New Child Life Program at Wolfson Children’s Hospital in Jacksonville, FL, Helps Young Children Have MRI Scans Without Sedation
Jacksonville, Florida (PRWEB) July 03, 2013
Wolfson Children’s Hospital recently launched a program aimed at reducing the number of pediatric patients undergoing sedation for magnetic resonance imaging (MRI) diagnostic scans.
The program, called “MR--I Am Ready!”, focuses on training and practice designed to familiarize children with the sights and sounds of the MRI scanner and prepares them to lie perfectly still for extended periods of time without sedation. Complete immobility during the procedure is critical for acquiring high-quality images used for diagnosis.
“MR-I Am Ready!” is a joint service of the Child Life and Radiology Departments at Wolfson Children’s Hospital, supported by pediatric anesthesiologists and other pediatric subspecialty physicians with Nemours Children’s Clinic, Jacksonville, and the University of Florida College of Medicine—Jacksonville, who serve on the hospital’s medical staff. It is offered free of charge.
The idea for the program began when Salvatore Goodwin, MD, chief of Pediatric Anesthesiology at both Wolfson Children’s and Nemours Children’s Clinic, Jacksonville, sought to lessen the time between referral for an MRI and actually having the procedure performed.
“It was out of a profound desire to make MRIs available on a timelier basis that we started this program,” says Dr.Goodwin. “The number of physicians ordering MRIs is increasing at a rate faster than most children’s hospitals can keep up with.” Often wait times for non-emergency MRI scans can be months due to the need for sedation provided by a board-certified pediatric anesthesiologist.
Dr. Goodwin was encouraged by the high success rate of Nelly Mauras, MD, division chief of Endocrinology at Nemours Children’s Clinic, Jacksonville, who uses diversion techniques for children with diabetes. He also saw an opportunity for parents and patients to avoid the risk and cost of general anesthesia, in addition to eliminating the costs of having a history and physical examination to verify the patient as a candidate for sedation.
After a review of studies and investigation of other programs around the nation used to address the problem, Dr. Goodwin presented the concept to Wolfson Children’s. The proposal received acceptance and plans were moved forward to get the program started to help reduce the MRI scan backlog, an issue common at children’s hospitals with this highly skilled pediatric specialty.
Late last year, Child Life Specialist Laura Merriem McCalvin, BS, CCLS, was brought on to design and implement the “MR – I Am Ready” program. After consultation with Dr. Goodwin, McCalvin reached out to other nationally recognized children’s hospitals, including Children’s National Medical Center in Washington, D.C., and Vanderbilt’s Monroe Carell Jr. Children’s Hospital in Nashville, Tenn., to learn about their successful programs to reduce the number of MRIs performed with sedation. From her research and planning, the “MR – I Am Ready!” program was launched early this year, with the first patient successfully completing a sedation-free MRI in January. Many of the patients who have attempted to have a sedation-free MRI through the program have had MRI procedures in the past with sedation.
“MR – I Am Ready!” is offered to children who are scheduled for an MRI at Wolfson Children’s prior to the exam, usually around the age of 6-8 and without special needs that may require sedation. The parents are contacted by a Child Life specialist at the hospital who provides preparation materials for use at home, then follows up with training and support one week before the exam and on the day of the procedure. The MRI with sedation appointment remains in place until after the child completes the program.
While some parents may be concerned about their child’s ability to complete an MRI without sedation, McCalvin believes the benefits far overshadow other considerations.
“The biggest concern parents have is that their child won’t be able to do it and it will just be a waste of time,” says McCalvin. “But the benefits of avoiding sedation totally outweigh that. If kids are given the right tools and practice, they can be successful. One of the neatest moments for me is seeing how excited the kids are about being able to complete something they thought they couldn’t do.”
7-year-old Christian Welch is one of the first participants in Wolfson Children’s Hospital’s “MR-I Am Ready!” program.
Christian Welch is a very active 7-year-old boy who loves horses, swimming and basketball. But when he came home from school one day in 2012, limping after having his right foot stepped on, his mother, Melody Welch, noticed that one leg appeared to be slightly longer than the other.
