When children must undergo medical procedures, imaginative play can be a key component in their care. Distraction, misdirection and theatrics are tools that many practitioners will use to build rapport with pediatric patients, and they’re equally applicable in the imaging suite. That’s why in 2013, the Children’s Hospital of Philadelphia (CHOP) launched its “Brave Kid Capes/Super Hero Support,” a superhero-themed program that added a narrative element to medical imaging treatment for children.
CHOP sees some of the most high-risk pediatric patients in the country and, like many pediatric specialty centers, is renowned for its sensitivity to families in its care. But the Super Hero Support program wouldn’t have gotten off the ground without the support of outside investment from AHRA: The Association for Medical Imaging Management (AHRA) and its Putting Patients First grant program.
Entering its eleventh year, Putting Patients First has handed out more than $600,000 in support of 64 grant programs at health care facilities across the country. The program was established in 2008 as a way to support patient safety and comfort initiatives that otherwise might not get off the ground in cost-cutting environments, and to seed those ideas that could prove reproducible in comparable settings. It is funded by Canon Medical Systems USA of Tustin, California.
Cathy Wolfe, senior director of strategic communications and market intelligence for Canon, has been involved in Putting Patients First since its early days. She describes the program as one of the company’s longest-lasting and most successful collaborations.
“We have a very strong focus on investing in the communities in which we operate,” Wolfe said. “Patient safety and education are critical concerns. We believe very strongly in the AHRA and we also believe very strongly in patient comfort. Any place where we can be supportive, we’re happy to do that.”
Eight grants are awarded annually through the program, six of which are $7,500 awards. Two of those are given to projects that improve patient safety or comfort in pediatric imaging, two are given for projects that improve overall patient safety, and two are given for oncology-specific imaging projects. Putting Patients First also awards two $10,000 grants to a hospital system or integrated healthcare delivery network (IDN) in the areas of patient safety or cybersecurity. Applications are accepted annually through October, and then are awarded based on the determinations of a selection committee.
The focus of the funded programs has evolved over time (the cybersecurity and oncology grants are recent additions), as the needs of the industry have changed. Wolfe said those changes are the result of the close collaborations among Canon, AHRA and its membership.
“We have to figure out where can we have the biggest impact,” she said. “We wanted to provide grants that would be able to impact the institution, but also do it at a level that a variety of institutions can benefit. AHRA selects submissions that align with the program, and meet their objectives as well as ours to have an impact with a local institution.”
Once the grants are awarded, funded programs report back on the results of their work within three to six months. Many of those reports are collected in Radiology Management, the AHRA professional journal. Canon marketing teams support AHRA in producing some of the supplemental materials associated with the program, including interviews with grant recipients, which are shared in the hope of proliferating the successes of the programs.
“Part of the intention of the program is that this gets shared with other members of the AHRA,” Wolfe said. “You’ll see that something done at one institution sometimes gets picked up at another institution; you’ll see a lot of organizational learning.”
Wolfe said the success of Putting Patients First has pushed other institutional partnerships, including Safety FiRsT, Canon’s provider safety collaboration with the American Society of Radiologic Technologists (ASRT) Foundation. Founded in 2015, Safety FiRsT awards a pair of $7,000 grants for medical imaging and radiation therapy practitioners annually. Wolfe said it’s continuing to build over time, for which she credits the tight integration of the two organizations.
“I think the thing that differentiates these programs is to really be a partner of the association we’re working with,” she said. “Our objectives, your objectives — where can we come together? What’s something that’s more creative but a good opportunity for the institution to advance their care and also their education?
“A lot of organizations will just give money and are not really involved in the creation of these programs,” Wolfe said. “One of the biggest things we learned was to be involved as much as you can, but give the real ownership to the organization. We consider this part of our commitment to our industry and to patients.”
AHRA President Bill Algee, director of imaging services at Columbus Regional Hospital in Columbus, Indiana, said Putting Patients First grants help fill an important stopgap role in imaging budgets.
“I believe all hospitals are suffering from this,” Algee said. “We have this list of equipment needs, or other program needs, and we only have X number of dollars. Something’s got to give, and you try to figure out what are must-haves versus things that are nice to do. That’s where the challenge comes in. Sometimes small-dollar ticket items make a huge impact. With this [grant money], they’re going to get the program off the ground.”
Algee said AHRA vendor partnerships and collaborations like Putting Patients First are “extremely important” to the advancement of industry-wide priorities in medical imaging, including dose monitoring and reduction, patient education and the often overlooked value of patient comfort to the quality of an imaging study. In facilities where environmental factors are secondary or tertiary priorities, grant programs can do significant work in improving patient comfort.
“It doesn’t do a patient any good to come in, and they can’t get their exam done because the room’s too cold or the light’s too bright,” Algee said. “A lot of patients have sensory issues; it’s a lot more challenging than one might think.”
In 2011, Cincinnati Children’s Hospital leveraged an AHRA grant to purchase tablets that can be used to calm pediatric patients during an imaging exam instead of anesthesia. The ability to distract and mollify children without the use of heavy sedatives was a technological opportunity that could be met with a one-time infusion of cash.
