应用智能化安抚策略信息系统降低学龄前儿童短时磁共振镇静率的质量改进研究

Reducing sedation rate of short-term magnetic resonance in preschool children by applying intelligent pacification strategy information system:A quality improvement study

背景MR扫描前采用安抚策略是否可提高患儿非镇静状态下的检查配合度尚不明确。目的探讨基于辅助决策的智能化安抚策略信息系统用于降低学龄前儿童短时MR扫描镇静率的成效。设计质量改进研究。方法纳入就诊于复旦大学附属儿科医院厦门分院门诊(不含急诊)和住院期间至放射科预约MR的年龄3~5岁患儿,行常见部位常规序列普通平扫且扫描总时间约10 min;排除因精神、心理疾病或智力障碍无法沟通及保持安静状态的患儿;排除因急重症需紧急行MR检查而无安抚条件的患儿。质量改进前由安抚师根据自身经验与家属讨论后制定安抚方案,质量改进后使用智能化安抚策略信息系统辅助决策。由安抚师陪伴执行安抚方案后进入模拟MR扫描,第一次或第二次模拟扫描成功则进入正式MR扫描;2次模拟MR扫描均失败,或正式MR不能配合者,则通过药物镇静完成扫描。比较质量改进前后的安抚成功率、安抚时间和图像质量。主要结局指标安抚成功率。结果125例3~5岁患儿进入本文分析,男65例(52%),改进前62例,改进后63例。通过安抚策略完成模拟MR扫描111例,改进前52例,改进后59例;通过安抚策略完成正式MR扫描99例,改进前46例,改进后53例。共26例通过灌肠镇静药物后完成MR扫描,改进前16例,改进后10例。质量改进后安抚成功率较改进前高(84.1%vs 74.2%)、安抚时间较改进前缩短[(42.91±5.43)min vs(54.35±7.02)min],差异均有统计学意义,改进前后和安抚成功组与失败组的图像质量比较差异均无统计学意义。结论应用基于辅助决策的智能化安抚策略信息系统,有助于减少学龄前儿童在行短时MR扫描时镇静药物的使用,且能提高安抚效率。

Background It is unclear whether the use of pacification strategies before MR scanning can improve the examination cooperation of children in a non-sedated state.Objective To explore the effectiveness of an intelligent pacification strategy information system based on assisted decision-making in reducing the sedation rate of short-term MR scans in preschool children.Design Quality improvement study.Methods Patients at the age of 3-5 years were enrolled from those who attended the outpatient(excluding emergency)and inpatient MR appointments in the Radiology Department at the Xiamen Branch of Children's Hospital of Fudan University.Regular plain scans of common parts were performed with conventional sequences,and the total scanning time was about 10 minutes.Those who were unable to communicate and maintain a quiet state due to mental or psychological illness or intellectual disability were excluded and those who needed urgent MR examination due to acute and severe illness without time and conditions to receive pacification were excluded.Before the quality improvement,specialists at pacification made a plan based on their own experience and discussion with the family member.After the quality improvement,the intelligent pacification strategy information system was used to assist the decision-making.Accompanied by the pacification specialist to perform the plan,patients first received the simulated MR scan.If they succeeded in finishing the scan,a formal MR scan was performed.If the simulated MR failed twice,or patients failed to receive formal MR,patients would be sedated with medication to complete the scan.The pacification success rate,pacification time,and image quality were compared before and after quality improvement.Main outcome measures The pacification success rate.Results One hundred and twenty-five children aged 3 to 5 years were included,with 62 before improvement and 63 after improvement.There were 65 males(52%).Simulated MR was completed by pacification in 111 cases,52 before improvement and 59 after improvement,and formal MR was completed by pacification in 99 cases,46 before improvement and 53 after improvement.A total of 26 cases completed MR after sedation by enema,16 cases before improvement,and 10 cases after improvement.The pacification success rate after quality improvement was higher than that before(84.1%vs 74.2%),and the pacification time was shorter than that before[(42.91±5.43)min vs(54.35±7.02)min].The differences were statistically significant.There was no statistically significant difference in image quality between the success subgroup and the failure subgroup as well as before and after improvement.Conclusions The application of an intelligent pacification strategy information system based on assisted decision-making can help reduce the use of sedative drugs in preschool children during short-term MR scans and improve the efficiency of pacification.