July 2 PAEDIATRIC MRI PROJECT THAMES VALLEY AND WESSEX ODN Paediatric MRI Prject Thames Valley and Wessex ODN IN THIS ISSUE February 2017 Welcme By Nadine Duffin Welcme t the third newsletter fr the Thames Valley and Wessex Paediatric MRI prject. Happy New Year! Althugh Christmas and New Year will seem a distant memry by the time this newsletter has been published. The first Thames Valley and Wessex Paediatric MRI multi-prfessinal study day was held in Nvember at the Ark Cnference Centre. This event was a great success, with a diverse grup f speakers. It has been a quieter end f the year, with data frm radilgy departments being reviewed t develp baseline data fr us t see the status qu and all0w us t measure change frm the implementatin f prjects. We nw have assistance frm Carrie-Anne Hwden Data Prject Manager fr the Paediatric Neursciences ODN. She jined the team at the beginning f the mnth and will help us with metrics fr Paediatric MRI data cllatin. I met with the Paediatric Innvatin, Educatin and Research netwrk that are keen t supprt the prject, which is fantastic as they have achieved significant quality imprvements since their inceptin. This prject aims t: Imprve access and availability f paediatric MRI Establish a clinical netwrk fr paediatric MRI fr TV&W All in all it s been a busy time! Share best practice acrss the regin Develp cmmn standards and prtcls Imprve and standardise patient pathways Prvided a pull shared imaging viewing platfrm acrss the regin Prcess Mapping The steps invlved in rganising a paediatric MRI Paediatric MRI Study Day Reprt back frm the study day Clinical Frum Abut the Paeds Radilgy Clinical Frum CESS Children s Epilepsy Surgery Service. Pre-Screening Prfrma Play Therapy fr MRI Yu said we did Page 2 Page 3 Page 3 Page 4 Page 4 A lk int what is planned next fr the paediatric MRI Prject Page 5 Cming up next A lk int what is planned next fr the paediatric MRI Prject Page 5
2 Prcess Mapping A prcess map fr a paediatric patient s Outpatient MRI Jurney, was cnducted t review areas that d nt add value. Initially we were ging t carry this ut fr multiple sites but the jurney was the same, with the same delays. The prcess map includes patients wh require MRI under general anaesthetic. Ptential delays r nn-added value steps are dented in range. These include; MRI requests withut the adequate clinical infrmatin. Delays ver setting dates fr GA lists as there are multiple grups and resurces that need t be available This is especially difficult when extra list are added t reduce the waiting time. When patients are unable t tlerate the MRI scan, there are added delays when the clinician is cntacted t decide t prceed t a GA MRI. The MRI prject is currently fcusing n Patient pathways fr MRI scans, t reduce inapprpriate referrals and delays thrugh inadequate clinical details Patients being unable t tlerate the MRI Scan Paediatric MRI Prject Cverage This map shws the gegraphical area the Thames Valley and Wessex Paediatric MRI Prject cvers.
3 MRI Study Day The first Thames Valley and Wessex Paediatric Multi-prfessinal study day was held n Nvember 18th 2016 at The Ark Cnference Centre in Basingstke. This event was the first f its kind in the regin, bringing tgether the wide range f health prfessinals including clinicians, radilgists, radigraphers, nursing staff and play specialists that are invlved in paediatric imaging. This study day was designed t share best practice, prmte multi-disciplinary team wrking and invke discussins n imaging children. The speakers were frm a variety f prfessinal backgrunds, presenting n a wide variety f tpics, including image sharing, play preparatin fr a MRI scan, nn-accident head trauma imaging and nurse led sedatin Cnsultant Radilgists presented interesting cases, patient pathways and imaging techniques The Develping Human Cnnectme Prject, shared nvel techniques t minimize the impact nise has n image quality when scanning infants. The prject identified that 52.5% f lw risk term infants have an incidental finding n their scan. There is ging t be a surge in purchasing Where s Wally bks after it was explained hw useful they are as a distractin technique, especially fr cannulatin due t the large page size! At lunch we gt t play with the Playful MRI simulatr and Hampshire hspitals Leg MRI mdel that can be cnstructed fr under 100. We fund ut the prcess invlved in develping a sedatin service, including making sure there is a clck in the scan rm t take bs as yu cannt wear a fb watch in MRI. The day was very successful and feedback frm the event shwed increased awareness f the imprtance f team wrking t achieve paediatric MRI and the alternatives t MRI under general anaesthetic. Watch this space fr future events. Dr Stdley Presenting n Nn-Accidental Head trauma Clinical Frum Feedback frm the MRI study day shwed an appetite fr mre pprtunities fr clinicians t netwrk especially radilgists, with talks frm specialist physicians n cnditins and what infrmatin they wanted frm the imaging. T fulfil this we are develping a Thames Valley and Wessex Paediatric Radilgy clinical frum. This will build upn the excellent Wessex Paediatric Radilgy frum, and expand t include the Thames Valley This will allw reginal discussins, case presentatins, and gvernance f paediatric imaging, review f natinal recmmendatins. Initially meetings are planned bi-annually. Dr Jseph Jacby, Cnsultant Radilgist at Ple Hspital is the incumbent chair f the Wessex Paediatric Radilgy Netwrk, and he has agreed t cntinue as Chair f the Thames Valley and Wessex Paediatric Radilgy Clinical Frum. Invitatins have been sent ut, but if yu are a Radilgist with an interest in Paediatrics, wh is nt n ur mailing list, please drp us an email. The next clinical frum is being held n March 14 th 2-4PM at Tidbury Farm, Suttn Sctney. CONTACT DETAILS Nadine Duffin Paediatric MRI Prject Manager Thames Valley and Wessex ODN M: 07464492622 E: Nadine.duffin@uh.nhs.uk
