Background: Utilization of MRI as diagnostic imaging continues to increase in the pediatric population. MRI with sedation accounts for 23% of pediatric MRI studies with 31% of those being inpatient. Barriers to completion of an MRI in pediatric populations includes the frequent use of sedation and poor communication amongst pediatric hospitalist, anesthesia and radiology. With a high demand for sedation during MRI studies, pediatric patients are frequently made NPO for prolonged periods of time. The period of prolonged NPO time is often a time of anxiety and distress contributing to lack of patient satisfaction. In this project we were afforded the opportunity to decrease NPO times for all pediatric patients undergoing sedated MRI in the inpatient setting to <8 hours.
Methods: We conducted a retrospective chart review of pediatric patients who had an MRI study ordered on pediatrics floor, PICU, NICU and as outpatient. The pre-intervention phase (August 2017) served as a control, and two PDSA cycles occurred over the post-intervention phase (September 2018 – November 2018). The first PDSA cycle entailed an in-house education provided to the pediatric residents regarding the scheduling and communication process for MRI studies. The second PDSA entailed another in-house education provided again to pediatrics resident involving inpatient MRI and sedation indications and recommendations regarding fasting prior to sedation. Data was obtained from UMC radiology billing department. QIRB approved project.
Results: Pre-intervention: 96 MRI studies were analyzed. 82% (n=79) of MRI studies were inpatient. 70% (n=55) of inpatient studies were ordered by pediatric floor and 30% (n=24) from PICU and NICU combined. Pre-intervention, 50% (n=24) had NPO times prior to sedated MRI studies lasting greater than 8 hours, which decreased to 21% (n=3) post-intervention cycle 1 and 36% (n=7) post-intervention cycle 2. Pre-intervention 50% (n=48) were sedated which significantly improved post-intervention cycle 1 to 19% (n=11) and post-intervention cycle 2 to 28% (n=11). Pre-intervention length of stay was reduced; pre-intervention average length of stay was 10.9 days as compared to 5.8 days post-intervention 1, and 5.2 days post-intervention 2. All sedated MRIs with NPO times lasting greater than 8 hours were ordered on the pediatrics floor and were sedated by anesthesia.
Conclusions: It is evident that the improvement of interdepartmental communication processes between pediatrics, anesthesia and radiology when ordering and scheduling MRIs is essential for having reduced NPO times. As well, knowledge regarding inpatient MRI indications, sedation indications and NPO times prior to sedation clearly decreased use of sedation for MRI.