta-analysis. Anxiety did not significantly reduce from pre- to post-MRI (Hedge's g = -0.20, P = 0.051). Pooled values of STAI-S (37) were 44.93 (pre-MRI) and 40.36 (post-MRI). Of all patients, 3.9% reported unwillingness to undergo MRI again. Pooled prevalence of unexpected patient behavior was 11.4%; rates for singular behaviors were: Failed scans, 2.1%; no-shows, 11.5%; sedation, 3.3%; motion artifacts, 12.2%. Year of publication was not a significant moderator (all P > 0.169); that is, the patients' response was not improved in recent vs. older studies. Meta-analysis of physiological responses was not feasible since preconditions were not met for any outcome.

DATA CONCLUSION

Advancements of MRI technology alone may not be sufficient to eliminate anxiety in patients undergoing MRI and related unexpected behaviors.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY: Stage 5.

Addressing the communication needs of cancer patients for Magnetic Resonance Imaging (MRI) investigations-A phenomenological study on the experiences of MRI radiographers

INTRODUCTION

A higher demand in MRI services could increase the pressure on MRI departments to increase scanning efficiency. This presents the risk of downplaying person-centred care especially for cancer patients with increased communication needs that result from anxiety associated with the nature of their disease. This study explored the experiences of MRI radiographers in addressing the communication needs of cancer patients attending for MRI examinations.

METHODS

The study adopted a descriptive phenomenological methodology. Single contact interviews were conducted on eight MRI specialist radiographers, and these were recorded and transcribed using Microsoft Teams conferencing platform. Thematic analysis of the transcribed data was done through an inductive approach, breaking down the data into meaningful codes and thereafter, into themes and sub-themes.

RESULTS

Common themes generated from the interview data included: identified communication needs, approach to communication needs, support for radiographers and factors affecting communication. Experiences of MRI radiographers indicated increased communication needs in anxious cancer patients and approaches adopted in addressing these were mainly through listening and use of empathetic gestures. Some radiographers admitted to using "blocking" strategies to avoid being drawn into emotionally exhausting conversations. Both intrinsic factors such as radiographers' personality and experience; and extrinsic factors such as time constraints, demanding workload, inadequate staffing, and skill mix were noted to influenced MRI radiographers in addressing these communication needs.

CONCLUSION

Cancer patients can present with communication needs due to anxieties related to their disease. For the radiographer to deal with these needs, adequate support is needed, and necessary steps taken to address the identified influencing factors.

IMPLICATIONS FOR PRACTICE

MRI departments should encourage enabling environment and services that address communication needs of patients with cancer.

"I think this could be a big success" - A mixed methods study on practitioner perspectives on the acceptance of a virtual reality tool for preparation in MRI

INTRODUCTION

A key part of a radiographer's role within MRI is providing the required emotional support to help patients succeed with a scan. Being informed is important; whilst information leaflets and videos are commonly used, these can be limited in their representation of the experience. Virtual reality tools are being shown to reasonably replicate a scan experience, having a positive impact on patient satisfaction and anxiety. The aim was to obtain the views of practitioners on the use and implementation of such a tool in practice.

METHODS

A mixed methods study was conducted looking at the use of a virtual scan experience for patients prior to MRI. Nine radiographers attended two focus group sessions to see the tool and undergo a virtual experience. Following this, a survey based on the technology acceptance model was completed along with a semi-structured discussion about its use.

RESULTS

Perceived usefulness, ease of use, attitude and intention to use were all positive towards the virtual scan tool. All practitioners saw value in such a tool and how it could be implemented within practice, highlighting areas for improvement and development.

CONCLUSION

The practitioner's perspective was that access to such a virtual scan experience could be of use to better prepare and support those patients needing extra support before a real scan. Acknowledgement of having time to discuss patient concerns was noted and this could provide a means of doing so away from busy scanning lists whilst not taking up additional time.

IMPLICATIONS FOR PRACTICE

Use of VR tools could be a conduit through which trust and rapport are built in advance away from busy scanning lists, thereby not impacting on operational throughput and hindering efficiency.

Individual and Contextual Variables as Predictors of MRI-Related Perceived Anxiety

BACKGROUND

Magnetic resonance imaging (MRI) generates patient anxiety (PA) and, therefore, it is important to understand individual and contextual variables that may cause it. In study one, we explored those anxiety predictors. In study two, we examined the effect of the experience of MRI on PA comparing anxiety pre- to post-MRI.

