Determining Neurosurgery Provider Readiness to Implement a Guideline Minimizing Contrast Use in Imaging

Abstract Background: Magnetic resonance imaging (MRI) is commonly used in neurosurgery and contrast is often ordered, but not always necessary. The Angioma Alliance has devised an imaging guideline for cavernous malformation patients that providers are not following. Readiness has been identified as a barrier to adhering to guidelines. Purpose: The purpose of this project was to heighten awareness of the guideline by embedding it into the project site’s electronic medical record (EMR), measure provider readiness to implement the guideline, and measure ordering practices after increasing awareness.
Theoretical Framework: Rogers’ diffusion of innovations theory Methods: This project used the Readiness for Organizational Change (ROC) Appropriateness subscale, which was administered pre- and post- delivery of an educational intervention and after embedding the guideline into the EMR. The subscale measured the impact of education on providers’ readiness to adopt the guideline. Pre- and post- intervention MRI ordering data were captured through the EMR. Results: The surveys were sent to 54 providers. Ten responded to the pre- and five responded to the post- education survey indicating low buy-in. The sum of responses to the pre- survey was 51.4 and post- survey was 61 indicating an increase in readiness to implement the guideline. Prior to implementation, contrast was ordered for 87.15% of MRIs and indicated 23.16% of the time. Afterwards, contrast was ordered 96.43% of the time and indicated 18.52% of the time.
Conclusions: Providers responded positively regarding guideline appropriateness. Percentage of MRIs with contrast increased after project implementation and was indicated in a smaller percentage of the cases. Limitations of the project negatively impacted the ability to fully evaluate whether aims were met.