Sedation procedures in MR imaging: Safety, effectiveness, and nursing effect on examinations

PURPOSE: To measure the safety and effectiveness of conscious sedation in order to assess utilization and the effect on magnetic resonance (MR) imaging examinations. MATERIALS AND METHODS: A database of conscious sedation records for MR imaging at the Johns Hopkins Hospital, Baltimore Md, from 1991 to 1998 was searched. Safety data according to medication and procedure duration for each nurse were tabulated for 6,093 patient records. Data were analyzed by using quality control statistical measures to determine time utilization and effectiveness. Break-even costs for the procedure were determined. RESULTS: Of 6,093 patients scheduled for examination, 4,761 patients (78.1%) received conscious sedation by the MR conscious sedation service. Complications were observed in 20 of the 4,761 patients (0.42%). No deaths occurred. The most common complication was oxygen desaturation (n = 8). Diagnostic and complete MR examinations were performed in 4,453 of the 4, 761 patients (93.5%). The mean time to sedate the patient (+/- SD) was 23.6 minutes +/- 15.2 for specialized MR sedation nurses and 26.8 minutes +/- 20.1 for general radiology nurses (P < .001). For inpatient nurses from the inpatient hospital units, the sedation time was considerably longer (47.3 minutes +/- 36.6, P < .001) and more variable. Break-even costs were 37% ($11 vs $8 for MR room time) more for general radiology nurses than for specialized MR sedation nurses performing the procedure. CONCLUSION: Conscious sedation is safe and has a high effectiveness rate. A highly specialized nursing staff reduces procedure variability and cost.