Reducing Sedation for Pediatric Thoracic CT Imaging Using Volumetric Target-mode EKG Gating
Summit H Shah1,2,3, Cody M Young1,2,3, Jessica Morrison1,2
1From the Department of Radiology, Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Sedation for pediatric thoracic CT scans in children aged 0-4 was significantly reduced from 65% to 24%. This improvement was sustained five years later, enhancing patient care during imaging procedures.
Area of Science:
- Pediatric radiology
- Medical imaging technology
- Patient safety in medical procedures
Background:
- Sedation is frequently required for pediatric thoracic (chest and cardiac) computed tomography (CT) scans.
- High sedation rates pose challenges for young children undergoing these essential imaging procedures.
Purpose of the Study:
- To decrease the rate of sedation for thoracic CT scans in children aged 0-4 years.
- To implement and sustain a reduction in sedation from a baseline of 65% to a target of 20%.
Main Methods:
- Developed a new volumetric target-mode electrocardiogram-gated CT imaging protocol to shorten scan times.
- Implemented staff training, improved communication, and removed default sedation orders for thoracic CT scans.
- Utilized statistical process control charts to monitor changes over time.
Main Results:
- Sedation rates for pediatric thoracic CT scans decreased from 65% (232/357) at baseline to 24% (217/794) during the intervention period.
- The reduction in sedation was sustained five years post-intervention.
- The rate of initially nondiagnostic nonsedated scans requiring repeat sedation was very low (0.1% to 0.4%).
Conclusions:
- A combination of a novel CT imaging protocol and revised ordering practices effectively reduced sedation in young children.
- The implemented changes, including a volumetric target-mode electrocardiogram-gated CT protocol and elimination of default sedation orders, proved sustainable.
- This approach enhances the safety and efficiency of thoracic CT scans for pediatric patients.
Introduction:
Many children require sedation for imaging. We aimed to reduce sedation for thoracic (chest and cardiac) computed tomography (CT) scans in children 0-4 years old from 65% to 20% by December 2018 and to sustain.
Methods:
We counted baseline, intervention, and a follow-up period thoracic CT scans performed with sedation in children 0-4 years old. We developed a new volumetric target-mode electrocardiogram-gated CT imaging protocol to reduce scan time and control for factors that decrease image quality. Additional interventions included technologist training, communication to radiologists and clinicians, and eliminating a default request for sedation accompanying the electronic order for most thoracic CT scans. A statistical process control chart tracked data to study process changes over time.
Results:
During the baseline and intervention periods, 232 of 357 and 217 of 794 scans required sedation. Interventions created 2 centerline shifts. Overall, thoracic CT scans in children 0-4 years old requiring sedation decreased from 65% to 24% and was sustained 5 years later. No patients during the baseline period, one (1 of 794, 0.1%) during the intervention period and 2 (2 of 480, 0.4%) during the audit period 5 years later, initially had nondiagnostic nonsedated scans that required an additional scan with sedation.
Conclusions:
We developed a volumetric target-mode electrocardiogram-gated CT protocol, eliminated default sedation ordering, and trained and educated staff to reduce sedation in young children undergoing thoracic CT scans. The frequency of sedation for thoracic CT in children 0-4 years old decreased from 65% to 24% and was sustained after revising imaging parameters and eliminating a default sedation order.
