The Reading Room

Need help reducing sedation use for pediatric patients? Ask the Avengers.

by Liam Frieswick and Matt Morrill

Managing pediatric imaging patients can be difficult due to sedation requirements, but one health system thinks it's found a way to ease patients' worries while improving throughput and reducing costs.

Fire trucks and frogs: 5 ways to reduce the need for sedation in kids

MRIs require patients to lay still for 30 to 60 minutes, enduring the loud noises of the machine, which can be challenging for children. Programs often resort to sedation to complete the scan. However, sedation creates operational problems and can also expose patients to anesthesia risks. Patients getting sedation both take longer and cost more than non-sedated patients.  

A caped solution: WCINYP's 'MRI-am-a-Hero' program

To reduce sedation rates, programs have implemented costly solutions, such as rehearsals using mock MRI machines. Weill Cornell Imaging at New York Presbyterian (WCINYP) set out to find a more cost-effective, generalizable strategy and formed a partnership with Siemens Healthineers and Marvel Custom Solutions. With the help of a child life specialist, they created the "MRI-am-a-Hero" program, which uses educational material, comic books, and a superhero cape to educate patients ahead of an MRI. The program includes a custom comic book about when Captain America injured his shoulder during a clash with some villains. After receiving guidance from Iron Man, Cap decides to get an MRI. The program also offers an educational DVD about a girl explaining her MRI experience for further education.

Traditional gowns are subbed out for a pair of shorts and a superhero t-shirt, and patients are offered a plush toy of either Captain American or Iron Man to take into the MRI with them. Upon completing the scan, they are given a superhero cape along with their toy and comic book to take home. Researchers found that the MRI-am-a-Hero program decreased sedation rates from 22.9% to 17.3%. When controlling for variables like patient age, neurological MRI, number of examinations in a case, and use of intravenous contrast, sedation rates decreased by 40%. Critical to this program's success was the availability of the child life specialist, who provided support before and throughout the MRI appointment. WCINYP believes this program is a cost-effective way to educate and engage patients while reducing sedation rates.

Limit sedation through protocol adherence with real-time management

While WCINYP offers a creative opportunity to reduce the need for sedation, there are still situations when sedation is necessary. Often when a patient is sedated, radiologists need to review the exam while the patient is still on the table. This allows radiologists to add sequences in the moment, at times unnecessarily, pushing the scan to exceed slot time.

At Children's Mercy Hospital, however, radiologists are required to submit sequence addition requests via PACs. Those are immediately reviewed by the technologist, patient flow technologist, and anesthesiologist. Factors considered include clinical need, urgency, current capacity, upcoming schedule, sequence length, patient preferences, and acuity of patient. The radiologist still makes the ultimate decision, but this structured management prevents protocol creep. Protocols are reviewed annually, and radiologists can offer input during this process to ensure sequences can be added when needed. Through this process, Children's Mercy now completes 70% of exams within standard scan time.

Benefits of reduced sedation

When looking to reduce and limit sedation for pediatric patients, your organization may benefit from the following best practices:

  1. Involve pediatric specialists and educational material that resonates with children to ease anxiety.

  2. Use multidisciplinary approach to ensure comprehensive and timely sequence decisions.

Regardless of your strategy, a deepened focus on sedation use can reduce costs, improve throughput, and reduce unnecessary anesthesia risks.

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