METHODS

PA was measured with an anxiety and stress scale in an interview format. Data collection occurred at a public hospital with MRI outpatients aged 18 or older. In study one (n = 204), participants answered the questionnaire immediately after experiencing the MRI and the data were analyzed through structural equation modeling. In study two (n = 242), participants answered the questionnaire before and after the examination and the data were analyzed through Bayesian statistics.

RESULTS

Being female, having a higher education level (EL), and not receiving information about the examination predicts higher PA after MRI. Patients with prior information have a decrease in PA from pre- to post-MRI. Those who do not have no change in PA. In low-educated patients, PA also decreases and no changes occur in highly educated patients.

CONCLUSION

This study provides health professionals with valuable indicators about patients who are more likely to perceive and express anxiety during MRI.

Effects of video-based patient preparation for MRI on clinical processes and patient experience

PURPOSE

To determine whether video-based informational or relaxational preparation reduces the number of unexpected patient-related events and scan duration more efficiently, and to assess how patients evaluate the interventions.

METHODS

We randomized 142 adult patients (mean age: 48 ± 16 years) to three groups. The control group (n = 48, 33.8 %) received standard care. The intervention groups watched an informational (n = 50, 35.2 %) or relaxational (n = 44, 31.0 %) video while awaiting their MRI examination. We recorded scan duration, number of motion artifacts/sequence repetitions, and patient-related incidents (e.g., interruptions, premature termination). Subjective evaluation of the interventions was provided by the patients after MRI completion.

RESULTS

Mean scan duration for the control, relaxation, and information group was 39.38 ± 16.62 min, 32.59 ± 11.67 min, and 34.54 ± 11.91 min. Compared to the control group, scan duration was significantly shorter in the relaxation, but not in the information group (relaxation vs control: p =.019; information vs control: p =.082). The information and relaxation group did not differ significantly (p =.704). In 35 (24.6 %) patients, one or more sequences were repeated; incidents occurred in six (4.2 %) patients. Neither the frequency of repeated sequences nor incidents differed between the groups (all p >.239). Patients evaluated both videos very positively; the information video received even better evaluations (all p <.027).

CONCLUSION

Additional preparation, especially information, is perceived very positively by patients and at least relaxational preparation may have a positive impact on clinical operations.

Review of claustrophobia incidence in MRI: A service evaluation of current rates across a multi-centre service

INTRODUCTION

Magnetic Resonance Imaging remains an anxious experience for many, often exhibiting as fear of enclosed spaces. A useful metric to assess its prevalence and impact in practice is premature termination due to claustrophobia. Incidence varies and depends on many factors such as the physical nature of the imaging equipment and examination being undertaken, as well as the patient themselves.

METHODS

Scan appointment data from between April 2019-March 2021 was extracted and reviewed. Analysis included the type of scanner used, patient age, sex, examination area, funding source, attendance and completion status. Binomial logistic regression was performed to look for any relevant predictors of failure to scan due to claustrophobia.

RESULTS

Overall incidence of incomplete examinations due to claustrophobia was 0.76%. Whilst the majority of scans were performed on conventional systems, those undergoing Open scans were over three times more likely to fail a scan due to claustrophobia, whilst those undergoing UpRight scanning were half as likely. Likelihood of claustrophobia increases with females, those between 45-64years of age, funded by the NHS and entering the scanner head first or having a head scan.

CONCLUSION

Incidence of incomplete scanning is below 1% but with the potential for further reduction with implementation and use of improved scanner design and technology. Understanding the impact of other variables is also useful to raise awareness of those at greater risk of claustrophobia. However, there are wider influences beyond data alone to consider and account for.

IMPLICATIONS FOR PRACTICE

Whilst occurrence of claustrophobia is low, there remains a cost impact, as well as an importance in understanding the patient experience. Drawing on operational data can help provide a limited, generalised view to support service improvement.

Radiographer Perspectives on current occurrence and management of claustrophobia in MRI

INTRODUCTION

Magnetic Resonance Imaging (MRI) is well known to be a source of anxiety for patients, commonly appearing as claustrophobia. One of the main reasons for this is due to the physical nature of the scanner itself. Despite technological improvements, there is lacking evidence on whether these improvements have resulted in a reduction in claustrophobia and anxiety in the clinical setting. Background anxiety associated with the current COVID-19 pandemic may also have shown an increase in prevalence. Therefore, the aim of this study was to survey MRI radiographers on their perspectives on the occurrence and management of claustrophobia in modern day clinical practice.

