South West Paediatric MRI Audit (SWAM) – South West Surgery in Children

South West pAediatric MRI (SWAM) multi-centre retrospective patient level audit 2024.

The SW SIC ODN core team are supporting the SWAM audit by working with Dr Katie Foy, the Severn Trainee Anaesthetic Research (STAR) network and the South West Anaesthetic Research Matrix (SWARM) to carry out an audit of MRI scans carried out on children across the South West region in Autumn 2024.

Click below to read more about the audit and how it is being carried out – initial findings were shared with the Optimising MRI Pathways for Children Working Group in March 2025 and a final report will be available later this year.

Audit Background

Requests for paediatric MRI scans are increasing in the South West and are likely to continue to increase. Sedation or general anaesthesia is often required for children to tolerate MRI scans and allow optimum image quality. General anaesthesia is associated with unavoidable risks and impacts on service delivery [1,2]. Risks and benefits of GA should be discussed and clearly documented [3,4]. All children should be assessed as to the safest pathway to achieve successful MRI and all options discussed with the child and care givers. This should include the option of an awake scan with appropriate support (e.g. from play therapists), policies and facilities in place to support this [2, 5].

The Getting It Right First Time (GIRFT) Radiology Report published in November 2020 recommends reducing the need for General Anaesthetic (GA) for children undergoing an MRI scan to benefit both the individual child and also to reduce the time required for an MRI procedure; thus freeing resources [2].

A 2022 service evaluation in the Severn region identified varying practice and concluded that reducing the number of MRI scans carried out under general anaesthetic in this region has potential benefits for patient safety, list efficiency, bed-occupancy, and cost, and that careful patient selection and preparation is needed to ensure awake scanning does not affect diagnostic yield [6]. The work led to the development of the ODN’s Paediatric MRI Pathway Best Practice Recommendations (published 2024) which are designed to support Trusts across the South West to implement the GIRFT recommendations.

This audit will expand on previous work, including the whole South West region, and review current practice against the new Paediatric MRI Pathway Best Practice. The audit will be led by Dr. Katie Foy [ST6 Anaesthesia] and supported by the South West Surgery In Children Operational Delivery Network. The work is also supported by the regional trainee networks STAR and SWARM.

Aims & Objectives

The aims and objectives of the SWAM audit of paediatric MRI scans across the South West are to:

• Understand current pathways and practice across the region for children undergoing an MRI scan.

• Explore the number of MRIs undertaken across the region and the proportion that are conducted while the child is awake, under sedation or under general anaesthetic and further explore the decision making criteria for which pathway a child follows.

• Review the quality of scans undertaken to understand the success rate of scans carried out awake vs under GA or sedation, and if there is any variation in scan quality regionally.

• Identify areas of existing pathways which do not currently align to the ODN’s Best Practice Recommendations and consider opportunities to support organisations with the implementation of the pathway.

• Identify variation in practice within Trusts and between providers.

• Identify potential opportunities for sharing learning of practice.

Methodology

• 1 month (June 2024) retrospective audit looking at all children undergoing MRI scans in eligible hospitals.
• The audit will be registered at all Trusts as per local protocol
• All data will be anonymised.
• Findings are aimed to be presented to the Optimising MRI Pathways for Children Working Group in Spring 2025 (date TBC).
• Please see SOP for full methodology

Inclusion Criteria:
Children aged 0 – 16 undergoing an MRI scan
Elective and emergency scans
Inpatient and outpatient scans

Exclusion Criteria:
Intubated and ventilated on PICU
Intra-operative MRI

Expected Outcomes

• Enhance understanding of MRI practice and pathways for children across the region
• Identify potential variation in practice of the use of general anaesthetic and sedation for supporting MRIs in children
• Identify variation between patient cohorts following an awake / sedation / GA pathway for their scans
• Data and findings to be presented to the Optimising MRI Pathways for Children Working Group in Spring 2025
• It is anticipated that data will also be presented at a regional and national level
• All Trusts will have access to their own data benchmarked against the regional average
• We would anticipate this work be submitted for publication

Why get Involved in the Audit?

We are looking for enthusiastic trainees to be local leads at all Trusts. This project covers the following HALOs for all stages of training:

Management and professional and regulatory requirements
Team working
Safety and quality improvement
Safeguarding
Research and Managing data

In addition, the project can offer:

Experience of regional audit project supported by an Operational Delivery Network and trainee research networks.
Experience of data handling at a regional level and collaboration with NHS digital.
Work is expected work to be presented nationally and submitted for publication with all local leads listed as contributors.
Support provided to present local data which could be used for local QI projects and ongoing audit.
Opportunity to attend the MRI Working Group meetings.
Opportunities to work with the network on other projects.

Audit Documents

South West pAediatric MRI (SWAM) Multi-centre Retrospective Patient Level Audit Protocol Document (for SW providers)
Paediatric MRI Project Plan
Paediatric MRI Pathways Best Practice Recommendations
SWAM Data Collection Template (v1.2)

Audit Contacts

Dr. Katie Ellen Foy
Clinical Project Lead - ST6 Anaesthesia
Email: katie.foy@nbt.nhs.uk
Mobile: 07940543227

Dr. Benjamin Parish
SWAM Audit Lead for the SW Peninsular
Email: b.parish@nhs.net

South West Surgery in Children ODN
Email: swsicodn@uhbw.nhs.uk