A quality improvement project to reduce magnetic resonance imaging sedation in children.

Background: Our institution decided to implement an awake MRI scanning quality improvement project using audiovisual distraction (AVD) technology.

Objective: To reduce the utilization of minimal/moderate sedation by at least 20% in children 4 to 18 years, while maintaining comparable diagnostic quality and adhering to allotted exam times, through the implementation of an awake MRI program.

Materials and methods: This project was conducted at a pediatric sedation clinic between October 2021 and January 2024. We included patients 4 to 18 years of age, scheduled for an MRI at the pediatric hospital, and eligible for either minimal/moderate sedation or AVD. The outcome measure was the percentage of patients referred to our sedation clinic who completed an MRI with AVD and without sedation, analyzed on a statistical process control (SPC) P-Chart. Process measures were the number of children eligible for AVD per month, analyzed on an SPC C-Chart. Balance measures were the number of studies that exceeded allotted exam time or were non-diagnostic.

Results: Of 734 MRI referrals aged 4 to 18 years, 320 patients met inclusion criteria. Two hundred twenty-eight (71.3%) received minimal/moderate sedation (mean age [SD] 9.7 years [± 3.0]) and 92 (28.8%) underwent AVD (mean age 10.0 years [± 2.7]). The average monthly decrease in minimal/moderate sedation use was 28.8 percentage points. The average number of children considered eligible for AVD increased by special cause variation from 3.8 to 7 patients per month. All 92 MRI referrals triaged to AVD completed their MRI successfully without sedation; all studies were diagnostic, and 96% of studies were within the allotted exam time.

Conclusion: We implemented an awake MRI program with AVD that decreased monthly sedation needs by 28.8 percentage points while maintaining a high rate of diagnostic studies and no MRI delays.