We've all heard the stories about MRI suites that don't perform as expected: Dismal failures of function and patient care that undermine patient throughput and safety. In the worst cases they also compromise the clinical value of the MRI equipment, placing the facility at a diagnostic and competitive disadvantage from day one. All too often, the first response to these snafus is, "But we followed the vendor template exactly."
But templates don't address a myriad of facility- and patient-specific issues. From interventional procedures to bariatric patients, and from screening protocols to patient safety issues, templates leave a profound amount up to the facility and its designers. Nowhere is this truer than in a facility with a significant pediatric patient load.
Who is the "typical" MRI patient? Generally it's an ambulatory adult in for an exam of the knee or a neuro series. Perhaps there is a spouse in the waiting area. It is this patient that comes closest to fitting the off-the-rack mold of the vendor typical suite template, but what about that adult patient's kindergartner? How are things different when she needs an MRI?
Probably unlike her parents, the 6-year-old will need to be fully anesthetized. And unlike adult metabolisms, those of pediatric patients are much more variable, making anesthesia slightly more of an art -- an imperfect art -- than it is with adults.
Because of the complication risks with anesthesia, the best practice is to reduce a child's anxiety prior to induction, which frequently reduces the quantity of anesthesia required. This relaxation of an anxious child can't really be accomplished when delivering anesthesia in a curtained-off area in the corridor. It is for this reason that many pediatric radiology facilities include special induction rooms near the imaging modalities, often with cushy chairs and illuminated murals or fiber optic "star field" ceilings.
Typically, the induced patient will have been fully gowned and screened. The parents, who accompany the pediatric patient in more than two-thirds of the exams at one prominent children's hospital, may not receive the same scrutiny. So whatever preparations have been made for the child, a parallel must be established for parents, including changing rooms, interview areas, and ferrous quarantine lockers.
And parents, preoccupied with their child's status, often aren't as focused on recalling their own full medical histories or inventorying what's in their pockets. In short, as long as the bulk of their attention is being devoted to their child, mom and dad become a safety liability in the MRI environment.
After conducting a thorough clinical screening for the parents, physical screening may be simplified and expedited with the use of ferrous detection devices. It should be made perfectly clear to parents that the screening is for their child's safety, as much as their own, and if they are unwilling to cooperate they will not be allowed into the magnet room.
Once everyone is cleared, the sedated patient is then wheeled in, complete with a trailing array of anesthesiologist, transport techs, parents, medications, and patient monitoring device -- everything minus the kitchen sink, into the magnet room. And most everything and everyone that goes in are likely to stay through the exam. Dad will pace, mom will want the glider right next to the patient table, and the anesthesiologist will want the ventilator controls and monitors arranged close at hand.
You could barely get all this in the door of the magnet room using the typical suite layouts provided by most vendors. In many contemporary MRI suites you'd have a hard time getting a gurney inside the magnet room, and forget about trying to maneuver it. It's ironic that with our smallest patients we find ourselves needing some of the largest magnet rooms in clinical settings, but that's why facility layout and design are such vital components of clinical care.
Following the scan, the clumsy ballet is repeated, in reverse. The patient once removed from the magnet and switched to a gurney, the child's belongings, mom, dad, the anesthesia nurse, and a transport tech are then wheeled to a postanesthesia care unit (PACU), which should probably have space for the four to six additional loved ones who were waiting in the lobby of the MRI department.
While the magnet doesn't care if it is in an outpatient imaging center, an intraoperative suite, or a pediatric hospital, clearly there are substantial differences in the care required in each different setting. Just as the medicine practiced in each facility will be a response to the patients' needs, so should the MRI suite we provide to enable that care. Make sure that your facility designers know this and provide you with an appropriate room size for your use.
Just as cookie-cutter care has repeatedly failed patients, canned solutions to healthcare delivery, in the form of one-size-fits-all MRI suite templates, also fail us. All a hospital, clinic, or physician's office will ever be is a tool for healthcare delivery, and the more that that tool responds to the specifics of the task, the more effective it will be in facilitating quality care.
By Tobias Gilk and Robert Junk
AuntMinnie.com contributing writers
April 25, 2006
Reprinted from www.mri-planning.com by permission of the authors. If you would like more information on any aspect of MR facility design or safety, please contact Robert Junk or Tobias Gilk at Jünk Architects.
Related Reading
MRI suite cryogen safety and magnet room entrapment, April 19, 2006
When MRI throughput means more than revenue, April 11, 2006
ECRI's report on MRI safety, March 28, 2006
Doubling down: Raising the stakes of MRI patient safety, March 9, 2006
Ten questions patients should ask their MRI provider: Is this real or is it hype? February 15, 2006
Copyright © 2006 Jünk Architects, PC
