In our May 25, 2010 Patient Safety Tip of the Week “Propofol Issues” we noted that propofol has quietly become the procedural sedating agent of choice in many venues, particularly when dealing with pediatric patients. In fact, at the recent Pediatric Academic Societies meeting research was presented on over 25, 000 cases using propofol sedation in areas outside the OR by emergency physicians. That abstract (Mallory et al 2010) presented data from the Pediatric Sedation Research Consortium. The vast majority of these (22,068) were performed in radiology. We discussed some of the safety issues in that column.
Now a new study (Vanderby 2010) addresses the financial impact of sedation for MRI scanning in pediatrics. They analyzed the workflow, personnel, and costs involved in MRI scanning of children at Hospital for Sick Children in Toronto, Ontario. They found that the average time spent in the MRI suite was 2 hours and 21 minutes for children scanned awake, 3 hours 38 minutes for those sedated, and 4 hours 7 minutes for those anesthetized. Corresponding average costs (in Canadian dollars) were $54.68, $177.27, and $522.73 respectively.
The Toronto group used their analyis to significantly redesign workflow and scheduling. This article has a good discsussion about those workflow and personnel issues and has some good lessons learned that you may apply in your organization. To their recommendations we would add that strong consideration needs to be given to the appropriateness of the MRI scan, in light of the patient safety and cost issues involved.
Smith M. PAS: Propofol Widely Used to Sedate Children. MedPageToday.com. May 3, 2010
Mallory MD, Baxter AL, Yanosky DJ, Cravero. JP. Use of Propofol for Sedation of Pediatric Patients by Emergency Physicians: A Report from the Pediatric Sedation Research Consortium (abstract). Pediatric Academic Societies meeting May 1, 2010
Vanderby SA, Babyn PS, Carter MW, et al. Effect of Anesthesia and Sedation on Pediatric MR Imaging Patient Flow. Radiology 2010; 256(1): 229-237