BERT to the rescue: Bedside theater reduces anxiety for patients going into surgery

Sam Rodriguez, MD and Thomas Caruso, MD

Bedside Entertainment Theatre (BERT) featured on NPR 6/29/16. On NPR’s All Things Considered, Jenny Gold tells the story of an innovative care program launched earlier this year by Packard Children’s doctors – aimed at reducing anxiety for kids going into surgery.

Read below – Healthier, Happy Lives Blog on BERT, published April, 2016.

*Approximately 60 percent of patients experience preoperative anxiety, which is typically treated with oral medications. But these medications can increase the time it takes a patient to emerge from anesthesia and prolong the postsurgical recovery period.

“I couldn’t be more thrilled!” said Stephanie Oshman, mom to 8-year-old Michael, who had just had his tonsils removed at Lucile Packard Children’s Hospital Stanford. “He was a rock star!”

It was not the behavior she had expected. Michael, who suffers from anxiety, was so worried about the surgery that he had experienced anxiety attacks the week prior. But his surgery experience exceeded everyone’s expectations—patient’s, parents’ and care team alike.

What Is BERT?

The key to Michael’s success was a new method his anesthesiologists had invented to engage and distract young patients in the minutes before surgery. Called the Bedside Entertainment and Relaxation Theater, or BERT, it distracts the patient and reduces nerves, crying and stress, all of which can impact clinical outcomes when it comes to induction of anesthesia and postsurgical recovery.

“Having a surgery can be one of the most stressful events to-date in a child’s and family’s life,” said Sam Rodriguez, MD, Michael’s pediatric anesthesiologist. “And separating from their parents is a frightening experience, so the time when they are moving from the presurgery waiting area to the OR is [a critical time] to keep patients from getting upset and anxious.”

That concept of promoting calm and relaxation before surgery inspired Rodriguez to invent the BERT contraption in his garage. Then, he turned to fellow pediatric anesthesiologist and friend Thomas Caruso, MD, to help gain support for implementing a program in the hospital. After months of collaboration across multiple departments, the BERT program launched this February in the perioperative unit.

Patient, Michael Oshman, interacts with BERT on his way to surgery

How It Works

BERT consists of a projector and large, white plastic screen, both which are mobile and attach to a patient’s bed with clamps. Patients can choose from a menu of age-appropriate entertainment options ranging from TV shows to movies to music videos.

The immersive media experience also includes an element of theatrics. For example, once inside the OR, the anesthesia team uses BERT to start a countdown as they put the mask on and the patient falls asleep. They will shake the bed and give verbal cues like, “You’re going to smell the rocket fuel now,” and “we’re taking off!” These “induction plays” span several themes, including a deep sea dive, rocket launch blast-off and whimsical My Little Pony and Dora the Explorer adventures.

For Michael Oshman’s presurgery experience, the team employed multiple tactics. Up until the moment he fell asleep, BERT was playing, and Michael could play games on an iPad. . His care team also provided soothing words: Child Life specialist Amanda Suhrke reassured him that he was not alone and that Mom would be there as soon as he woke up.

“It will feel like just closing your eyes for about four seconds, then opening them,” Suhrke told Oshman. After surgery, Michael, who was in good spirits, confirmed, “it was like I blinked and it was all over.”

BERT’s Impact

Even if a patient does require preoperative oral medication, BERT can still help ease preoperative stress and anxiety. Studies show that preoperative anxiety can delay the induction of general anesthesia and trigger the release of stress hormones, which can hinder postoperative healing. Employing nonmedicinal techniques of distraction like BERT could both reduce the need for these oral medications and serve as a complement to oral antianxiety medicine in patients who still require it.

To measure BERT’s clinical efficacy, the perioperative team will analyze the patients’ anxiety from the perspective of families and anesthesiologists. Although the team is still gathering data, the initial observations are very promising.

“BERT has made a visible impact already from the Child Life perspective,” said Suhrke, “and adding options to our toolbox of nonmedicinal anxiolytic techniques can be beneficial for patients.”

Rodriguez and Caruso develop much of BERT’s media content in their free time and are constantly looking for ways to continue to improve the system and the patient’s experience.

“It’s so worth it,” said Rodriguez, and the feeling is mutual among all of BERT’s “players”—from the OR assistants and surgeons to the Child Life and patient experience teams, who are seeing the results come through in patient satisfaction surveys.

“BERT is where the medically complex work of the surgery process meets the pragmatism of keeping the patient and family comfortable,” said Christine Cunningham, director of Patient Experience.

Now that there is tremendous interest in BERT from other departments and services in the hospital, work is underway to scale the program.

For Drs. Rodriguez and Caruso, it’s about doing what they would want someone to do for their children.

“I greatly respect the opportunity to be a caregiver for a child when their parent cannot be there in the OR,” said Caruso. “As a father, I appreciate how difficult it is for a parent to be apart from their child while [the child is] getting a procedure.”