METHODS

Following ethical approval, an online survey was used to gather the opinions of MRI radiographers. This used closed ranking questions as well as open responses to gain insight into how this issue may be presenting in practice, preferences in management, and barriers to providing support.

RESULTS

Responses provide an up-to-date view on how radiographers perceive both displays of anxiety and associated impacts on patient outcome, the considered sources of anxiety, the use and effectiveness of support strategies, barriers to providing this support, and views on how COVID-19 has impacted on practice.

CONCLUSION

The study provides a current view from radiographers on their experience of claustrophobia in practice. It shows that this remains a regular part of practice within the modality. Therefore, for MRI radiographers managing this is an essential component of their role. Communication and interaction with the patient are recognised as important, although time is a barrier to always being able to provide patient centred care.

IMPLICATIONS FOR PRACTICE

Ongoing support is needed for both patients and radiographers to improve experience within MRI.

Efficacy of a Self-Hypnotic Relaxation App on Pain and Anxiety in a Randomized Clinical Trial: Results and Considerations on the Design of Active and Control Apps

Despite an explosion of mobile app offerings for management of pain and anxiety, the evidence for effectiveness is scarce. Placebo-controlled trials are the most desirable but designing inactive placebo apps can be challenging. For a prospective randomized clinical trial with 72 patients in a craniofacial pain center, we created an app with self-hypnotic relaxation (SHR) for use with iOS and Android systems. A placebo background audio (BA) app was built with the same look and functionality. Both iOS and Android SHR apps alone and in comparison to the BA group significantly reduced pain and anxiety during the waiting-room time. The Android BA app significantly reduced anxiety but not pain. The iOS BA app affected neither pain nor anxiety, functioning as an ideal placebo. Usage analysis revealed that different default approaches of the iOS and Android devices accounted for the difference in results.

Analysis of socioeconomic and demographic factors and imaging exam characteristics associated with missed appointments in pediatric radiology

BACKGROUND

Missed appointments can have an adverse impact on health outcomes by delaying appropriate imaging, which can be critical in influencing treatment decisions.

OBJECTIVE

To assess for socioeconomic and imaging exam factors associated with missed appointments among children scheduled for diagnostic imaging.

MATERIALS AND METHODS

We retrospectively analyzed children (<18 years) scheduled for outpatient diagnostic imaging during a 12-month period. In doing so, we obtained socioeconomic and radiology exam characteristics (modality, intravenous contrast administration, radiation and use of sedation) data from the electronic medical record. We employed multivariate logistic regression to assess the association of socioeconomic, demographic and imaging exam characteristics with imaging missed appointments.

RESULTS

In total, 7,275 children met inclusion criteria. The mean age was 8.8 years (standard deviation [SD] = 6.2 years) and the study population consisted of 52% female gender, 69% White race, 38% adolescent age group and 32% with a median household income by ZIP-code category of <$50,000. Logistic regression showed increased likelihood of missed appointments among children of Black/African-American race (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.4-2.5); with insurance categories including Medicaid (OR=2.0; 95% CI=1.6-2.4), self-pay (OR=2.1; 95% CI=1.3-3.6) and other (OR=2.7; 95% CI=1.3-5.4); with <$50,000 median household income by ZIP-code category (OR=1.7; 95% CI=1.4-2.0); and with examination wait time of 7-21 days (OR=2.7; 95% CI=2.1-3.5) and >21 days (OR=3.7; 95% CI=2.9-4.8). The use of radiation, intravenous contrast agent or sedation was not associated with increased likelihood of missed appointments.

CONCLUSION

Expanding our knowledge of how different socioeconomic and imaging-related factors influence missed appointments among children can serve as a foundational step to better understand existing and emerging disparities and inform strategies to advance health equity efforts in radiology.

