Kids Can Program Shows MRIs Without Anesthesia are Possible
From the Show: Childrens Health - Peer
Summary:
Air Date: 3/9/20
Duration: 10 Minutes
Dr. Booth and Stephanie Price discuss the Kids Can Program and how it helps reduce the need for anesthesia, shorten procedure times, and improve patient safety.
Transcription:
Bill Klaproth: When it comes to anesthesia, the concept can be unnerving for a parent, especially when they're entrusting their child's health and wellbeing to someone else. That's where the Kids Can program at Children's Health comes in. To help reduce the need for anesthesia, shorten procedure times, and improve patient safety. So coming up we'll learn more about the Kids Can program and doing MRIs without anesthesia. This is Pediatric Insights, Advances and Innovations with Children's Health where we explore the latest in pediatric care and research. I'm Bill Klaproth, with me is Dr. Tim Booth, Chief of Pediatric Radiology at Children's Health and Professor of Radiology and Otolaryngology at UT Southwestern Medical Center and Stephanie Price, Certified Child Life Specialist at Children's Health. Dr. Booth and Stephanie, thank you for your time. Stephanie, let's start with you. Can you explain what the kids can program is?
Bill Klaproth: When it comes to anesthesia, the concept can be unnerving for a parent, especially when they're entrusting their child's health and wellbeing to someone else. That's where the Kids Can program at Children's Health comes in. To help reduce the need for anesthesia, shorten procedure times, and improve patient safety. So coming up we'll learn more about the Kids Can program and doing MRIs without anesthesia. This is Pediatric Insights, Advances and Innovations with Children's Health where we explore the latest in pediatric care and research. I'm Bill Klaproth, with me is Dr. Tim Booth, Chief of Pediatric Radiology at Children's Health and Professor of Radiology and Otolaryngology at UT Southwestern Medical Center and Stephanie Price, Certified Child Life Specialist at Children's Health. Dr. Booth and Stephanie, thank you for your time. Stephanie, let's start with you. Can you explain what the kids can program is?
Stephanie Price: Yes. This program was developed in hopes of reducing anesthesia use in pediatric MRIs, so Kids Can is a program we developed that offers child life preparation and age appropriate resources in order to help kids have a successful MRI without anesthesia.
Host: And Dr. Booth, when was the concept of this program born and what inspired it?
Dr. Booth: Really what inspired it was we saw a fair number of children undergoing general anesthesia and we thought really these kids could do it without. We looked at some national numbers and saw that our rate of general anesthesia for MRIs was on the higher side. So we really initially tried to decrease the number of general anesthesia cases by sort of reaching out to providers, reaching out to families when they got here. And really the program didn't take off until we ended up hiring Stephanie, and bringing Stephanie on board. And really she kind of took the reigns of the program and really started developing a lot of material for parents and sort of pushed this program out to the public.
Host: So what are the drawbacks of using anesthesia for MRIs?
Dr. Booth: I mean, there's a risk involved. So anytime you use general anesthesia, there's a small risk, but still a risk. With very young children there have been sort of published risks of developmental issues, but mostly on the very, veryyoung children. The other main drawback is the fact that these kids, they tend to be a much longer study and the children have to be NPO. So they can't eat or drink before the study. And the study tends to take a long time on the back-end as well. So theytend to have a fairly long time to sort of wake up and to really sort of get back to school and to normal activities again. And with the Kids Canprogram and these doing it non-sedate meaning that no anesthesia at all. Basically once the exam is over theyhop in the car and can go straight back to school or any other activity that they might have scheduled.
Host: So this is a really thoughtful program. Stephanie, can you talk about how you gain buy in from parents on this concept?
Stephanie Price: Sure. You know, I think sometimes parents, this might be their first exposure to an MRI for their child or you know, the first time we talk about doing it without anesthesia. And so since they've never actually been in the room during that event, they don't know what to expect. And so going back a bit and talking about what to expect when they're in their room, when their child is in the room, what their child might need to do, and explaining the procedure and a little bit in a way that the child can understand helps gain buy in. And also just talking about how successful we've been with child life preparation and the resources that are available to their child in order to help them be successful. Children are able to watch movies or listen to music and then a parent is always able to be in the room with them. And those factors definitely help kids be successful.
Host: And Dr. Booth, let me ask you the same question. How do you gain buy in from providers on this concept?