Six years later, the Carti Cancer Center in Little Rock, Arkansas used a Putting Patients First grant to purchase blanket warmers for patients undergoing PET scans. In such a setting, it’s not uncommon for a patient to wait 45 minutes to an hour in an isolated room to be injected with a contrast agent for the scan. That’s a long time to spend in an air-conditioned room wearing only a dressing gown, Algee said.
“Historically, what we do in imaging is take people’s clothes off when they come in the door,” he said. “For years and years, we never thought about putting blanket warmers in imaging departments. You don’t want to X-ray with the blanket on the table, but if you put the blanket on the table, it warms the table first.”
Another grant, awarded in 2017, went to Massachusetts General Hospital in Boston to pay for in-bore lighting and a cinematic projector for pediatric patients and their parents during imaging studies. Again, Algee said the equipment could help reduce patients’ anxiety, and possibly eliminate the use of anesthesia.
The focus on environmental sensitivity is something that he’s observed having an impact in his own hospital, where a recent remodel of the nuclear medicine suite included “a patient experience enhancement room” with special lighting and ceiling-mounted speakers. Those additions are patient-focused, but they have an effect on the staff and their ability to be able to treat patients, Algee said.
“It doesn’t look like any other room you go in,” he said. “When I walked by there, I immediately felt relaxed. I think it takes that weight off you. That creates an environment where the staff and patients can connect on another level. If the patients are calmer because of one of these experiences, that helps the staff to remain calm as well.”
Patient safety can also be improved by improving cancer detection rates, an area in which Algee foresees future potential for innovation through artificial intelligence, either via software solutions or other automated processes. Grant programs like Putting Patients First may play a role in expanding those mechanisms.
“All of those screening programs are based on early detection, that’s putting patients first,” Algee said. “There are scholarships out there, but you have to apply for them, and you have to know that they exist. The biggest obstacle is people taking the opportunity and just going for it.”
MRI safety consultant Tobias Gilk, of ferromagnetic detection system manufacturer Metrasens, said programs like Putting Patients First work best when they collaborate directly with health care practitioners and clinical staff to solve industry problems. Combined with the scope of small-scale grants, Gilk said the initiative has a high success rate because it enables people working in the field to advance the practice by meeting specific, niche needs in grassroots ways.
“You need to find what you need to do at your institution,” he said. “Facilities really sponsoring these small seed projects… all of that has gotten harder to do internally, which I think is a tremendous shame.”
“I hope that more facilities and health care groups see this, and begin to say, ‘It is worthwhile investing in our people, investing in our processes,’” Gilk said. “They should do that for their people in-house, or let other groups take up the banner that Canon has really led with.”
Gilk, who specializes in MRI safety training, said he’d like to see patient safety concerns come to the fore through expanded professional development, embracing an organizational safety chart and expressing broader practice goals through specific, personalized patient needs. The best way he foresees that happening is by expanding training to allow staffers to “feel comfortable with that kind of responsibility,” improving the overall safety of the environment. By exceeding minimum annual safety benchmarks, institutions advance their overall success.
“We want to do something better, more advanced, to make sure that we’re not treating MRI safety as another layer that we’re slapping on top of existing processes. Developing a knowledge and competency woven into patient care has an orders-of-magnitude impact.”
Gilk believes the Putting Patients First focus on pediatric needs will also help advance those goals in adult care, because best practices in the broader setting seem to emerge from such environments. Focusing on walking patients through the process of getting a scan before it happens not only reduces the use of anesthesia and improves image quality, but also can improve patient satisfaction scores and, ultimately, revenues and reimbursements.
“With most things in radiology, we can look at pediatric settings and seeing what they’re doing that will hopefully be more comfortable in the adult world 10-15 years from now,” he said. “If they have a child specialist and can do play simulation with respect to using the MRI — this is what it sounds like, this is what it looks like, let’s practice holding still — those things can have a remarkable impact for reducing anxiety, reducing anesthesia.
“Nobody is happy about getting an MRI,” Gilk said. “To start out, not being pleased that you have a diagnosis, then you compound that with the fact that a lot of patients have anxiety about medical tests, and we layer on these stressors, and it makes the process harder for the patient, harder for the facility.”
Gilk also noted that the expanded focus on environmental factors plays a big part in the diversity of patient populations who present for study. Today, specialists may see trauma patients, emergency patients, nonverbal or non-communicative patients, and may be performing more complex medical procedures on them. Making sure staff are fully trained in safety protocols is a critical piece of that puzzle, but so is presenting staff and patients with a calm environment to smooth the entire process.
“The ground has shifted under our feet, and the risk factors have shot up and up and up,” Gilk said. “It puts the people who actually deliver care — the technologists, the radiologists, and the medical physicists who support them — in the crosshairs, because they have to make more decisions for patients who have a greater degree of complications.
“We need to give folks the resources to make better decisions,” he said. “At its core, that comes down to teaching them the information that they need to have to be able to make the better decisions.”
Children’s Hospital of Philadelphia (2014 winner): Brave Kid Capes/Super Hero Support: help minimize the anxiety that younger patients often sense when undergoing radiology imaging examinations by handing out brave kid kits and having super heroes visit the patients and families: