Mandatory Child Life Consultation and Its Impact on Pediatric MRI Workflow in an Academic Medical Center.
Pediatric patients undergoing MRI often require general anesthesia, which may improve image quality but is associated with significant medical risk and economic cost. It has previously been shown that certified child life specialists using high-tech interventions (eg, MRI-compatible video goggles) significantly reduce the number of pediatric MRI patients who require sedation. Most imaging centers lack such technology, however, and it remains unclear whether simpler and less costly child life interventions may be equally effective in avoiding general anesthesia. The aim of this study was to assess the impact of requiring mandatory child life evaluation for all patients aged 5 to 18 years undergoing MRI before referral for general anesthesia. Inserting this simple step into the scheduling workflow significantly reduced the use of general anesthesia in this population: general anesthesia was required in 564 of 2,433 MRI cases during the 1-year baseline period compared with 484 of 2,526 cases during the 1-year intervention period (P < .01 by z test for proportions; absolute reduction, 4.0%; relative reduction, 14.8%). The authors estimate that instituting mandatory child life evaluation avoided the use of general anesthesia in approximately 102 patients during the intervention period. Further subgroup analysis revealed that avoidance of general anesthesia was highly significant in the 5- to 10-year-old age group, whereas those aged 11 to 18 years experienced only a trend toward modestly decreased use of general anesthesia. These results suggest that mandatory evaluation for standard child life interventions is a worthwhile step that can save many children from unnecessary exposure to the risks, cost, and inconvenience of general anesthesia.
Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins, University School of Medicine, Baltimore, Maryland. Electronic address: daniel.j.durand@gmail.com.
Daniel J
DJ
Durand
Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins, University School of Medicine, Baltimore, Maryland.
Mollie
M
Young
Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins, University School of Medicine, Baltimore, Maryland.
Paul
P
Nagy
Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins, University School of Medicine, Baltimore, Maryland.
Aylin
A
Tekes
Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins, University School of Medicine, Baltimore, Maryland.
Thierry A G M
TA
Huisman
D000046:Academic Medical Centers; D000293:Adolescent; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D012017:Referral and Consultation; D057188:Workflow
Child life; MRI; child life specialist; general anesthesia; magnetic resonance imaging; pediatric MRI; procedural sedation; team-based care