Dr. Booth: That was really kind of one of the more difficult sort of avenues that we kind of went down. The providers had been used to sort of doing general anesthesia in these cases and to a certain extent it's easier as far as just in the short term and getting the study done. But we sort of reached out to all the major sort of referral physicians and reached out to hematology, oncology, neurology, some of the general pediatricians that were actively referring people to our institution, and really had a talk with them and telling them that we could do these studies and we can do these studies more quickly. And really get the same diagnostic information and avoid general anesthesia. So moral is sort of a grassroots sort of effort, and talking to all the referring services or referring clinicians and basically just more than anything, educating them to tell them that, okay, well the child doesn't need, didn't necessarily hold still for 45 minutes and not move at all. We can do a sequence for five minutes. The child can then just get up, can walk around, can rest, and then continue on. And, and usually once we've sort of, we explained it that way, we got a lot more buy in from the referring services.
Host: Yeah, I could see how this concept is very comforting for parents. So Stephanie, how do you identify good candidates for a sedation free MRI?
Stephanie Price: So like Dr. Booth was talking about is kind of gaining provider buy in. Some of that, those referrals will come from physicians, um, and their assessment when they are working hands on with the patient in their clinic or at the bedside, and they see the child's temperament and their developmental levels and they're able to make referrals from there. And good recommendations on if they might be appropriate to complete an MRI without the anesthesia. They can now through our system make a referral through the MRI order for us to be involved and provide support through the Kids Can program. And another thing that we've added in, in order to, to screen for great patients for this program is in screen questions added at scheduling. Some of those questions include is your child able to follow directions? Are they able to remain moderately still for a few minutes at a time? Are there any developmental considerations that we might need to consider? And all of these things help us predict if their child may or may not be able to complete a scan without anesthesia.
Host: And then Stephanie, how do you prepare patient families for a sedation free MRI?
Stephanie Price: So preparation I say is a key aspect to this program and we recommend that preparations start from home and so once we find out that a patient's choosing to participate in Kids Can, there's going to be information that's emailed to the parent to review with their child at home from a safe nonthreatening environment. We just ask that the parent talk to their child about what to expect before the appointment arrives and then practice. The way we ask them to practice is just by holding still for one to two minutes at a time with MRI sounds, playing in the background, this familiarizes the child with what is going to be expected of them and then what the environment is going to sound like. Once they arrive for the appointment, then there's preparation that's provided day of and then we'll review any and all of that information that was discussed at home. We'll assess for any potential stressors or barriers to success and then help the patient develop a coping plan in order to be successful. We have lots of different tools that we use with different developmental stages and different learning styles. Some of those are just pictures and sounds that we review to explain the environment and then there's other hands on resources that we use. We have a small mini mock scanner that kids can manipulate and test outwith either a Barbie figurine or a superhero figurine. We have a popup tunnel that kids can crawl in and practice being inside, almost like an MRI bore. And then we also have VR goggles that really helps simulate what it's going to be like when they get in there. All of those different techniques can help prepare the patient for a successful MRI.
Host: Well, this has really been informative. Stephanie and Dr. Booth, thank you very much for your time.
Stephanie Price: Thank you.
Dr. Booth: Okay, thank you very much.
Host: That's Dr. Tim booth and Stephanie Price, and thank you so much for listening to Pediatric Insights. For more information, please visit childrens.com/imaging that's childrens.com/imaging. And if you found this podcast helpful, please rate and review or share the episode and follow Children's Health on your social channels. This is Pediatric Insights, Advances and Innovations with Children's Health. Thanks for listening.
Host: And Dr. Booth, when was the concept of this program born and what inspired it?
Dr. Booth: Really what inspired it was we saw a fair number of children undergoing general anesthesia and we thought really these kids could do it without. We looked at some national numbers and saw that our rate of general anesthesia for MRIs was on the higher side. So we really initially tried to decrease the number of general anesthesia cases by sort of reaching out to providers, reaching out to families when they got here. And really the program didn't take off until we ended up hiring Stephanie, and bringing Stephanie on board. And really she kind of took the reigns of the program and really started developing a lot of material for parents and sort of pushed this program out to the public.
Host: So what are the drawbacks of using anesthesia for MRIs?
Dr. Booth: I mean, there's a risk involved. So anytime you use general anesthesia, there's a small risk, but still a risk. With very young children there have been sort of published risks of developmental issues, but mostly on the very, veryyoung children. The other main drawback is the fact that these kids, they tend to be a much longer study and the children have to be NPO. So they can't eat or drink before the study. And the study tends to take a long time on the back-end as well. So theytend to have a fairly long time to sort of wake up and to really sort of get back to school and to normal activities again. And with the Kids Canprogram and these doing it non-sedate meaning that no anesthesia at all. Basically once the exam is over theyhop in the car and can go straight back to school or any other activity that they might have scheduled.
