WIP 132 - Utilizing Performance Measures to Improve Endoscopy Experience, a Hospital Based QI Project

Poster Number: WIP 132
Publication Number: WIP 132.2507

Background: The pre-procedure endoscopy experience can cause significant anxiety for both pediatric patients and their parents. Those at highest risk include children greater than 7 years of age, shy or introverted temperament, children with anxious parents, and those with previous negative medical encounters. In our institute, with an average of 600 annual upper and lower endoscopies, we have visually seen cases of anxiety prior to procedures but its impact was not quantified. Pediatric anxiety in a pre-procedural setting has shown to have negative immediate affects such as delaying induction of anesthesia, hindering recovery and long-term detriment of causing behavioral problems. Understanding the impact of anxiety can help change the clinical outcomes for children, their families and healthcare system as a whole.

Objective: Evaluate patient’s self-reported level of anxiety for upper and lower endoscopies with dedicated questionnaire and provide pre-procedure interventions, including use of Virtual Reality and mindfulness application. Our goal is to reduce anxiety and overall improve endoscopy experience using SMART goals and PDSA cycle. Our aim is to provide effective and high-quality care in pediatric endoscopy.

Design/Methods: We created a dedicated anxiety screening questionnaire with validated Visual analog scale to assess baseline pre- procedural anxiety. The initial results showed that from a total of 52 patients, 56% patients showed moderate anxiety, 9.6% severe anxiety, 17% showed mild anxiety with an additional 17% showing no anxiety. The most common cause of anxiety was anticipation of pain, fear of potential complications, unfamiliarity of procedure, and unclear instructions. Given these baseline results, we are using Virtual Reality (VR) goggles with a 6 minute sensory guided Mindfulness app as the pre-procedure intervention. We are providing pre and post-VR questionnaire to asses changes in anxiety level while observing the patient's vital signs. We are collecting data and re-visiting the PDSA cycle in December 2023 to ensure continued improvement in our initiative.