Marcia Frellick

December 04, 2015

CHICAGO — No-show and incompletion rates for MRI decreased after technologists were trained in patient calming techniques, according to early results from a large study.

Sometimes just a simple word change can make a big difference, said Alexander Norbash, MD, chair of radiology at the University of California in San Diego.

For instance, instead of saying, "make sure you push this panic button only if you need me," technologists can say, "this is a button that will call me immediately," Dr Norbash told Medscape Medical News.

And instead of saying, "you will hear loud banging," they can say, "you will hear some low-frequency vibrations," he added. Or instead of telling large patients that the scanner might feel tight, technologists can say, "every time you feel the equipment touching you, use that as a signal to relax."

Body language is also important. When patients are lying down, it is important that the technologist stay at eye level so patients don't feel like the technologist is towering over them, Dr Norbash explained.

He presented results here at the Radiological Society of North America 2015 Annual Meeting.

The study involved 97,712 patient visits from three tertiary academic medical centers. About half the visits occurred in the 12 months before the training and about half occurred in the 12 months after the training.

The three centers served very different patient populations. One was a safety-net hospital with a large number of disenfranchised patients; one was a hospital where the majority of patients were working class and Asian, and English was not the primary language; and one was a suburban hospital with blue- and white-collar patients, Dr Norbash reported.

Each MRI team received training from a program called Comfort Talk, developed by Elvira Lang, MD, an interventional radiologist in Brookline, Massachusetts, and former associate professor of radiology at Harvard Medical School in Boston.

The training consisted of two 8-hour workshops and several weeks of online instruction in advanced communication skills, specially designed web tools and apps, and case simulations.

Words Matter

The rates for incomplete MRI — started but not finished — at the three centers before the training ranged from 0.8% to 3.7%. The overall incompletion rate for all study visits decreased from 2.3% before the training to 1.4% after the training.

The no-show rates at the three centers before the training ranged from 5.0% to 19.4%. The overall no-show rate for all study visits decreased from 11.2% before the training to 8.7%.

It was not a surprise that the incompletion rate dropped after the training, Dr Norbash reported, but the decrease in the no-show rate is harder to explain. He speculated that the training changed the culture of the workplace, which spread to the schedulers and front-desk people, even though they were not the focus of the training.

The study is limited by the lack of a control group and by variations in the training of staff members, Dr Norbash acknowledged. He said the next step is to measure differences in the patient experience.

Although this research focused on the MRI experience, the techniques can be used in other healthcare services and settings, he added.

There is no mention of stick, pinch, here it comes, pain, etc. Mind over matter — it works.

Stacy Kimball, a radiologic technologist and operations manager at the North Shore Medical Center Imaging in Salem, Massachusetts, said that technologists at her center received Comfort Talk training in 2007, and they have been using the techniques ever since.

North Shore technologists now avoid negative suggestions that draw attention to unwanted activities, such as "don't swallow or don't move," she told Medscape Medical News.

And between every MRI pulse sequence, they ask how the patient is doing and report how long the next segment will take.

Also, when technologists place an intravenous line, they ask patients to breathe in and out instead of warning them they will feel pain. "There is no mention of stick, pinch, here it comes, pain, etc. Mind over matter — it works," Kimball said.

Dr Norbash is vice president of business development and cofounder of Boston Imaging Core Lab, and a scientific adviser for Stryker. Dr Lang's Comfort Talk work was supported by a Small Business Innovative Research Grant from the National Institutes of Health and the National Center for Complementary and Alternative Medicine, which is now known as the National Center for Complementary and Integrative Health, and she is founder of Hypnalgesics. Ms Kimball has disclosed no relevant financial relationships.

Radiological Society of North America (RSNA) 2015 Annual Meeting: Abstract SSM12-06. Presented December 2, 2015.


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