Requesting spinal MRIs effectively from primary care referrals

  • Ignatius Liew
  • Fraser Dean
  • Gillian Anderson
  • Odhrán Murray
Original Article



To define if MRI scans can accurately be requested based on information provided in the primary care referral and, therefore, streamline the patient journey.

Summary of background data

The demand for outpatient spinal appointments significantly exceeds our services’ ability to provide efficient, high-quality patient care. Currently, magnetic resonance imaging (MRI) of the spine is requested following first consultation.


During routine vetting of primary care referral letters, three consultant spinal surgeons recorded how likely they thought each patient would be to have an MRI scan. Following the first consultation with the spinal service, the notes of each patient were reviewed to see if an MRI was requested. We measured the positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of ordering MRI scans based on primary care referral letters.


149 patients were included [101 females, 48 males, mean age 49 (16–87)]. There were 125 routine, 21 urgent, and 3 ‘urgent-suspected cancer’ referrals. The PPV of ordering MRIs before first consultation was 84%, NPV was 56% with the sensitivity and specificity being 82 and 59%, respectively. Ordering MRIs during initial vetting could shorten the patient journey with potential socioeconomic benefits.


MRI scans can be effectively ordered based on the information provided by the primary care referral letter. Requesting MRI scans early in the patient journey can save considerable time, improve care, and deliver cost savings.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Outpatient department Magnetic resonance imaging Quality improvement Patient care General practitioners Quality of patient care Sensitivity Specificity Streamline patient journey 


Compliance with ethical standards

Conflict of interest

No conflict of interest. No funds were received in support of this work. No relevant financial activities outside the submitted work.

Supplementary material

586_2018_5578_MOESM1_ESM.pptx (146 kb)
Supplementary material 1 (PPTX 145 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Spine, Trauma and OrthopaedicsQueen Elizabeth University HospitalGlasgowUK
  2. 2.Department of Management Science, University of Strathclyde Business SchoolGlasgowUK

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