In the Neuro Nurturing NICU, the mainstay of diagnostic neuroimaging for encephalopathy or suspected brain injury is magnetic resonance imaging (MRI). While MRI is considered a safe imaging modality, the process of achieving a quality study can be fraught with hazards. The infant must be transported to/from the MRI suite, and maintain physiologic stability throughout the study. Additionally, achieving minimal patient movement with the least amount of sedation possible, and ideally no sedation, can be a daunting task. This complex set of tasks affords plenty of opportunities for quality improvement initiatives, and the foundation of any QI project are quality metrics. So what are some basic measures of success to consider in neonatal MRI protocols?
Time off Unit
Unless your unit has an in unit MRI, chances are your MRI protocol involves travelling to your hospital’s MRI suite. The intra-hospital transport process involves time off the unit taking the neonate outside the controlled environment of the NICU. What is your average time off unit? What elements of your protocol are aimed at reducing your time off unit for MRI?
Studies suggest the noise levels during an MRI study can reach from 80-100+ dBA. Chronic as well as acute exposure to noise in the 80 dBA range can cause damage to the hair cells of the inner ear and lead to permanent hearing loss. Interventions such as ear muffs and acoustic hoods can reduce noise to safe levels during MRI. What noise reducing interventions are you using? Can you measure noise exposure?
One of the largest concerns regarding physiologic stability is temperature management. The prospect of being moved from a transporter to the MRI table and undergoing what may be a lengthy MRI study puts the neonate at risk for hypothermia. Interventions such as the use of an MRI compatible incubator, warming mattresses and increasing the temperature in the MRI suite may help to reduce this risk. What interventions are included in your protocol to help maintain euthermia during MRI?
What are your MRI measures for success? We’d love to hear from you! Email us at email@example.com
Aspect has an upcoming webinar on November 24 about QI and MRI — NEED LINK