Reducing Cardiac Radiation Dose From Breast Cancer Radiation Therapy With Breath Hold Training and Cognitive Behavioral Therapy

The delivery of radiation therapy shares many of the challenges encountered in imaging procedures. As in imaging, such as MRI, organ motion must be reduced to a minimum, often for lengthy time periods, to effectively target the tumor during imaging-guided therapy while reducing radiation dose to nearby normal tissues. For patients, radiation therapy is frequently a stress- and anxiety-provoking medical procedure, evoking fear from negative perceptions about irradiation, confinement from immobilization devices, claustrophobia, unease with equipment, physical discomfort, and overall cancer fear. Such stress can be a profound challenge for cancer patients' emotional coping and tolerance to treatment, and particularly interferes with advanced radiation therapy procedures where active, complex and repetitive high-level cooperation is often required from the patient.In breast cancer, the most common cancer in women worldwide, radiation therapy is an indispensable component of treatment to improve tumor control and outcome in both breast-conserving therapy for early-stage disease and in advanced-stage patients. High technological complexity and high patient cooperation is required to mitigate the known cardiac toxicity and mortality from breast cancer radiation by reducing the unintended radiation dose to the heart from left breast or left chest wall irradiation. To address this, radiation treatment in daily deep inspiration breath hold (DIBH), to create greater distance between the treatment target and the heart, is increasingly practiced. While holding the promise to decrease cardiac toxicity, DIBH procedures often augment patients' baseline stress and anxiety reaction toward radiation treatment. Patients are often overwhelmed by the physical and mental demands of daily DIBH, including the nonintuitive timed and sustained coordination of abdominal thoracic muscles for prolonged breath holding.While technologies, such as DIBH, have advanced to millimeter-precision in treatment delivery and motion tracking, the "human factor" of patients' ability to cooperate and perform has been addressed much less. Both are needed to optimally deliver advanced radiation therapy with minimized normal tissue effects, while alleviating physical and cognitive distress during this challenging phase of breast cancer therapy.This article discusses physical training and psychotherapeutic integrative health approaches, applied to radiation oncology, to leverage and augment the gains enabled by advanced technology-based high-precision radiation treatment in breast cancer. Such combinations of advanced technologies with training and cognitive integrative health interventions hold the promise to provide simple feasible and low-cost means to improve patient experience, emotional outcomes and quality of life, while optimizing patient performance for advanced imaging-guided treatment procedures - paving the way to improve cardiac outcomes in breast cancer survivors.

Underlying Mechanisms of Psychological Interventions in Magnetic Resonance Imaging and Image-Guided Radiology Procedures

Positive patient care and healthcare facility outcomes are associated with using various psychological interventions during magnetic resonance imaging and interventional radiology procedures. Interventions such as hypnosis, relaxation, guided imagery, and empathic communication can improve anxiety, pain, and hemodynamic stability during procedures, as well as improve claustrophobia and anxiety during magnetic resonance imaging. Little is understood as to the potential underlying mechanisms of how these interventions operate and contribute to positive outcomes. Thus, this article seeks to address that question by integrating autonomic nervous system functioning, neuropsychological concepts, and common factors theory of psychotherapy as potential underlying mechanisms. Opportunities for future directions in the field are also included.

Communication and Team Interactions to Improve Patient Experiences, Quality of Care, and Throughput in MRI

Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients' motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.

Prevalence and Financial Impact of Claustrophobia, Anxiety, Patient Motion, and Other Patient Events in Magnetic Resonance Imaging

Claustrophobia, other anxiety reactions, excessive motion, and other unanticipated patient events in magnetic resonance imaging (MRI) not only delay or preclude diagnostic-quality imaging but can also negatively affect the patient experience. In addition, by impeding MRI workflow, they may affect the finances of an imaging practice. This review article offers an overview of the various types of patient-related unanticipated events that occur in MRI, along with estimates of their frequency of occurrence as documented in the available literature. In addition, the financial implications of these events are discussed from a microeconomic perspective, primarily from the point of view of a radiology practice or hospital, although associated limitations and other economic viewpoints are also included. Efforts to minimize these unanticipated patient events can potentially improve not only patient satisfaction and comfort but also an imaging practice's operational efficiency and diagnostic capabilities.

Training health professionals in patient-centered communication during magnetic resonance imaging to reduce patients' perceived anxiety

OBJECTIVE

We examined how a patient-centered communication training program for magnetic resonance imaging (MRI) affected health professional (HP) practice and patients' perceived anxiety (PA).

METHODS

We implemented an intervention program. Six of the 17 eligible HPs completed the study. The proportion of observed desired behaviors (PODBs), including MRI procedure explanation (MRI-PE), communication, and MRI checking procedures was measured using an observation grid. We tested 182 patients (85 pre-, 58 post-, and 39 at follow-up) for PA pre- and post-MRI.

