Patient Awake While Scanned

Program to Reduce the Need for Anesthesia in Pediatric MRI

Camille Fraser, MS, CCLS; Sarah Beth Gray BS, CCLS; Jessika Boles, PhD, CCLS


Pediatr Nurs. 2019;45(6):283-288. 

In This Article


Over the past 6 years, the PAWS program has grown and adapted with the ever-changing medical field. Continuous education and advocacy by the PAWS program team has been crucial in sustaining and growing the program. Program awareness and success brought an increase in program referrals and participation. Extensive data collection, an additional trial, and advocacy led to an increase in CCLSs staff to support the growing number of participants and work. In addition to the original 1.0 FTE radiology CCLS staff who began the program, two part-time CCLSs have been acquired; one position was added one year and another five years after program implementation.

The program has experienced challenging times as well. Possessing ample child life staffing and scan time on the medical center's two MRI scanners have proven to be consistent challenges. Through challenging times, the program's infrastructure (goals and protocol) are solid and have not changed. The PAWS program team continues to advocate for the needs and support required to ensure the integrity of the program remains.

The PAWS program has served as a model program across the Children's Hospital at Vanderbilt and pediatric health care facilities nationwide to encourage patient and family satisfaction and cost savings. Feedback obtained from families has been abundant with appreciation for incorporating family-centered care and providing an alternative to anesthesia. Patients have built confidence by completing an MRI awake while spending less time in the hospital. Additionally, most PAWS program MRIs are completed outside of school hours, so patients do not have to miss school. This creative scheduling, along with the intentional relationship formed during the pre-appointment interventions, has resulted in a no-show rate of only 4%, which is also cost saving to the institution.

The greatest impact of this program has been the positive culture shift within the MRI team and hospital as a whole. Now that administrators, physicians, and frontline staff see that children can complete challenging procedures like an MRI without medication, they believe in the impact of this program and child life services. Other institutions have also recognized the benefits of the PAWS program. Interest in the program's criteria, structure, and impact is evident due to the frequent inquires the PAWS program team receives from parents, CCLSs, and radiology staff and managers across the nation. Other health care facilities that serve pediatric patients have incorporated similar child life programs into their radiology departments, resulting in benefits to patients, families, and staff (Durand et al., 2015; Tyson et al., 2014). These benefits include minimizing the need for anesthesia throughout the hospital and reducing unnecessary risk and distress experienced by the patient (Baron et al., 2016; Brewer et al., 2006; Tyson et al., 2014). Additionally, the work of a CCLS can decrease cost to both the family and the institution (Scott et al., 2016).

The collaborative, interprofessional approach of the PAWS program has been vital to ensure proper implementation, positive patient experience, and staff involvement. Previous research has shown that radiology technologists cite challenges with the child moving during the scan and having worked with parents who may be perceived as being "difficult" (Baron et al., 2016). CCLSs are experts in working with children and families, and can be a vital resource to other staff members who need support in working with the pediatric population. When a collaborative approach is used, members of the interprofessional team can best support each other and better cope with their often stressful working environment (Lown & Manning, 2010).

As evidenced throughout the PAWS MRI program, CCLSs possess specialized skills that enhance medical experiences for patients and families. CCLSs also contribute positively to the overall culture of a medical center. Integrating child life services into shared departmental and medical center goals can have a significant impact on the overall patient and family experience. Wolf (2018) describes CCLSs as skilled experts in promoting positive patient experiences. Equally as important as the concept of patient experience is family-centered care. Patient- and family-centered care has become the standard of practice in hospitals nationwide. The care provided by a CCLS aligns with the key elements of family-centered care by collaborating with the family to create a unique and supportive experience for each patient based on their specific needs (Frost, Green, Glance-Cleveland, Kersten, & Irby, 2010). It is of great importance that pediatric health care facilities pursue and incorporate CCLSs into their interprofessional care teams.