The costs of sedating or anesthetizing children for MRI exams can add up quickly. One Canadian hospital analyzed what it was spending on sedation and subsequently changed its workflow to improve efficiency, according to an article in the July issue of Radiology.
An evaluation of 203 children, ranging from infancy to age 18, at the Hospital for Sick Children in Toronto determined that the average overall cost to perform an imaging procedure on an anesthetized patient was almost 10 times that of a patient who did not require sedation. Sedation increased exam cost to the hospital by more than 300% (Radiology, July 2010, Vol. 256:1, pp. 229-236).
Researchers from the University of Toronto's department of mechanical and industrial engineering performed a patient flow and cost analysis over a two-month period in which 827 children had MRI exams performed.
The analysis period began when patients arrived in the waiting room, and the analysis included individual measurements for arrival and registration, waiting, induction, MRI imaging, recovery, and departure. Twelve different flow "paths" for a patient were identified, representing one to eight different steps.
The majority (58.8%) of the 148 patients who did not require any type of sedation went from the waiting room to the MRI suite and departed. The flow for the majority (42.9%) of 28 patients requiring sedation was a four-step process, adding induction and recovery.
Twenty-two percent of anesthetized patients also followed this flow pattern. However, the majority (63%) of the 27 patients spanning all age groups required a six-step process that included two induction periods before an MRI exam was performed.
On average, patients who were scanned while awake spent two hours and 20 minutes in the radiology department, compared with three hours and 37 minutes for sedated children and four hours and seven minutes for anesthetized ones. However, the analysis revealed that times could fluctuate widely. Durations for alert children ranged from one to more than five hours; for sedated children, two to five hours; and for anesthetized children, two to more than seven hours.
|Cost to perform MRI (in Canadian dollars)
As a result of the analysis, lead author Sonya Vanderby, PhD, and colleagues reported that scheduling changes have been made to improve the scheduling mix of appointments between 8 a.m. and 4 p.m. To better accommodate anesthesiologist availability, patients requiring this service are alternated with patients requiring no type of sedation, rather than cared for sequentially. Appointments are also staggered between the two MRI suites to improve use of the nursing staff and the induction room.
Other changes are also planned, with the goals of reducing delays for patients and their families and better utilizing the two MRI suites, according to the authors.
By Cynthia E. Keen
AuntMinnie.com staff writer
July 2, 2010
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