Childhood anxiety reduction through innovation and technology (CHARIOT): Outcomes and strategies for implementing a bed mounted theater system in the perioperative environment

Samuel Rodriguez sr1@stanford.edu

Abstract

Background
The Stanford Childhood Anxiety Reduction through Innovation and Technology (CHARIOT) Program was created to address the challenges of adapting existing technologies and creating novel solutions for treating the stress that comes with being a child in the health care setting. The CHARIOT Program focuses on strategies to take technologies from the “bench to the bedside” by working with a multidisciplinary team to effectively navigate the health care environment. We describe the numerous obstacles, creative solutions, and outcomes of a department-wide implementation strategy to target preoperative anxiety using an in-house developed bed-mounted theater system.

Most children undergoing anesthesia experience preoperative anxiety, which is associated with increased postoperative pain, emergence agitation, and sleep disturbances. Non-pharmacologic interventions that effectively decrease anxiety include parental presence at induction, tablets/phones, video games, and video glasses. Despite their efficacy, they share limitations of time, cost, and necessary patient cooperation.

We explore an inexpensive, novel, near-immersive Bedside Entertainment Theater (BERT) as an alternative method of preoperative anxiolysis. We propose that near-immersive video projection is an ideal non-pharmacologic intervention because it engages the child’s attention while allowing for their passive participation in the preoperative process.

Objective
The primary objective was to determine if BERT provides anxiolysis equivalent to other modalities without prolonging pre-induction time.

Methods
Context
This retrospective cohort study was conducted between February 1, 2016 and October 1, 2016. Exclusion criteria included cardiac anesthesia patients and anesthesia recipients at locations where BERT was not offered.

Intervention
BERT consists of a battery-powered projector enclosed in a custom case, its clamp mounted at the bed’s head, and a 24 x 36” customized plastic screen mounted via clamp and double ball joint at the bed’s foot. Examples of issues that needed to be addressed and some solutions are presented in table 1 (see attached).

Results(see attached)

Conclusion
These results demonstrate that BERT is not inferior to other modalities of anxiolysis. BERT is effective in augmenting pharmacologic anxiolytics, or as a standalone modality. The use of BERT does not increase time to induction and results in more playful patients. More importantly, this large scale implementation program (now having reached over 1,000 patients) paves the way for creating, adapting, and implementing new technologies to address countless challenges that both clinicians and patients deal with on a daily basis in an ever changing health care landscape. 
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