Leading change

A Play Specialist on the acute general paediatric ward at Northern Devon Healthcare NHS Trust led on the implementation of a pre-operative model for children requiring Magnetic Resonance Imaging (MRI). The new model supports improved outcomes, experiences and use of resources.

Where to look

Paediatrics is the branch of medicine which focuses on the development of children and the diagnosis and treatment of childhood illness. The paediatric department at Northern Devon Healthcare NHS Trust runs a variety of specialist clinics including diabetes, neurology, oncology and premature baby follow up. Members of the department work closely with the community children’s services to ensure that any support required outside of hospital is put in place.

Health play specialists support child development and use therapeutic play activities to help children cope when in hospital. On the ward, this included pre-assessment work to support different procedures and diagnostics like assisting with blood tests in outpatients and reassuring children who needed a skeletal survey in x-ray.

The play specialist identified unwarranted variation in that children in North Devon needed to travel to another hospital to have some procedures like an MRI under general anaesthetic (GA), because there is limited space in the MRI scanner situated at a small Devon General Hospital. Therefore, GA is not an option and all MRI scans are done without sedation or anaesthesia. Prior to this initiative, common practice in many units had been to image under GA. This prompted the play specialist to look at developing a new approach to MRIs for children at North Devon Hospital.

What to change

Children’s MRI uses a powerful magnetic field, radio waves and a computer to produce detailed images. MRI may be used to help diagnose or monitor treatment for a variety of conditions within the brain, chest, abdomen, pelvis and extremities. MRI is used to help diagnose a wide range of conditions in children due to injury, illness or congenital abnormalities.

Before the change, children were having to travel to other hospital sites. There was opportunity to engage support from specialist paediatric services from the regional units to facilitate successful procedures locally. Travel to the specialist unit often meant time off work for 2 parents/carers, possibly having unpaid time off, incurring expenses as well as increased stress.

How to change

The pre-operative model was developed by the local paediatric team whereby each child was supported by professionals identifying approaches that could enhance recovery and result in less traumatic experiences. Tailoring the pre-operative approach to the individual also increases successful MRI scanning without GA.

This was a collaborative team approach, liaising with the radiology staff before inviting the child and family to visit the scanner room as well as supporting the play specialist team to see the child and family before their tests This gives children and families the opportunity to ask questions and to see some photos of the scanner room. In this manner, the new approach to MRIs has already been adapted to explore in-house services before referral to other hospital sites and use of a general anaesthetic.

An information leaflet has been developed to support children and their families. This is sent out to them in advance of their appointment, to give them time to digest the information and to ask questions when they attend hospital.

The new model now means (unless there is a clinical reason) the team are able to support the child and family to have the MRI at the local hospital without a general anaesthetic, which means less risk of complications and better outcomes for the child.

The new model is adaptable for different age groups and is being scaled up at the Trust.

Adding value

Better outcomes – An evaluation of the new service provision has shown an increase in children having their MRI at the Trust without the need for general anaesthetics which is positive. This has included children of a younger age with numbers having doubled over the last 10 years (from 55 to 110 per year in this age group). The working relationship between the radiology staff and the ward has become much stronger.

Better experience – A considerably better experience for the child and family has been observed. This is demonstrated through positive feedback from children, parents but also adults attending MRI appointments at the Trust through the Friends and Family surveys. Comments have included that “staff within the department give time” to them, “excellent communication,” “answering all questions and a friendly atmosphere which I think comes from working closely with families.”

Better use of resources –  Staff now have a better understanding of each other’s role which supports effective working. In addition, the last year saw 99 children imaged in this way reducing bed days in a specialist unit saving in the region of £49,000.

Challenges and lessons learnt for implementation

Collaborative discussions with relevant leads of services are recommended to explore the thoughts and vision for improving a service.

Explore models from other Health Care providers which may already be in place, this ensures continuation of the same level of input/service across the region. Attend network groups with peers to work together and share ideas.

Ask for help if information is not readily available – for instance costs information is supported by finance departments.

For more information contact

Fran Greenaway
Play specialist
Northern Devon Healthcare NHS Trust
frances.greenaway@nhs.net

Darryn Allcorn
Chief Nurse
Northern Devon Healthcare NHS Trust
darryn.allcorn@nhs.net