Enhancing access and service: growing pediatric interventional radiology at MCH
Ten-year-old Robyn Schmidt relies on interventional radiology at McMaster Children’s Hospital (MCH) to stay alive. Born with an extremely rare genetic condition called DNM1 mutation, Robyn requires round-the-clock care and feeding through specialized tubes that must be regularly replaced by an interventional radiologist.
“These appointments aren’t optional. When we need our appointment, we need our appointment,” explains Robyn’s mother, Elena. “Those tubes have to be changed because they break down and stop working. Robyn can’t go without them.”
However, the family sometimes faces frustrating delays when coming in for Robyn’s critical tube changes every three to four months. They’ve experienced hours-long waits and last-minute rescheduling that can throw Robyn’s carefully planned care routines into disarray.
“These appointments aren’t optional. When we need our appointment, we need our appointment”
But that’s changing. As part of a historic provincial investment of more than $48 million in care at MCH, the hospital’s interventional radiology and sedation services are receiving a $500,000 investment to expand and improve services for children and their families.
Interventional radiology (IR) uses imaging techniques including fluoroscopy, ultrasound, and CT scan to perform minimally invasive procedures on children. While watching live on a monitor, the interventional radiologist can perform a variety of procedures, such as inserting chemotherapy ports, conducting biopsies, and inserting drains and feeding tubes.
IR team growing to meet the needs of children
The MCH pediatric interventional radiology team (Dr. John Donnellan far left)
MCH’s interventional radiology service has seen remarkable growth since 2018, when the hospital hired its first pediatric interventional radiologist, Dr. John Donnellan. The program has since expanded from 200 cases per year to more than 1200, with a second pediatric interventional radiologist joining the team in September 2023.
“Interventional radiology responds to the growth in the rest of MCH. It is integral to the flow of patients through the hospital and the operating room. By increasing capacity in IR, the operating room has more capacity to do bigger surgeries like scoliosis and cancer surgeries,” said Donnellan.
“Expanding the service not only allows us to see more kids during the day, but it also means we have the ability to care for the kids that would otherwise have to wait until an operating room is free at night to get procedures done with anesthesia,” adds Donnellan.
“By increasing capacity in IR, the operating room has more capacity to do bigger surgeries like scoliosis and cancer surgeries”
Children requiring interventional radiology services often need to fast as procedures must be done on an empty stomach to avoid complications. Lengthy waits can be challenging and stressful for hungry kids and their parents or caregivers.
“There’s more certainty with a booked timeslot during the day rather than the uncertainty of not knowing when an operating room will be free after surgeons are finished working on urgent cases,” he added.
The interventional radiology program at McMaster Children’s Hospital relies heavily on the support of pediatric anesthesiologists who administer full general anesthetic, which is essential for patient care and safety.
Comfort and safety: providing sedation support for all
Demonstrating an interventional radiology procedure.
The program’s growth also includes a new GI fluoroscopy room which is used to diagnose structural or functional abnormalities of the upper gastrointestinal tract – the esophagus, stomach, and duodenum. The patient swallows contrast so that the body part and its motion can be seen in detail using fluoroscopy, a type of x-ray. As the patient swallows the drink, the radiologist looks at a monitor to see the movement of the contrast through the GI tract. The same equipment can also be used to perform some less complex interventional procedures.
The new sedation room will be completed in 2024 and will complement the team’s existing service offered to MCH patients who require specialized support.
“Our sedation team of 24 nurses offer an incredible service – they’re experts at all parts of the patient care journey when a child comes for a sedated procedure- from the way they greet the families and put the children at ease with laughter and games but all the while ensuring no important clinical detail is overlooked, they help to ensure that children have the best hospital experience possible,” said Donnellan.
The new capacity will enable the IR and sedation team to support extra procedural work, such as echocardiograms, dressing changes for burn patients, and closed fracture reduction, a procedure to set a broken bone without cutting the skin open. It will also expand the service provided by Pediatric IR during daytime hours.
Interventional radiology offers services and procedures that allow for much shorter recovery times. The margin of safety is improved by shorter anesthetic times or, when possible, the substitution of conscious sedation.
“Ask any parent. When your child is sick, your instinct is to try and support them as quickly as possible with the best care possible.”
Appreciation for investments
Elena hopes these improvements will help ease the burden on all families. With Robyn also requiring full-time home nursing care and seizure management, every aspect of their hospital experience matters.
“Ask any parent. When your child is sick, your instinct is to try and support them as quickly as possible with the best care possible. But when those services are interrupted, not available or delayed, it’s disappointing. You’re feeling bad for your child, but you’re also frustrated,” said Elena.
Despite the challenges, Robyn’s family is grateful for the care they receive.
“We’ve been going to McMaster Children’s Hospital for 10 years. We’re there all the time. Staff are dedicated and always so apologetic when they have to delay or reschedule. It’s hard for them too. Improving this service is important for all,” Elena added.
Donnellan expressed appreciation for the government’s investment in children.
“By increasing access to interventional radiology and sedation services, we can ensure quicker recovery times and enhanced safety for patients across a broad spectrum of medical needs,” he said. “With improvements to the overall process, patients receive care that is more specifically tailored to their needs, leading to improved experiences and outcomes.”