RESULTS

The Bayesian ANOVA effect size suggested moderate evidence of improvement in HP PODBs, pre- to post-intervention. Use of MRI-PE declined between post-intervention and follow-up (6 months later). Observed changes in PA, pre- to post-MRI, could be related to time constraints and perceived pressure to explain the exam in detail once institutional routines are reestablished.

CONCLUSION

In MRI units, time constraints condition the performance of HPs who address patients' PA.

PRACTICE IMPLICATIONS

"Real workplace" interventions that promote better patient-centered communication and provide each patient with a comprehensive explanation of MRI procedures also appear to improve HP PODBs.

A study of the relationship between the level of anxiety declared by MRI patients in the STAI questionnaire and their respiratory rate acquired by a fibre-optic sensor system

Magnetic resonance imaging (MRI) patients often experience anxiety-related respiratory disorders, including hyperventilation, but their respiratory indicators are not routinely monitored during scanning. Free from metal parts and immune to electromagnetic radiation, fibre-optic sensors have the potential to better control the patient’s condition by providing continuous non-invasive monitoring of the respiratory rate (RR). The study was purposed to assess the relationship between anxiety in MRI patients and their RR acquired by a fibre-optic sensor system. Forty-four subjects were involved in the study. The mean RR values recorded for 2 minutes immediately after the beginning and immediately before the end of the scanning were assessed relative to the State-Trait Anxiety Inventory (STAI) X-1 scores obtained immediately before and immediately after the scanning, respectively. A growth mixture model analysis was performed to statistically differentiate two groups of subjects according to the trends in repeated measures of RR. A significant lowering of the anxiety state was observed in the group characterised by a decrease in RR, whereas essentially no change in anxiety level was observed in the group with a stable RR. The t-test showed significant differences in changes in anxiety between these groups (t₍₃₉₎ = −2.349, p = 0.012, Cohen’s d = 2.13).

Understanding Why Patients No-Show: Observations of 2.9 Million Outpatient Imaging Visits Over 16 Years

PURPOSE

To understand why patients "no-show" for imaging appointments, and to provide new insights for improving resource utilization.

MATERIALS AND METHODS

We conducted a retrospective analysis of nearly 2.9 million outpatient examinations in our radiology information system from 2000 to 2015 at our multihospital academic institution. No-show visits were identified by the "reason code" entry "NOSHOW" in our radiology information system. We restricted data to radiography, CT, mammography, MRI, ultrasound, and nuclear medicine examinations that included all studied variables. These variables included modality, patient age, appointment time, day of week, and scheduling lead time. Multivariate logistic regression was used to identify factors associated with no-show visits.

RESULTS

Out of 2,893,626 patient visits that met our inclusion criteria, there were 94,096 no-shows during the 16-year period. Rates of no-show visits varied from 3.36% in 2000 to 2.26% in 2015. The effect size for no-shows was strongest for modality and scheduling lead time. Mammography had the highest modality no-show visit rate of 6.99% (odds ratio [OR] 5.38, P < .001) compared with the lowest modality rate of 1.25% in radiography. Scheduling lead time greater than 6 months was associated with more no-show visits than scheduling within 1 week (OR 3.18, P < .001). Patients 60 years and older were less likely to miss imaging appointments than patients under 40 (OR 0.70, P < .001). Mondays and Saturdays had significantly higher rates of no-show than Sundays (OR 1.52 and 1.51, P < .001).

CONCLUSION

Modality type and scheduling lead time were the most predictive factors of no-show. This may be used to guide new interventions such as targeted reminders and flexible scheduling.

Economics of MRI Operations After Implementation of Interpersonal Skills Training

PURPOSE

Examine the cost of MRI operations before and after implementation of interpersonal skills training to reduce unanticipated patient-related events in an academic medical center.

METHODS

Teams at four MRI sites (two hospital-based, two freestanding) were trained in evidence-based communication skills in February to April 2015. Training was designed to enable staff members to help patients mobilize their innate coping skills in response to any distress they experienced during their MRI visit. Data were collected before training and afterward from January to June 2016. Staff reported the incidence of disruptive motion, sedation use, MRI delays, incomplete examinations, and no-shows. Cost and revenue associated with MRI operations and staff and physician costs were estimated using Medicare and private insurance rates and data from the US Bureau of Labor Statistics.

