Background and Aim of the Audit: 
Diagnosis and follow-up of Inflammatory Bowel Disease (IBD) in patients younger than 50 years of age is a widely accepted indication for Magnetic Resonance Enterography (MRE). However, at our institution (St. Joseph’s Healthcare Hamilton (SJH)), there has been a gradual increase in the average age of referred patients and in inappropriate indications such as anemia, diarrhea and abdominal pain. The purpose of this quality assurance study was to determine the referral practices for MRE at SJH and to educate the referring physicians about the appropriateness of the test.

Standard: 
The standard is to accept all the MRE requests.

Audit Target:
MRE indication limited to diagnosis and follow-up of IBD in young patients. 

Methods:
A total of 150 consecutive MRE examinations from July to October 2017 were retrospectively reviewed. The study date, patient age, clinical indication and quality of the study were recorded. Indications were categorized based on the pathology in question. Any failed examinations and the reason for failure were recorded.

Results:
A total of 52 patients (35%) were older than 50 years. A total of 127 studies (85%) involved IBD as an indication and 107 studies (71%) involved specifically Crohn’s disease. Six studies (4%) were related to ulcerative colitis. Twenty-one (21%) studies included non-specific indications, most common being polyps and chronic small bowel obstruction. Other less common indications included carcinoid, esophageal cancer and anal cancer. No study was incomplete due to technical factors.

Interventions:
An educational letter was drafted to the top 20 referring clinicians to clarify the appropriateness criteria for MRE.

Conclusions:
While majority of indications were appropriately related to IBD, up to 21% included inappropriate indications. As well, up to 35% of patients were older than 50. For both these patient populations, a CT Enterography is the study of choice. To attempt to remedy this, an educational letter was drafted to the top 20 referring clinicians to clarify the appropriateness

Magnetic Resonance Enterography (MRE) – A Single Institution Audit of Referral Compliance with Appropriateness Criteria