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Growth rates in pediatric diagnostic imaging and sedation
Ruth E Wachtel1, Franklin Dexter, Angella J Dow
1Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242, USA.
Insights
Pediatric anesthesia provider workload for imaging scans increased with the number of procedures. Scan duration and patient age (3-5 years) influenced anesthesia use, while sedation nurses did not reduce overall anesthesia provider demand.
Area of Science:
- Anesthesiology
- Pediatric Imaging
- Healthcare Management
Background:
- Anesthesia provider workload for pediatric diagnostic imaging has significantly increased.
- This trend necessitates an examination of factors influencing anesthesia care demand.
Purpose of the Study:
- To analyze the growth of anesthesia provider utilization for pediatric magnetic resonance imaging (MRI) and computerized tomography (CT) scans.
- To compare this growth with the overall increase in pediatric MRI and CT procedures.
- To investigate the impact of sedation nurses and patient/scan characteristics on anesthesia provider workload.
Main Methods:
- A 12-year retrospective analysis of data from an academic medical center.
- Comparison of anesthesia provider growth with total pediatric MRI/CT scan volume.
- A 6-month study on sedation nurse utilization, scan duration, and patient age.
Main Results:
- Anesthesia provider care for pediatric MRI/CT scans grew annually at 8%-9%, mirroring scan volume.
- The introduction of a sedation nurse team did not decrease anesthesia provider utilization but increased hypnotic use.
- Longer scan durations and patient age (3-5 years) correlated with higher anesthesia provider use.
Conclusions:
- Future anesthesia provider workload for pediatric imaging is tied to scan volume trends.
- Factors like increasing scan duration and the proportion of 3-5-year-old patients will influence demand.
- Reimbursement policies may also impact future workload.
Background:
Workload has increased greatly over the past decade for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging.
Methods:
Data from an academic medical center were studied over a 12-yr period. Growth in the number of children 0-17 yr of age undergoing magnetic resonance imaging (MRI) and/or computerized tomography (CT) scans who received care from anesthesia providers was compared with the increase in the total number of MRI and CT procedures performed in children. Anesthesia providers included anesthesiologists, residents, Certified Registered Nurse Anesthetists, and student Certified Registered Nurse Anesthetists. Toward the end of the study, a team of sedation nurses was employed by the hospital to administer moderate sedation. They provided an alternative to anesthesia providers from the anesthesia department, who usually administered general anesthesia. Use of sedation nurses versus anesthesia providers, and the relationship to scan duration and patient age, were studied over a 6-mo period.
Results:
The number of children receiving care from anesthesia providers for MRI and CT scans grew at the same 8%-9% annual rate as the number of scans performed. The percentage of children receiving anesthesia care did not change over the 12 yr. Creation of a nurse sedation team that provided moderate sedation did not alter the number of children receiving care from anesthesia providers but did increase the total number of children receiving hypnotics. Anesthesia was rarely used for scans shorter than 30 min in duration. Increases in scan duration were associated with increased utilization of anesthesia providers for both MRI and CT after stratifying by age. An age of 3-5 yr was associated with the highest rates of anesthesia care.
Conclusions:
Future workload for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging will depend on trends in the total number of scans performed. Workload may also be sensitive to factors that increase scan duration or alter the percentage of patients in the 3-5 yr age group. It may additionally depend on reimbursements from insurance companies.
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