Project Name: Virtual Magnetic Resonance Imaging (MRI) Reading Project

Start Date & Duration: September 2021, 24 months

Project Summary:

The Trust’s Multiple Sclerosis (MS) Magnetic Resonance Imaging (MRI) reporting service is under significant demand, notwithstanding forecasted increased pressures.

Such pressures include progressive patients requiring frequent MRI scans and also all patients requiring disease modifying therapies (DMTs) moving to having an obligatory 12-month MRI scan.

In November 2019, there were nearly 600 unreported scans in Neurology.  These are believed to include a cohort of active MS patients that are sub-optimally reviewed.  This has been identified as high risk for both the service and the Trust.

Patient numbers/demand on service remains high at the Trust: 2,903 MS patients, of which 1,166 are taking a disease modifying therapy (DMT).

A capacity and demand analysis was undertaken around MRI and produced the following results:

  • If all patients were receiving an annual MRI: the trust would need to do 64 MRIs per week (26 DMT and 38 non DMT patients).
  • If all DMT patients were receiving an annual MRI and non DMT patients were receiving an MRI every two years, the trust would need to do 45 MRIs per week (26 DMT and 19 non DMT patients).

The Project will contract the use of third party Icometrix to write the MRI reports for the Trust’s surveillance scans of patients that have already received a diagnosis of MS by the Trust’s Multi-Disciplinary Team (MDT).

By reducing delays in diagnosis it is anticipated that the saved time will facilitate the Trust MS Team to achieve an increase in standards of the following service evaluation, benchmarking and improvements;

  • Alignment to NICE Quality Standards QS108 for MS Brain Health by supporting the pillars that underpin patient care;
    • Symptom onset
    • Referral & diagnosis
    • Treatment decision
    • Lifestyle
    • Disease monitoring, and,
    • Managing new symptoms
  • MRI provision would help to reduce treatment delays, enable HCPs to monitor disease activity closely and proactively and underpin decision making with up to date scans. It will enable the service to achieve the core standards that they are aspiring to which are to have an MRI completed within 4 weeks of a patient referral (2 weeks for the achievable standards)
  • Improved MRI reporting means that this no longer presents a risk to patients and potential clinical governance risks to the trust
  • Reduced delays and improved patient management and treatment initiation (including Novartis treatments)
  • Opportunity to implement a scalable MRI project across other NHS sites.  To collaborate with the NHS Trust to improve their service and patient management, to become a preferred partner of the NHS.

The Project will assess whether the third party makes a positive difference to the MS Service at the Trust.

Planned Milestones:

Milestone 1: Kick-off meeting

Milestone 2: Baseline Report, Trust protocol written and agreed, Trust full review of Icometrix

Milestone 3: Trust contract with Icometrix signed

Milestone 4: Installation and testing of Icometrix “icobridge”* at the Trust, commencement of MRI scans being sent to Icometrix for write up

Milestone 5: Trust sending scans to Icometrix

Milestone 6: Report at end of year one verses baseline at start of project Assessment of Icometrix impact on MS Service at Trust.  Decision whether to proceed to second year, Trust contract with Icometrix signed/extended second year

Milestone 7: Project write-up/poster

Expected Benefits:

Expected benefit to the NHS

By reducing delays in diagnosis it is anticipated that the saved time will facilitate the Trust MS Team to achieve increase in standards of the following service evaluation, benchmarking and improvements:

  • Adults with MS to have a face to face appointment with a Healthcare Professional (HCP) with experience in MS to take place 6 weeks after diagnosis
  • Adults with MS are offered a comprehensive review at least once a year by healthcare professionals with experience in MS
  • Alignment to NICE Quality Standards QS108 for MS Brain Health by supporting the pillars that underpin patient care:
  1. Symptom onset
  2. Referral & diagnosis
  3. Treatment decision
  4. Lifestyle
  5. Disease monitoring, and,
  6. Managing new symptoms
  • Adherence to NHS England commissioning guidance.  These are MS Brain Health Standards (defined in three categories; Core, Achievable and Aspirational) https://www.msbrainhealth.org/article/ms-brain-health-consensus-standards
  • MRI provision would help to reduce treatment delays, enable HCPs to monitor disease activity closely and proactively and underpin decision making with up to date scans.  It will enable the service to achieve the core standards that they are aspiring to which are to have an MRI completed within 4 weeks of a patient referral (2 weeks for the achievable standards)
  • Improved MRI reporting means that this no longer presents a risk to patients and potential clinical governance risks to the trust
  • A reduction in referral to treatment time
  • A reduction in clinic cancellations and rescheduling which improves waiting times
  • Pressure taken off nurse team to chase up results and ensure the pathway is functioning efficiently
  • Better management of active/progressive patients

Expected benefit to the Patient

  • Reduced waiting times from referral to treatment initiation
  • Mitigating issues threatening patient safety, such as delay in referral to treatment, by early intervention
  • Improved access to treatments as eligibility is confirmed via MRI
  • Increased proactive management of their MS
  • Improved patient identification for the correct treatments
  • Improved patient experience by reducing risk of clinical cancellations and rescheduling

UK2109085135