Rationale and Objectives
Assess whether staff training in advanced rapport skills and self-hypnotic relaxation techniques reduces noncompletion rates during magnetic resonance imaging (MRI).
Methods and Materials
All staff of a free-standing MRI facility was invited to 3 hours of preparatory communication lectures. Half of the practice was then engaged in intensive training. Clerical personnel and nonlicensed health care professionals received training in advanced rapport skills only (8 hours); licensed health care professionals were trained in advanced rapport skills plus rapid hypnotic techniques (17 hours). Content was adapted so that no interruptions of workflow would become necessary. The format included lectures, large group discussions, small group practice, and a microteaching exercise.
Results
During the quarter of operation before the training 1.2% (80 of 6,654) of patients could not complete their studies. After training, 0.74% (52 of 7,008) patients did not complete their scans ( P < .01). Noncompletion rates of scans on the open magnet, on which the most anxious patients were scheduled, decreased from 3.43% (37 of 1,078 patients per quarter) to 1.45% (19 of 1,098). After staff was informed that the MRI partnership would be dissolved and personnel might be transferred or laid off, the noncompletion rate increased again, although not to the original levels; then, after partial dismantling of the facility, leveled off to 0.92% overall and 1.84% on the open magnet. Success was maintained at 1-year follow-up.
Conclusion
Team training in advanced rapport skills and self-hypnotic relaxation techniques significantly reduces MRI noncompletion rates. Personnel distress can adversely affect the patient experience.
Magnetic resonance imaging (MRI) can provide exquisite anatomic detail but fails when preexisting pain, claustrophobia, or panic from physical confinement and loud noise make it impossible for patients to remain still on the examination table. Estimates are that an average of 2.3% of patients is unable to complete their scan and obtain a diagnosis . This not only complicates the patients’ subsequent care, but also poses a considerable burden on the imaging facility when the suddenly opened time slot cannot be filled without delaying subsequent patients and reimbursement is lost.
Prior studies in radiology departments showed that patients’ pain and anxiety during invasive procedures can be reduced by rapid hypnotic techniques provided to patients without prior preparation . In these studies, the hypnotic interventions were structured by specially trained personnel while the patients were prepared for their interventions on the procedure table. Based on this experience, we came to hypothesize that the medical personnel already present in MRI facilities should be able to reduce noncompletion rates. We were able to test this hypothesis when asked by a large free-standing MRI facility to design a program that would result in the reduction of the rate of claustrophobia-caused noncompletion of MRI examinations. The rationale was mainly economic: to reduce revenue loss incurred with patients who cannot undergo or complete examinations and to gain a competitive advantage by providing exceptional attention to patient comfort, especially those with claustrophobic issues. The program objective was to train an entire team in interpersonal skills and mind-body techniques. This approach was intended to permit a streamlined procedure from the moment a patient calls for an appointment to the performance of the scan. This article describes how the request developed and how the project fared from the initial concept of need to execution and 1-year follow-up.
Materials and methods
Determination of Need and Search for Options
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Course Design
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Teaching Content
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Follow-up Activities
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Assessment of Noncompletion Rates of Scans
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Results
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Table 1
Noncompletion Rates in Percent of Patients Imaged on the Individual Scanners
Scanner Pretraining Q1 Patients Q2 Patients Q3 Patients Q4 Patients Q5 Patients 1 1.96 0.51 0.89 0.52 0.96 2 0.76 1.02 0.85 1.08 0.92 1.02 3 (open) 3.43 1.45 3.04 2.78 2.14 1.84 4 0 0.10 0.10 0.33 0.72 0.38 5 1.39 0.64 0.65 1.20 0.42 0.82 6 0.44 0.53 0.31 0.78 0.45 0.28 8 1.40 All scanners 1.33 0.74 1.13 1.18 0.93 0.92
Scanner #3 is the open magnetic resonance imaging scanner. Scanner #1 was taken out of service in the fifth quarter (Q5) after training. Its license was transferred to Scanner #8, a 3T magnet.
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Discussion
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