64 * AUDIT OF INPATIENT MRI WAITING TIMES FOR SUSPECTED OCCULT FEMORAL NECK FRACTURE

Abstract

Background to the audit: Most femoral neck fractures are readily diagnosed on plain radiographs with anteroposterior (AP) and lateral projections; however a delayed diagnosis of occult fracture can significantly increase morbidity and mortality. Standard: National Institute of Health and Care Excellence (NICE) Guidance recommends magnetic resonance imaging (MRI) for suspected occult hip fracture within 24 hours if dedicated radiographs are negative. Indicator: We audited inpatient MRI provision for occult femoral neck fracture at Plymouth Hospitals NHS Trust. Target: 100%. Methodology: Data were collected using the computerised radiology in-formation system on consecutive patients between 01/09/14 and 30/08/15. We collected date and time of: plain film, MR request, MR performed and reported, and MRI findings. Results of first audit round: 117 patients underwent pelvic MRI for occult hip fracture, with fractures seen in 72 patients (61.6%). Median interval between plain film and MRI was 48 hours. 61% of patients were scanned within 24 hours of MR request, with a median interval of 19 hours. 29% of MR reports were verified within 24 hours of MR request with a median interval of 47 hours. The median interval between MR performed and verified report was 23 hours. First action plan: Reasons for delayed reporting were discussed at the local audit meeting. A consultant reporting rota has been put in place. A voice recognition (VR) code 'Get Occult Hip Protocol' was introduced to alert referring clinicians. Increased prioritisation of vetting and MRI scans for occult hip fractures has been agreed in the department. Second action plan: Re-audit of 01/09/15e30/08/2016 is underway. References: Kim K, Ha Y, Kim T, Choi J, Koo K. Initially missed occult fractures of the proximal femur in elderly patients: implications for need of operation and their morbidity. Arch Orthop Trauma Surg 2010;130(7);915e20. National Institute for Health and Care Excellence. NICE: Clinical Guidelines [CG124]. London: National Institute for Health and Care Excellence; 2011. Gill S, Smith J, Fox R, Chesser T. Investigation of Occult hip fractures: the use of CT and MRI. Sci World J 2013;2013:1e4. Tiwari S, Sprenger De Rover W, Sahota O, Moran C, Dawson JS. Completed audit cycle of inpatient MRI waiting times for suspected occult femoral neck fracture. ECR 2014/C-0291.