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ECONOMICS, EDUCATION, AND POLICY

Growth Rates in Pediatric Diagnostic Imaging and Sedation

Ruth E. Wachtel, PhD, MBA^*, Franklin Dexter, MD, PhD, and Angella J. Dow, BS

From the *Department of Anesthesia, University of Iowa, Iowa City, Iowa; Departments of Anesthesia and Health Management and Policy, University of Iowa, Iowa City, Iowa; and Farrell Growth Group, LLC, Liberty, Missouri.

Address correspondence to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu. Web site www.FranklinDexter.net.

Abstract

BACKGROUND: Workload has increased greatly over the past decade for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging.

METHODS: Data from an academic medical center were studied over a 12-yr period. Growth in the number of children 0–17 yr of age undergoing magnetic resonance imaging (MRI) and/or computerized tomography (CT) scans who received care from anesthesia providers was compared with the increase in the total number of MRI and CT procedures performed in children. Anesthesia providers included anesthesiologists, residents, Certified Registered Nurse Anesthetists, and student Certified Registered Nurse Anesthetists. Toward the end of the study, a team of sedation nurses was employed by the hospital to administer moderate sedation. They provided an alternative to anesthesia providers from the anesthesia department, who usually administered general anesthesia. Use of sedation nurses versus anesthesia providers, and the relationship to scan duration and patient age, were studied over a 6-mo period.

RESULTS: The number of children receiving care from anesthesia providers for MRI and CT scans grew at the same 8%–9% annual rate as the number of scans performed. The percentage of children receiving anesthesia care did not change over the 12 yr. Creation of a nurse sedation team that provided moderate sedation did not alter the number of children receiving care from anesthesia providers but did increase the total number of children receiving hypnotics. Anesthesia was rarely used for scans shorter than 30 min in duration. Increases in scan duration were associated with increased utilization of anesthesia providers for both MRI and CT after stratifying by age. An age of 3–5 yr was associated with the highest rates of anesthesia care.

CONCLUSIONS: Future workload for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging will depend on trends in the total number of scans performed. Workload may also be sensitive to factors that increase scan duration or alter the percentage of patients in the 3–5 yr age group. It may additionally depend on reimbursements from insurance companies.