title: Effect of anesthesia and sedation on pediatric MR imaging patient flow.
abstract: OBJECTIVE
  To determine the effect of sedative and anesthetic administration on the duration and costs of pediatric magnetic resonance (MR) imaging.
  
  
  METHODS
  This prospective study was approved by the institutional research ethics board; informed consent and/or assent was obtained from all participants or their parents. A patient flow study was conducted in a pediatric MR imaging clinic in which research assistants tracked participants' progress through the clinic. Demographic, visit process, and medication information was collected for 237 participants, categorized as awake, sedated, or anesthetized. The data were analyzed to (a) determine total visit duration differences, (b) investigate variations in visit stage durations according to patient type, and (c) estimate visit costs on the basis of human resource and medication use. Linear regression, the Shapiro-Wilk test, the two-tailed t test, and the nonparametric Mann-Whitney test were used.
  
  
  RESULTS
  Complete data sets were obtained for 148 awake, 28 sedated, and 27 anesthetized participants. Data revealed 12 stage sequences among patient visits; dominant sequences differed according to patient category. An awake patient's average visit duration (2 hours 21 minutes) differed significantly from that of sedated (3 hours 38 minutes, P < .001) and anesthetized (4 hours 7 minutes, P < .001) patients; sedated and anesthetized visit durations did not differ significantly (P < .073), although this finding may be attributable to the small sample sizes. Variation in stage durations was also evident within and among patient types. Visit costs for sedated and anesthetized patients were 3.24 and 9.56 times higher, respectively, than those for awake patients. Costs for anesthetized patients were 2.95 times higher than those for sedated patients.
  
  
  CONCLUSIONS
  Visit durations were significantly longer for anesthetized and sedated patients. Anesthetized patients incurred the highest costs, followed by sedated patients.
authors.affiliation: Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada. s.vanderby@utoronto.ca
authors.forename: Sonya A
authors.initials: SA
authors.lastname: Vanderby
authors.forename: Paul S
authors.initials: PS
authors.lastname: Babyn
authors.forename: Michael W
authors.initials: MW
authors.lastname: Carter
authors.forename: Susan M
authors.initials: SM
authors.lastname: Jewell
authors.forename: Patricia D
authors.initials: PD
authors.lastname: McKeever
mesh_terms: D000758:Anesthesia / Q000191:economics* / Q000379:methods*; D002648:Child; D016292:Procedural Sedation / Q000191:economics* / Q000379:methods*; D003287:Contrast Media / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media