Using Quality Improvement Methodology to Reduce Sedation for MRI in a Quarternary Care Neonatal Intensive Care Unit
Purpose or Case Report: Background: Brain MRI has become an integral tool in the diagnosis and management of neonates with possible brain injury. In a large quaternary care neonatal intensive care unit (NICU), MRIs are routinely performed for the identification of white matter lesions in preterm infants, prognostication in hypoxic ischemic encephalopathy, peri-operative evaluation of patients with meningomyeloceles and hydrocephalus among other indications. Patients are often sedated in order to obtain high quality images, but sedation comes with complications. As these studies become an integral part of our practice in the NICU, we have identified a need to minimize the use of sedation to obtain clinically acceptable neonatal brain MRIs. Methods & Materials: Methods: We reviewed baseline data of patients who underwent brain MRI. This was done via prospective data collection. A multidisciplinary committee was created. Neonatology, Neurology, Neuroradiology, Radiology, Sedation. We identified existing barriers that prevent us from obtaining unsedated MRI studies, as detailed in the attached fishbone diagram. Results: Our outcome metric will be MRIs obtained without sedation particularly focusing on non-intubated patients. Our process metrics include length of scans, frequency with which clinicians are ordering the shortened MRI scan for appropriate patients. As a balancing metric we will look at frequency of repeated scans due to unacceptable image quality from infant movement and frequency of patient safety events while in the immobilizer leading to interruptions of scans Results: Based on baseline data collection, in 2015, we performed a mean of 22 brain MRIs per month, 50.3% of those were unsedated. The average duration of a study was 52 minute. We are currently in the implementation phase of our interventions, which started in January 2016. In the first 2 months of implementation, 14 brain MRIs were ordered and performed on the screening protocol, and all of the images obtained were acceptable image quality, without need for repeat Conclusions: Conclusions Working with a multidisciplinary team we identified barriers to changing practices surrounding sedation for brain MRIs. It is possible to implement a neonatal specific MRI protocol that with the input of a multidisciplinary team.
( Children's Hospital of Philadelphia
, United States