RESULTS

The study included 12,930 outpatient MRI visits. From baseline to follow-up, average monthly patient volume increased from 1,105 to 1,463 at hospital MRI sites and from 245 to 313 at freestanding MRI sites. Patient factors necessitating sedation or interfering with image progression or quality decreased from 9.0% to 5.5% at hospital sites and from 3.1% to 1.2% at freestanding sites. These changes translated into a reduction in operational costs of $4,600 per 1,000 scheduled patients and an increase in profit of $8,370 per 1,000 scheduled patients in hospital MRI sites, and a corresponding increase in operational costs of $1,570 per 1,000 scheduled-patients and an increase in profit of $12,800 per 1,000 scheduled patients in freestanding MRI sites.

CONCLUSIONS

We found significant improvements in MRI operational efficiency after interpersonal skills team training, which were associated with reductions in costs and growth in revenue.

Impact of Delayed Time to Advanced Imaging on Missed Appointments Across Different Demographic and Socioeconomic Factors

PURPOSE

The aim of this study was to investigate the impact of wait days (WDs) on missed outpatient MRI appointments across different demographic and socioeconomic factors.

METHODS

An institutional review board-approved retrospective study was conducted among adult patients scheduled for outpatient MRI during a 12-month period. Scheduling data and demographic information were obtained. Imaging missed appointments were defined as missed scheduled imaging encounters. WDs were defined as the number of days from study order to appointment. Multivariate logistic regression was applied to assess the contribution of race and socioeconomic factors to missed appointments. Linear regression was performed to assess the relationship between missed appointment rates and WDs stratified by race, income, and patient insurance groups with analysis of covariance statistics.

RESULTS

A total of 42,727 patients met the inclusion criteria. Mean WDs were 7.95 days. Multivariate regression showed increased odds ratio for missed appointments for patients with increased WDs (7-21 days: odds ratio [OR], 1.39; >21 days: OR, 1.77), African American patients (OR, 1.71), Hispanic patients (OR, 1.30), patients with noncommercial insurance (OR, 2.00-2.55), and those with imaging performed at the main hospital campus (OR, 1.51). Missed appointment rate linearly increased with WDs, with analysis of covariance revealing underrepresented minorities and Medicaid insurance as significant effect modifiers.

CONCLUSIONS

Increased WDs for advanced imaging significantly increases the likelihood of missed appointments. This effect is most pronounced among underrepresented minorities and patients with lower socioeconomic status. Efforts to reduce WDs may improve equity in access to and utilization of advanced diagnostic imaging for all patients.

Helping Children Cope with Medical Tests and Interventions

Medical procedures and tests become a challenge when anxiety and pain make it difficult for the patient to cooperate or remain still when needed. Fortunately a short intervention with hypnoidal language at the onset of a procedure induces a positive and sustained change in the way pain and anxiety are processed. While anesthesia may appear to be a simple solution to eliminate pain, the adverse effects of pre-anesthesia anxiety on postoperative behavior and recovery are often not fully appreciated. This paper discusses options for self-hypnotic relaxation that are applicable to interactions with children. The high suggestibility of children makes it relatively easy to engage them in make-believe scenarios. Avoidance of negative suggestions is key in avoiding nocebo effects that may be difficult to overcome later. Once a child is immersed in his or her preferred scenario or hobby/activity of choice, environmental and procedural stimuli can be easily integrated in the imagery. Ego-strengthening metaphors that tie in features of strength, confidence, or resilience are particularly empowering. Even when children are fully under general anesthesia they may still have recall of what is said in the room and therefore caution in word choice should be maintained.

Predictors of missed appointments in patients referred for congenital or pediatric cardiac magnetic resonance

BACKGROUND

Congenital cardiac magnetic resonance is a limited resource because of scanner and physician availability. Missed appointments decrease scheduling efficiency, have financial implications and represent missed care opportunities.

OBJECTIVE

To characterize the rate of missed appointments and identify modifiable predictors.

MATERIALS AND METHODS

This single-center retrospective study included all patients with outpatient congenital or pediatric cardiac MR appointments from Jan. 1, 2014, through Dec. 31, 2015. We identified missed appointments (no-shows or same-day cancellations) from the electronic medical record. We obtained demographic and clinical factors from the medical record and assessed socioeconomic factors by U.S. Census block data by patient ZIP code. Statistically significant variables (P<0.05) were included into a multivariable analysis.

