Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) exams are essential diagnostic tools used for identifying and monitoring many different diseases and ailments. When deemed medically necessary, it is important for a patient’s care that they receive these exams within a targeted timeframe based on the level of urgency.
Clinical evidence from the Canadian Institute for Health Information (CIHI) and other authoritative sources indicates that not all CT and MRI exams currently provided are clinically appropriate. For example, in Alberta, 30 per cent of patients with lower back pain without red flags had at least one unnecessary X-ray, CT or MRI.
Wait times for medical imaging are an ongoing concern across Canada. In Alberta, wait times for CT and MRI exams are among the longest in the country, and the demand for these exams is growing.
Excessive wait times may worsen health outcomes for patients and create economic inefficiencies. Wait times are impacted by a number of factors, including:
- demand for diagnostic exams, primarily driven by referring clinicians and the number of Albertans
needing these exams
- supply of exams, which may be constrained by the facilities, equipment and medical professionals
available to perform the exams
- costs associated with performing exams, which affects the number of exams that can be completed
given a set level of funding
Exam intake and scheduling processes play an important role in both supply and demand and potentially, the cost of exams.
Our audit focused on the intake and scheduling processes Alberta Health Services (AHS) uses for publicly funded outpatient CT and MRI services to assist in determining the right services for patients, at the right time, as determined by medical evidence.
We examined the following categories of outpatient exams, and related target wait times:
- Priority 1 (P1): Urgent CT and MRI targets within seven days
- Priority 2 (P2) Semi-urgent CT and MRI targets within 30 days
- Priority 3 (P3) Non-urgent CT target within 60 days; MRI target within 90 days
We also examined whether the planning, measuring, and reporting activities for CT and MRI services provide sufficient accountability for results, including managing wait times.
For the purpose of this audit we excluded routine follow-up (P4), emergency and inpatient exams. Our audit also did not include examining the clinical decisions and appropriateness of individual exams, or compensation levels of professionals that affect the cost of the exams.
We found outpatient CT and MRI intake and scheduling processes are inefficient, generally with manual and decentralized processes.
We recommend AHS improve its outpatient CT and MRI intake and scheduling processes, and implement an effective process to measure and report on performance for these services.
In some cases, AHS cannot implement improvements unilaterally.
We recommend Alberta Health work with AHS and stakeholders to implement, and measure the effectiveness of, standard operational policy and work-flow for electronic order entry that will assist primary care and non-AHS clinicians when ordering CT and MRI exams.