Host: So this is a really thoughtful program. Stephanie, can you talk about how you gain buy in from parents on this concept?
Stephanie Price: Sure. You know, I think sometimes parents, this might be their first exposure to an MRI for their child or you know, the first time we talk about doing it without anesthesia. And so since they've never actually been in the room during that event, they don't know what to expect. And so going back a bit and talking about what to expect when they're in their room, when their child is in the room, what their child might need to do, and explaining the procedure and a little bit in a way that the child can understand helps gain buy in. And also just talking about how successful we've been with child life preparation and the resources that are available to their child in order to help them be successful. Children are able to watch movies or listen to music and then a parent is always able to be in the room with them. And those factors definitely help kids be successful.
Host: And Dr. Booth, let me ask you the same question. How do you gain buy in from providers on this concept?
Dr. Booth: That was really kind of one of the more difficult sort of avenues that we kind of went down. The providers had been used to sort of doing general anesthesia in these cases and to a certain extent it's easier as far as just in the short term and getting the study done. But we sort of reached out to all the major sort of referral physicians and reached out to hematology, oncology, neurology, some of the general pediatricians that were actively referring people to our institution, and really had a talk with them and telling them that we could do these studies and we can do these studies more quickly. And really get the same diagnostic information and avoid general anesthesia. So moral is sort of a grassroots sort of effort, and talking to all the referring services or referring clinicians and basically just more than anything, educating them to tell them that, okay, well the child doesn't need, didn't necessarily hold still for 45 minutes and not move at all. We can do a sequence for five minutes. The child can then just get up, can walk around, can rest, and then continue on. And, and usually once we've sort of, we explained it that way, we got a lot more buy in from the referring services.
Host: Yeah, I could see how this concept is very comforting for parents. So Stephanie, how do you identify good candidates for a sedation free MRI?
Stephanie Price: So like Dr. Booth was talking about is kind of gaining provider buy in. Some of that, those referrals will come from physicians, um, and their assessment when they are working hands on with the patient in their clinic or at the bedside, and they see the child's temperament and their developmental levels and they're able to make referrals from there. And good recommendations on if they might be appropriate to complete an MRI without the anesthesia. They can now through our system make a referral through the MRI order for us to be involved and provide support through the Kids Can program. And another thing that we've added in, in order to, to screen for great patients for this program is in screen questions added at scheduling. Some of those questions include is your child able to follow directions? Are they able to remain moderately still for a few minutes at a time? Are there any developmental considerations that we might need to consider? And all of these things help us predict if their child may or may not be able to complete a scan without anesthesia.
Host: And then Stephanie, how do you prepare patient families for a sedation free MRI?
Stephanie Price: So preparation I say is a key aspect to this program and we recommend that preparations start from home and so once we find out that a patient's choosing to participate in Kids Can, there's going to be information that's emailed to the parent to review with their child at home from a safe nonthreatening environment. We just ask that the parent talk to their child about what to expect before the appointment arrives and then practice. The way we ask them to practice is just by holding still for one to two minutes at a time with MRI sounds, playing in the background, this familiarizes the child with what is going to be expected of them and then what the environment is going to sound like. Once they arrive for the appointment, then there's preparation that's provided day of and then we'll review any and all of that information that was discussed at home. We'll assess for any potential stressors or barriers to success and then help the patient develop a coping plan in order to be successful. We have lots of different tools that we use with different developmental stages and different learning styles. Some of those are just pictures and sounds that we review to explain the environment and then there's other hands on resources that we use. We have a small mini mock scanner that kids can manipulate and test outwith either a Barbie figurine or a superhero figurine. We have a popup tunnel that kids can crawl in and practice being inside, almost like an MRI bore. And then we also have VR goggles that really helps simulate what it's going to be like when they get in there. All of those different techniques can help prepare the patient for a successful MRI.
Host: Well, this has really been informative. Stephanie and Dr. Booth, thank you very much for your time.
Stephanie Price: Thank you.
Dr. Booth: Okay, thank you very much.
Host: That's Dr. Tim booth and Stephanie Price, and thank you so much for listening to Pediatric Insights. For more information, please visit childrens.com/imaging that's childrens.com/imaging. And if you found this podcast helpful, please rate and review or share the episode and follow Children's Health on your social channels. This is Pediatric Insights, Advances and Innovations with Children's Health. Thanks for listening.