Significant portion of stat MRI orders are not actually urgent
Data presented during the 2025 annual meeting of the Radiological Society of North America question the legitimacy of high priority MRI orders.
Stat, urgent and high priority requisitions take precedence over other imaging requests, often bringing the orders to the front of the line for completion. For cases that are truly critical, this move can significantly influence outcomes. When used inappropriately, however, stat orders can delay care for patients most in need.
Recently, staff at an academic-affiliated, community-based level 1 trauma center in Colorado noticed an uptick in the number of stat MRI orders for inpatients, many of whom did not meet the criteria in place for high priority requisitions. This resulted in increased order-to-scan times, leading to longer hospital stays and poorer outcomes for some patients.
“Inappropriate use of stat designation can result in delays of truly emergent cases, adversely impacting patient care. Top priority indication for emergency imaging is meant for examinations necessary to diagnose and treat an injury/disease that is immediately threatening to life, limb or organ,” Lucas Eggers, with the University of Colorado School of Medicine, and colleagues noted in a poster presentation. “Longer wait times are associated with negative outcomes in healthcare, including mortality and increased length of stay.”
The group set out to determine how prevalent the issue was within their organization and how it affected other outcomes, such as length of stay, hospital costs and patient care delays. They reviewed all emergency and inpatient MRI orders from two six-month periods, taking note of the ordering department, order time, patient location, indication, MRI start time, diagnosis and order priority. The orders were categorized into five priority groups: RAD-0 (disaster/stroke/trauma), RAD-1 (ED/urgent inpatient), RAD-2 (ICU), RAD-3 (awaiting discharge) and RAD-4 (all other inpatients); RAD-0 and RAD-1 were the only two categories that truly qualified for high priority status.
Two independent reviewers evaluated the orders for appropriateness using “a standard of imminent mortality of morbidity.” They also compared these findings to order-to-scan times and patients’ length of stay.
There were a total of 6,734 MRI orders placed during the timeframes studied. From those, the team extracted a random sample (15%) of stat orders, resulting in 571 requisitions that were reviewed to ensure the appropriateness of their high priority status. Of that sample, 25.6% were deemed inappropriate; discordant orders accounted for nearly 80,000 minutes of order-to-scan time. Longer durations also were associated with prolonged hospital stays for many patients, which consequently increased hospital costs as well.
When the reviewers discussed the requisitions with the ordering providers, they determined that a lack of education on order priority status criteria was most often the cause of discordant orders. However, some providers admitted to knowingly requesting orders stat because they were frustrated by prolonged wait times.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.