Gill Winter, MRI Clinical Lead, InHealth

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Gill Winter, MRI Clinical Lead, InHealth
TO IDENTIFY THE KEY FACTORS AFFECTING
CLAUSTROPHOBIC PATIENTS ATTENDING FOR MAGNETIC
RESONANCE IMAGING ON A MOBILE TRAILER
Gill Winter, MRI Clinical Lead, InHealth
Outcomes
Key themes were identified from the transcripts of the interviews.
These included:
•
Lack of information about what the scan would entail from the
referring clinician
•
Less than 50% of patients had received an information leaflet in
time for their appointment
•
The fact the patient was seen on a mobile trailer and not a hospital
unit/clinic
•
Patient had a previous claustrophobic episode which they did not
advise the imaging provider about at point of appointment
•
Patients not made aware that they may have attempted their
scan feet first
•
Patients not made aware they could have had a chaperone
for support
•
Staff on duty demonstrated a great deal of sensitivity and were
supportive when the patient suffered claustrophobia
•
The importance of being advised what will happen next following
a failed attempt at MRI
Background and introduction
The reported incidence of premature termination, or failure, of MRI examinations due to claustrophobic reactions ranges between 1% and 14.5% (mean
2.3%) Dewey et al (2007)1. In a large cohort study, 5798 patients undergoing MRI, Eshed et al (2007)2 report 1.97% of subjects could not be examined due
to claustrophobia and 1.22% prematurely terminated the examination due to claustrophobia. Thorpe at al (2008)3 report that records at a local hospital
indicated that over a 7 year period, 1% of people undergoing MRI could not complete the scan as a result of claustrophobic reactions. These studies were
all conducted in a static MRI unit environment.
Mobile MRI services currently provide significant additional capacity to the provision of static MRI in the United Kingdom. Space on board the trailers is
limited and patients with a tendency towards claustrophobia find this a challenge. In a previous mobile services audit, it was identified that over a 4 week
period, 66% of the total number of patient events classified as “rejected for clinical reasons” the reason recorded was claustrophobia (Table 1).
Week commencing
Total patients scanned
Claustrophobic Patients
% Claustrophobic patients
24-10-2011
1119
15
1.34
31-10-2011
1146
12
1.04
7-11-2011
1171
23
1.96
14-11-2011
1196
22
1.60
21-11-2011
1185
19
1.61
28-11-2011
1188
19
1.59
Purpose
10. At what point in the procedure did you realise you had a problem
with claustrophobia?
A follow up audit was indicated to identify the key factors, as perceived by
the patient, which were most significant in their claustrophobic episode.
The audit also sought to evaluate the management of the patient during
and after their scan attempt.
11. Can you explain how our radiographers handled it? What did they
do to try and help you through it?
12. When you left the scanner, what did the staff tell you would happen
next as regards your options?
Method
13. Is there anything we could have done, before, during or after your
appointment that might have helped you to tolerate the scan?
Over a period of 6 weeks, records of claustrophobic patients scanned
on mobile units for the NHS London Diagnostics Service were reviewed
based on documentation and alerts on the Radiology Information System.
From each week of data, 2 patients were selected at random and a semi
structured telephone interview was conducted based around the following
framework of questions:
Seven male and five female patients were interviewed. Their ages varied
from 34 to 79 years old. Six further patients were contacted during
the period but the interviews had to be abandoned because language
difficulties prevented a meaningful discussion. It is possible that this
difficulty in communication may limit the ability of staff to reassure and
counsel the patients during their claustrophobic episode.
1.
Did your referrer/GP tell you anything about the scan during your
consultation with him/her?
2.
Have you ever had an MRI scan before anywhere?
3.
Did you know you were claustrophobic before you came?
4.
If yes: during your telephone conversations with our administrators,
did you mention you may be claustrophobic?
5.
Did you receive a letter and information leaflet about MRI scanning,
before your appointment?
6.
Did you/were you able to read the information?
7.
If yes, did you feel it told you enough about what was going
to happen?
8.
Did you have any questions?
9.
If yes, did you contact our Patient Referral Centre and ask to speak
to someone?
Recommendations
Referring clinicians could make more effort to explain what an MRI scan
will involve at the time of referral or provide the patient with a number to
call to speak to a radiographer. MRI service providers may consider giving
a stock of patient leaflets to outpatient departments which can be handed
out at this stage of the pathway.
Patient information leaflets should be specific to a mobile service and
should include images of both the trailer and scanner itself so that the
patient knows what to expect. Where this is not possible, a link to an
appropriate website should be provided so the patient can familiarise
themselves with the environment.
Informed consent
T he inf ormation c ontained
w ithin this
leaf let is intended to prov
ide you w ith an
ov erv iew of the ex aminati
on or treatment
that you are to rec eiv e. Prio
r to any
medic al proc edu re b eing
c arried ou t,
the healthc are prof essiona
l c ondu c ting
the proc edu re w ill desc rib
e the natu re
of the ex amination or trea
tment you
are to rec eiv e and w ill deta
il any risk s
assoc iated w ith the proc
edu re. It is you r
right to b e giv en su f f ic ient
inf ormation to
b e ab le to mak e an inf orm
ed dec ision
as to w hether you w ish to
c ontinu e w ith
the ex amination/ treatment
or to ref u se to
u ndergo the proc edu re.
T he natu re of some ex ami
nations and
treatment req u ires that you
r c onsent to
c ontinu e mu st b e giv en in
w riting and
a f orm w ill b e prov ided f or
you to sign.
S ome ex aminations may
only req u ire you r
v erb al c onsent. F or f u rthe
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regarding ou r c onsent polic
y, please
c ontac t the Centre to w hic
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Rev iew D ate: S ept 12
Copyright © 2012 InHea
lth Limited
7 7 7 . 0912. v 1
Understanding your MR
I scan
Y ou hav e b een ref erred
f or an M RI ex amination
.
T his gu ide w ill tell you ab
ou t the proc edu re and
help you prepare f or the
appointment.
When making appointments, patients should be advised that they are
booked on a mobile scanner and asked if they have had an MRI before
and how they found the experience. This will help to identify those patients
who may have a problem without actually introducing the concept of
claustrophobia directly.
Feet first scans should be offered as standard where equipment and
examination allows the radiographer to do so.
Patients expressing reservations should be encouraged to try again with
a chaperone. Music and an eye mask should be offered In the event of a
failed attempt.
References
1.
Dewey M. et al 2007. Claustrophobia During Magnetic Resonance Imaging: Cohort Study in Over 55000 Patients. Journal of Magnetic Resonance Imaging. 26: 1322-1327
2.
Eshed I. et al 2007. Claustrophobia and Premature Termination of Magnetic Resonance Imaging Examinations. Journal of Magnetic Resonance Imaging. 26: 401-404
3.
Thorpe S. et al 2008. Claustrophobia in MRI: the role of cognitions. Magnetic Resonance Imaging. 26: 1081-1088
Patients are very often distressed when they fail to succeed in the scanner.
This adds to any stress they are already experiencing on account of their
illness. Patients felt it was very important that they know when they leave
the MRI scanner, what the possible alternatives are, such as light sedation or
other imaging modalities. MRI staff should be clear about what will happen
next particularly if the patient needs to arrange to go back to their referrer.
Author: Gill Winter, MRI Clinical Lead, InHealth
InHealth, Beechwood Hall, Kingsmead Road, High Wycombe, Buckinghamshire HP11 1JL
Telephone: 01494 560000 Fax: 01494 560056 Web: www.inhealthgroup.com
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UKRC Poster_230413_930 Copyright © 2013 InHealth Limited