Pediatric imaging is a tricky business. Staying still represents a challenge for pint-sized patients, translating into routine sedation of children for imaging exams, which in turn, brings safety concerns as well as throughput challenges. Children’s Hospital of Pittsburgh of UPMC (CHP) addressed the problem by launching its Adventure Series program, which employs theme-based imaging suites outfitted with music and videos and staffed by carefully trained technologists. After launching the first room in September 2005, the program expanded to nine rooms in May 2009.
CT served as the pilot project for the adventure series. CHP houses two themed CT suites: Pirate Island and Coral City. The number of sedations for pediatric CT plummeted from 354 cases in 2005 to four in 2009. Total sedation among all imaging modalities dropped another 25 percent between 2009 and 2011. The program eliminated the department's 16- to 18-day CT backlog, while volume swelled 66 percent between 2009 and 2011. Partial credit for these outcomes rests with rewards for patients. Pirate Island includes a treasure chest where children can choose their reward for remaining still and being brave, says Kathleen Kapsin, (RT), MS, director of radiology at CHP.
Blast-off to MR
CHP's four MR suites employ a space camp theme. Technologists invite children to board the space capsule rather than the scanner, and play the part of astronauts rather than healthcare providers. Children can watch a movie during the scan using one of three sets of virtual reality goggles. The combination of videos and goggles cut MR sedation 35 percent in 2007.
CHP aims to further drop this rate with an MR simulator to be deployed this fall. The life-sized simulator is a step up from toy scanners that allow kids to image stuffed animals. By assessing how a child de-sentitizes in the simulator, staff may better identify candidates able to bypass sedation as well as reduce prep time in the actual scanner, says Kapsin.
Adventure Beach, a.k.a. the radiation oncology suite, features a linear accelerator disguised as a sand castle, a hybrid surfboard/transport table and a scuba tank for oxygen.
During the year-long planning period preceding the launch of the themed rooms, an in-house team comprised of nurses, technologists and child-life specialists collaborated with the imaging vendor to develop engaging designs and story lines. A music therapist created themed music while the child-life specialist crafted educational materials, including coloring books for children and parent pointers to help their children through the procedures. Online pointers for parents given ahead of appointment times detail comfort-care positions for IV placement and an overview of distraction tools like deep breathing and guided imagery.
What not to say Try this instead
"Learning how to talk to children is one of most important strategies for staff to learn," says Kapsin. CHP Child-life Specialist Natalie Sten recommends giving children a voice and a choice. "Children are concrete thinkers and we have to use concrete language, not medical jargon," she adds. Sten recommends staff tailor language to the child's age and medical experiences.
Giraffe on Staff
A key member of CHP imaging team is Giraffe on Staff, a vein viewer that uses ultraviolet light to locate vessels. Like his human counterparts, Giraffe wears a name tag with his picture on it.
Dollars, Cents & Strategies
Each CHP suite carried a $35,000 to $40,000 price tag, costs the hospital maintains can be recouped through decreased sedation and increased throughput related to fewer cancellations and shorter scans. Facilities on a shoestring budget can pilot lower cost interventions such as a disco ball, projector, CD or DVD player, aromatherapy and bubble columns, which total less than a few hundred dollars. "These are doable in anyone's budget," says Kapsin.
Other low-cost strategies include staff training on age-appropriate relaxation techniques, such as singing, role playing and story telling. Children's imaginations take over, says Kapsin. They believe the stories, which captivates and distracts them.
Images courtesy of Children's Hospital of Pittsburgh