424 - Utilization of a standardized protocol to equitably reduce sedation use for neonatal magnetic resonance image (MRI) studies.

Poster Number: 424
Publication Number: 424.2248

Background: Pharmacologic sedation in neonates has been associated with short & long-term adverse effects. For neonatal MRI, most institutions utilize feed and swaddle (F&S) as the preferred method to minimize movement without pharmacologic sedation. Our neonatal ICU (NICU) had no protocol for F&S nor standardized communication between NICU & MRI staff. This led to high failure rate of F&S MRI & high percentage of babies requiring general anesthesia (GA) for MRI.

Objective: Our global aim was to decrease pharmacologic sedation for NICU MRI studies by implementing a standardized protocol for F&S & to assess the impact of our initiative across all races. We created the following SMARTE aims:
1. Increase successful F&S MRI 10% from baseline over 12 months across races.
2. Decrease use of GA for MRI 10% from baseline over 12 months across races.
3. Decrease MRI wait time 10% from baseline over 12 months across races.

Design/Methods: In February 2022, we created a multidivisional collaborative team, with key stakeholders from NICU, Radiology & Pediatric Anesthesia. Operational definition (OD) of unsuccessful F&S MRI was agreed upon by all team members as presence of motion artifact & need for study repetition < 7 days from initial study. Utilizing fishbone diagram & process mapping, we identified various factors leading to unsuccessful F&S, which led to creation of a standardized protocol and communication for F&S MRI, with implementation in June 2022.

Results: Baseline mean rate of successful F&S was 61%, which increased to 93% & > 6 points above the median suggesting special cause variation (Fig 1). Benefit across all races was seen (Fig 3). Baseline data showed mean rates of GA MRI of 27%, which reduced to 22% after protocol use. Baseline mean study wait time (from order to study completion) for MRI was 39 hours, which increased to 53 hours, without special cause variation (Fig 2). Special cause variation suggesting consistent, significant improvement in successful F&S MRI was seen across racial categories. However, we have not seen sustained improvement in decreasing the use of GA for MRI or decreased time from order to completion of MRI study.

Conclusion(s): This project demonstrates the value of QI tools in identifying & overcoming system barriers & improving medical care in an equitable fashion. Stratifying data by race showed equitable improvement in successful F&S MRI. Increased study wait time can be explained by MRI understaffing since early 2023. Future protocols aimed at using intranasal sedation to decrease GA use & to decrease study wait time are in development.