Christian was examined by pediatrician Randolph Thornton, MD, who referred him to pediatric orthopedic surgeon John M. Mazur, MD, and pediatric neurologist David M. Hammond, MD, both with Nemours Jacksonville. Dr. Hammond decided that an MRI was necessary to make sure nothing was pressing on Christian’s spine and that his spinal cord was not tethered.
Because of Mrs. Welch’s concerns about sedation and her desire to have the scan done as quickly as possible, Christian was later sent to a mobile adult MRI unit to attempt the procedure without sedation. But after 30 minutes, the technician said he was not holding still enough and the scan was cancelled. Christian was rescheduled for an MRI at Wolfson Children’s Hospital, this time with sedation.
Two weeks before the procedure, McCalvin called Mrs. Welch to offer the hospital’s new “MR – I Am Ready!” program, which is designed to enable children to successfully complete an MRI without sedation.
“When Laura called and offered the sedation-free MRI, I felt like it was an answer to prayer,” says Mrs. Welch. “I was so happy!”
Prior to Christian’s first visit to Wolfson Children’s, McCalvin emailed videos to him showing a character going through the procedure and what to do to prepare. One week later, Christian went to Wolfson Children’s for further training.
“When we were practicing, Christian did an excellent job holding still for one minute,” says McCalvin. “When we were about to go for two, he said he wanted to go ahead and do five.”
On the day of the procedure, Christian and his Mom were ready.
“I was actually pretty calm,” says Mrs. Welch. “I felt he was prepared and would be able to hold still. He was bouncing off the walls in the waiting room and told me he was just trying to get all the energy out before the scan started.”
McCalvin had taught Christian distraction techniques such as closing his eyes and thinking about things like basketball and horses, but he later told his mom that he mostly thought about a Bible verse he had learned at church, Mark 5:36, that says, “Do not be afraid; only believe.”
“The MRI took one and a half hours,” says Mrs. Welch. “Halfway through, Laura came out and told me how great he was doing. They later told me they thought he was asleep during the scan, but he was just really well-prepared.”
Immediately after the scan, Christian was back to his normal routine, again bouncing off the walls.
Christian was diagnosed with hemihypertrophy, defined as the enlargement of one side of the body or part of the body. His prognosis is good, and he continues to be followed up by Dr. Mazur.
Christian has a very direct assessment of the training he did at home and the actual event.
“The training was kind of the same, except training used a couch and the MRI was not as comfortable as the couch,” he says. “The sound was very loud, like a building falling down, but you wear earplugs so you don’t hear so loud.”
Mrs. Welch encourages other parents of children scheduled for an MRI to consider “MR – I Am Ready!”
“There’s no need to be concerned,” she says. “The program does an excellent job of making your child prepared, relaxed and unafraid. The whole thing is really ‘easy-peasy,’ as Christian would say.”
“Pretty much don’t worry,” adds Christian. “It just makes a sound.”
About Wolfson Children’s Hospital
Wolfson Children’s Hospital in Jacksonville, Florida, serves as our region’s pediatric referral center and only hospital just for kids. The 180-bed, patient- and family-centered hospital features an environment filled with bright colors, warm smiles and the latest children’s medical technology. At Wolfson Children’s Hospital, nationally recognized pediatric specialists representing nearly every medical and surgical specialty work with pediatricians to provide care for children of all ages with congenital heart conditions, cancer, neurological disorders, orthopaedic conditions, behavioral health disorders, and more. The hospital is staffed by pediatric nurses and other healthcare professionals specially trained to work with children. Wolfson Children’s pediatric partners include Nemours Children’s Clinic, the University of Florida Jacksonville, and Mayo Clinic Florida. For additional information, please visit wolfsonchildrens.org.
Nemours (NAH-mors) is an internationally recognized children’s health system that owns and operates the Alfred I. duPont Hospital for Children in Wilmington, Delaware and the Nemours Children’s Hospital in Orlando, Florida along with major pediatric specialty clinics in Delaware, Florida, Pennsylvania and New Jersey.
Established as The Nemours Foundation through the legacy and philanthropy of Alfred I. du Pont, Nemours offers pediatric clinical care, research, education, advocacy and prevention programs to all families in the communities it serves. For more information, visit http://www.Nemours.org