Reducing Anesthesia Use for Pediatric Magnetic Resonance Imaging: The Effects of a Patient- and Family-Centered Intervention on Image Quality, Health-care Costs, and Operational Efficiency Kari A. Mastro, PhD, RN, NEA-BC a,* , Linda Flynn, PhD, RN, FAAN b , Toni F. Millar, MS, CCLS c , Tina M. DiMartino, MS, MBA, CCLS d , Sarah M. Ryan, MS e , Mark H. Stein, MD f a Department of Nursing and Patient Care Services, St. Mary Medical Center, Langhorne, Pennsylvania; College of Nursing, University of Colorado, Denver, Colorado b School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey c Department of Patient Centered Care, New York-Presbyterian/Columbia University Medical Center, New York, New York d Department of Child Life, New York-Presbyterian/Morgan Stanley Children's Hospital, New York, New York e Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado f Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey Keywords: Pediatric magnetic resonance imaging Patient- and family-centered care Anesthesia and pediatric MRI MRI image quality abstract Children with complex medical problems who require anesthesia are known to be at risk for acute adverse physiologic events related to anesthesia. The risks of anesthesia include short- and long-term psychological and neurobehavioral issues. Magnetic resonance imaging (MRI) has emerged as the standard of care for diagnosis and follow-up of many conditions, and more children are being sub- jected to anesthesia to ensure acceptable motion-free image quality of the MRI scans. The aim of this study was to evaluate the effectiveness of an anesthesia-free patient- and family-centered intervention through an analysis of MRI quality, health-care costs, and operational efficiency as compared with other approaches. This study retrospectively reviewed patient data extracted from electronic medical records of children aged 3-17 years, who underwent outpatient MRI at an urban academic medical center from 2015 to 2016. A total matched sample size of 500 children, 125 per group, was used to investigate the outcome variables including the quality of magnetic resonance image, health-care cost, and procedural time. The groups included are as follows: (1) intervention group, patient- and family- centered preparation of the child, and no anesthesia given (PFC/NA); (2) comparison group, no structured preparation, and no anesthesia given (SC/NA); (3) comparison group, certified child life specialist preparation, and anesthesia given (CCLS/A); (4) comparison group, no structured prepara- tion, anesthesia given (SC/A). The PFC/NA intervention group was found to have significantly lower costs (p < .0001) and shorter procedure times (p < .0001), and 96.8% of the MRI images were of acceptable or better quality than those of the SC/A and CCLS/A groups. The PFC approach provides a way for children to undergo outpatient diagnostic MRI without the need for anesthesia, thus reducing risk, costs, and procedure time. © 2018 Association for Radiologic & Imaging Nursing. Published by Elsevier Inc. All rights reserved. Funding Source: A $72,000 grant from the Hugs for Brady Foundation was obtained to fund the equipment and supplies needed for the patient- and family-centered care intervention group of patients. In addition, there was a $16,000 donation by a philanthropic organization that wished to remain anonymous. There were no conflicts of interest declared by that source. Specifically, that money was used to pay for the radiologist's time in evaluating, grading, and coding the 4610 magnetic resonance images that were among the outcome variables of this study. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest: There are no conflicts of interest declared by any of the authors. * Corresponding author: Kari A. Mastro, PhD, RN, NEA-BC, 6 Shari Way, Kendall Park, NJ, 08824. E-mail address: kari.mastro@icloud.com (K.A. Mastro). Contents lists available at ScienceDirect Journal of Radiology Nursing journal homepage: www.sciencedirect.com/journal/ journal-of-radiology-nursing https://doi.org/10.1016/j.jradnu.2018.12.003 1546-0843/$36.00/© 2018 Association for Radiologic & Imaging Nursing. Published by Elsevier Inc. All rights reserved. Journal of Radiology Nursing xxx (2019) 1e7 Please cite this article inpress as: Kari A.LindaToni F.MastroFlynnMillar, Reducing Anesthesia Use for Pediatric Magnetic Resonance Imaging: Th Eff t f P ti t dF il C t dIt ti I Q lit H lth C t dO ti l Effi i J l f