RESULTS

Of 795 outpatients (median age 18.5 years, interquartile range 13.4-27.1 years) referred for congenital cardiac MR, a total of 91 patients (11.4%) missed appointments; 28 (3.5%) missed multiple appointments. Reason for missed appointment could be identified in only 38 patients (42%), but of these, 28 (74%) were preventable or could have been identified prior to the appointment. In multivariable analysis, independent predictors of missed appointments were referral by a non-cardiologist (adjusted odds ratio [AOR] 5.8, P=0.0002), referral for research (AOR 3.6, P=0.01), having public insurance (AOR 2.1, P=0.004), and having scheduled cardiac MR from November to April (AOR 1.8, P=0.01).

CONCLUSION

Demographic factors can identify patients at higher risk for missing appointments. These data may inform initiatives to limit missed appointments, such as targeted education of referring providers and patients. Further data are needed to evaluate the efficacy of potential interventions.

Predicting No-Shows in Radiology Using Regression Modeling of Data Available in the Electronic Medical Record

PURPOSE

To test whether data elements available in the electronic medical record (EMR) can be effectively leveraged to predict failure to attend a scheduled radiology examination.

MATERIALS AND METHODS

Using data from a large academic medical center, we identified all patients with a diagnostic imaging examination scheduled from January 1, 2016, to April 1, 2016, and determined whether the patient successfully attended the examination. Demographic, clinical, and health services utilization variables available in the EMR potentially relevant to examination attendance were recorded for each patient. We used descriptive statistics and logistic regression models to test whether these data elements could predict failure to attend a scheduled radiology examination. The predictive accuracy of the regression models were determined by calculating the area under the receiver operator curve.

RESULTS

Among the 54,652 patient appointments with radiology examinations scheduled during the study period, 6.5% were no-shows. No-show rates were highest for the modalities of mammography and CT and lowest for PET and MRI. Logistic regression indicated that 16 of the 27 demographic, clinical, and health services utilization factors were significantly associated with failure to attend a scheduled radiology examination (P ≤ .05). Stepwise logistic regression analysis demonstrated that previous no-shows, days between scheduling and appointments, modality type, and insurance type were most strongly predictive of no-show. A model considering all 16 data elements had good ability to predict radiology no-shows (area under the receiver operator curve = 0.753). The predictive ability was similar or improved when these models were analyzed by modality.

CONCLUSION

Patient and examination information readily available in the EMR can be successfully used to predict radiology no-shows. Moving forward, this information can be proactively leveraged to identify patients who might benefit from additional patient engagement through appointment reminders or other targeted interventions to avoid no-shows.

Effects of Interpersonal Skills Training on MRI Operations in a Saturated Market: A Randomized Trial

PURPOSE

The aim of this study was to assess the effects of team training on operational efficiency during outpatient MRI.

METHODS

In this institutional review board-approved, HIPAA-compliant study, six MRI outpatient sites of a midwestern hospital system were randomized to serve as controls or have their teams trained in advanced communication skills. The fourth quarter of fiscal year 2015 was the trial baseline. The trial ended in the third quarter (Q3) of fiscal year 2016 (FY16). Equipment utilization (completed scans/available slots), hourly scan rates (total orders completed per machine per hour of operation), and no-show rates stratified by time were analyzed using the Cochran-Mantel-Haenszel method, with individual comparisons performed with Bonferroni correction.

RESULTS

The study encompassed 27,425 MRI examinations. Overall volume peaked at baseline and then declined over the following quarters. Compared with baseline, untrained sites experienced significant drops in equipment utilization (P < .01 for the first quarter of FY16 and P < .0001 for the second quarter of FY16 and Q3 FY16), decreasing from 77% to 65% over the study period, corresponding to a decrease from 1.15 to 0.97 in hourly scan rates. For trained sites, these metrics showed no significant change, with maintenance of hourly scan rates of 1.23 and 1.27 and equipment utilization rates of 83% and 85% between baseline and Q3 FY16. No-show rates remained stable at trained sites but increased at untrained sites in the last two quarters (P < .05). Nationally benchmarked patient satisfaction percentile ranking gradually increased at trained sites from 56th at baseline to 70th and successively decreased at untrained sites from 66th to 44th.

CONCLUSIONS

MRI outpatient facilities trained in advanced communication techniques may have more favorable operational efficiency than untrained sites in a saturated market.