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Posted October 28, 2013
Innovative Care: MRI Without Sedation

When it comes to ordering tests and procedures for the tiny patients in All Children’s Neonatal Intensive Care Unit (NICU), there is careful consideration of the potential benefit and harm. The NICU team’s dedication to patient safety led them to develop an innovative way to perform an MRI of the brain while avoiding the potential risks associated with sedation.  

This ingenuity was recognized by the Florida Hospital Association at its annual meeting in Orlando, with team leader Cindy Driscoll, RN, BSN, MSHCA, accepting the award for Innovation in Health Care.

Physicians and staff had wondered if it might be possible for these fragile patients to undergo MRI of the brain (the most frequently ordered MRI for NICU patients) without anesthesia. Driscoll, the director of All Children’s 97-bed NICU, convened a team to design and implement a pilot study. Members included pediatric radiologist Evan Harris, M.D., neonatologist Anthony Napolitano, M.D., pediatric anesthesiologist George Alvarez, M.D., medical informatics director Dipti Amin, M.D., radiology director Mary Ann Bruton, Karen Theobald, ARNP, and Karen Schmitt, RN.

Aside from the MRI scanner, the key piece of equipment they needed was surprisingly simple and affordable: a vacuum bag immobilizer with a rigid frame that swaddles the infant tightly once air is pumped out of the immobilizer.

“We worked from the premise that infants fall asleep after eating, and that they like to be held securely and bundled,” Driscoll explains. “MRIs were scheduled to occur after an infant’s scheduled feeding. The baby would be bundled in the immobilizer and quickly fall asleep, and continue to sleep soundly throughout the scan.”

At less than $800, the immobilizer may be the least expensive piece of medical equipment I’ve purchased, and it eliminates considerably higher charges that would have been needed for sedation with each scan.

Infants in the study were at least 36 weeks postconceptual age and less than six months postnatal age. They were breathing on their own without mechanical ventilator support and without an episode of apnea or bradycardia (slow heart rate) recorded in the 72 hours before the scan. They also were receiving at least half their total fluid volume through oral feeding. Eligible MRI procedures were those that did not require contrast and were not deemed urgent.

The percentage of infant brain MRIs performed without sedation and contrast went from 42.9 percent at the start of the study to 66.3% by the end of 2012 and has since exceeded 85 percent. Each time the immobilizer was used, the MRI was successfully performed without sedation.  

“At less than $800, the immobilizer may be the least expensive piece of medical equipment I’ve purchased, and it eliminates considerably higher charges that would have been needed for sedation with each scan,” notes Driscoll. “Most importantly, we improve patient safety by avoiding the risks and potential long-term effects of anesthesia in very young patients.”

“This effort resulted in increased access to MRI, decreased costs for the procedure and, most of all, it led to improved patient safety for the NICU population,” said Dr. Harris, medical director for pediatric radiology.

Because the project proved so successful with NICU patients, the same technique is now used with patients up to the age of two from all of the hospital’s inpatient units as well as for those having MRI as ambulatory or Emergency Center patients. Reducing the use of sedation also provides time for additional scans, increasing access for outpatient MRI studies.

“Our MRI without sedation project highlights the impact of collaboration,” notes Dr. Napolitano. “Thanks to multiple teams working together, we’ve improved the quality of patient care by decreasing the risks associated with the procedure. That’s an outstanding result.”

 


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