Poster (15W200)

Clinical impact of prolonged wait times for MRE in patients with Inflammatory Bowel Disease

Author(s)

J. Duignan, B. Neary, C. Moran, D.Keegan, D. Malone, G. Doherty

Department(s)/Institutions

Dept of Gastroenterology, St Vincent's University Hospital, Dublin

Introduction

Clinical impact of prolonged wait times for MRE in patients with Inflammatory Bowel Disease

Aims/Background

Timely access to Magnetic Resonance Enterography (MRE) aids decision making in the management of patients with IBD. Prolonged wait times can burden IBD services with additional inpatient and outpatient care of patients awaiting MRE, resulting in missed opportunities to treat active or complicated disease.

Our primary aim was to investigate average wait time for MRE in our IBD population, and assess compliance with UK IBD standard of care guidelines (updated 2013), which states that MRE should be performed within one month of request. Secondary objectives were to assess:

(a) Whether triaging requests into categories of priority by radiologists, affects wait time for MRE.

(b) Proportion of investigations that revealed active disease or new evidence of complicated disease behavior.

(c) Utilization of health care resources; namely outpatient visits, hospital & ED admissions, surgical interventions and alternative cross sectional imaging with Computed Tomography (CT) whilst awaiting MRE.

Method

We analysed all IBD patients that had outpatient MREs requested from January 1st 2014 to December 31st 2014. MRE reports were read to record clinical findings of activity or evidence of new fistulae or strictures. Hospital & ED admissions, outpatient appointments, surgical interventions and CT abdomens performed during wait time were recorded. Statistical analysis was performed by using Microsoft Excel and IBM SPSS software version 20.

Results

73 outpatients (57.5% male), had MREs requested during the time period, this represents 4% of all patients with Crohn’s Disease on our IBD database. Mean age was 37.8 years (median 37, Std Dev 13.7). The mean waiting time was 216 days (median 223, Std Dev 66.4). Only 3 patients (4.1%) had MRE performed within recommended interval, 89% of patients waited more than six months for MRE. Median waiting times did not vary significant according to radiology priority category.

20.5% of MRE’s performed revealed new evidence of complicated disease (strictures or fistulae). Nearly half of patients, 47.9% (35/73) had radiological signs of active disease or new evidence of complicated disease on MRE. During the interval waiting time 58.9% of patients required an outpatient appointment, 11% inpatient admission. 2.7% surgical intervention or emergency department visit. Alternative cross sectional imaging with CT was necessitated in 9.6% of patients whilst they were awaiting MRE.

Conclusions

There is evidence of under utilisation of MRE due to prolonged waiting times, which limits its value in influencing clinical decisions.