4 Children s Epilepsy Surgery In 2012, the Children s Epilepsy Surgery Service (CESS) was set up t imprve access t epilepsy surgery fr children in England. As a result,. the rates f surgery in epilepsy patients have increased significantly. Frm April 2017 all children under 18 requiring 1.. surgery will receive it in ne f fur designated CESS centres: Birmingham Children s Hspital NHS Fundatin Trust University Hspitals Bristl NHS Fundatin Trust Great Ormnd Street Hspital fr Children NHS Fundatin Trust and King s Cllege Hspital NHS Fundatin Trust, Lndn Alder Hey Children s NHS Fundatin Trust (Liverpl) with Central Manchester University Hspitals NHS Fundatin Trust (NrCESS) Currently, arund a third f children with epilepsy d nt respnd t anti-epileptic drugs r have a type f epilepsy that spntaneusly reslves. Evidence shws that surgical interventin in these children culd maintain neurdevelpment, whereas their develpment slws if seizures cntinue. The CESS centre fr the NHS England Suth regin is Bristl Children s Hspital. The Thames Valley and Wessex Paediatric Neursciences ODN is wrking with Bristl t develp cmmn and ptimal patient pathways fr referrals t the CESS service whether a patient lives in Plymuth r Prtsmuth, Nrthamptn r Suthamptn. MRI scans are an integral part f the surgical wrk up. The paediatric MRI prject is wrking alngside the ODN t develp a reginal (TV&W + Suth West) MRI prtcl fr epilepsy surgery scanning. This will ensure that scans are f a suitable quality t be reviewed at the CESS MDT and reduce repeat scans where ptimal images are nt available.. The aim f develping these prtcls is t prvide equity fr the Suth ppulatin and t allw patients have t have their surgical wrk up MRI scans and assciated imaging as clse t hme as apprpriately pssible. REFERENCES Epilepsy Actin (2016) Abut CESS If yu wuld like further infrmatin n CESS, please cntact Heather Deeley, Paediatric Neursciences ODN Manager. T: 07464 492624 E:heather.deeley@uh.nhs.uk Prescreening Prfrma An MRI pre-screening prfrma has been devised t assist the clinician deciding whether referral fr play therapy is apprpriate. The final amendments pst reviews are being made. Once cmpleted this will being sent ut fr cnsultatin. Pilt and implementatin is planned frm April fr tw mnths. The prfrma is designed t be cmpleted in clinic at the time f referral f children ver 3 years ld fr a MRI scan. It is brken dwn int 3 sectins. The first sectin is fr parents t cmplete and lks at bth the child s and the parent s previus expsure t MRI and levels f anxiety regarding the scan. The secnd sectin includes a test exercise fr children 3-7 years ld. This exercise can be dne with children ver 8 years ld when there are cncerns the child may struggle t stay still. The shrt exercise is designed t be undertaken by clinic HCA s fllwing additinal training. The final sectin is fr patients where cntrast is ging t be given, as anxiety regarding IV access needs t be cnsidered. The frm is then scred. This will allw apprpriate referrals fr play therapy t target the patients wh will benefit frm interventin. Play therapy has a strng evidence base fr reducing the need fr GA MRI scans and increased patient Ryal Berkshire Hspital s Leg MRI Scanner University Hspital Suthamptn s Inflatable MRI Scanner
5 Yu said. We are ding (Study Day Special) Mre practical advice n what will be the way frward, especially with hw t deal with small numbers f cnsultant paediatric neurradilgists We are in the prcess f reviewing innvative examples t prvide radilgy services where there is a shrtage f radilgists. Wuld be great t have anaesthetist input Unfrtunately the Anaesthetists wh were invited t present were unable t attend, but we are using their knwledge and skills in the wrking grup. Presentatin f individual cases The clinical frum is ging t have a peer case review fr discussin f difficult r interesting cases anyne chses t bring. Mre netwrking Opprtunities. We are develping the Thames Valley and Wessex Paediatric Clinical Frum t allw mre netwrking pprtunities and facilitate reginal discussins. Other study days n ther tpics wuld be appreciated by everyne I spke t n the day We are lking fr ways fr anther reginal study day t be held, but t encmpass all aspects f paediatric radilgy in Nvember after the MRI prject cmes t an end. Cming up next February March April Prfrma fr the pre-screening f paediatric patients t help the decisin making prcess regarding the need fr GA / play specialists input t be ratified Identificatins f Pilt/Implement Site fr Pre-screening Prfrma Prpsal fr extensin f the prject t cmmissiners. Thames Valley and Wessex Paediatric Radilgy Clinical Frum Meeting 14 th March CESS Meeting Prspective data capture- MaRcH Watch this space. Pre-screening prfrma pilt glive Wrkshp t develp standardised patient pathways and scan prtcls fr the tp bdy and MSK scan indicatins