Around 70, 000 patients per year in the UK attend hospital with serious wrist pain after an injury, which although painful on examination, look normal on X-rays. In these cases, the National Institute for Health and Care Excellence (NICE) recommends giving patients an MRI scan. However, early MRI use varies across the UK, with only a minority of National Health Service (NHS) centres being able to offer this to patients for many complex reasons.
‘We therefore set up this study to explore the views of staff and patients on the use of early MRI in the management of wrist injuries,’ said Dr. Ben Dean, Senior Research Fellow at NDORMS.
The qualitative research, published in BMJ Open, explores the perspectives of both patients and healthcare staff on the management of wrist injuries in the UK's National Health Service (NHS).
For patients, wrist injuries can have a significant negative impact on their lives, causing them to worry whilst waiting for a diagnosis about worst-case scenarios and the potential for long-term disability if a serious injury like a scaphoid fracture is missed.
Healthcare staff also expressed concerns about the consequences of missed diagnoses. They felt that older diagnostic pathways, relying on X-rays alone, often left patients feeling "short-changed by the health service."
‘Early MRI was seen as a win for everyone,’ said Ben. ‘For patients, the win encompassed the relief of a speedy diagnosis which helped them to get better. Staff saw early MRI as a win because it ‘revolutionised care’ and ‘reduced the clinic footprint.’
The study also described the key ingredients in delivering an effective wrist injury pathway:
- A simple, clear pathway with defined roles and responsibilities
- Timely access to MRI scans and prompt reporting of results
- A safe pathway with safety nets to avoid patients falling through the cracks
- Data collection and audit to track performance
- Bottom-up, frontline-led change rather than top-down directives
- Clear communication with patients and between healthcare teams
- Dedicated time and resources for staff to implement and maintain the pathway
‘Our findings contribute to a better understanding of stakeholders' perspectives on wrist injury pathways in the UK NHS,’ said Ben. ‘We are now using the study's results to design a 'complex intervention' to help NHS centres to improve their wrist injury pathways for patients.’