Screen-Based Distraction Tool for Preoperative Preparation

Patients will initially be approached about the study during a pre-surgical phone call that every patient receives prior to their procedure by a Nurse Practitioner (NP). During this phone call, the NP will ask if the family would be interested in participating in a research study and if they may be contacted by the research team. If the family expresses interest, the NP will follow-up with the research team and a eligibility screening phone call will be given. If families decline interest, we will respect their decision and will not pursue the family any further for this study. Not all families will be available during the initial pre- surgical phone call, and in this case, the medical staff member and research assistant will approach the family in the pre-operative holding area day of surgery. Interested families will be given a brochure with information about the study and screened for eligibility.

Upon arrival for preoperative preparations, the research assistant will go over the consent and assent forms with the parent and child and answer any questions they may have about the study. While child is being prepped to be transported to the preoperative holding area, a research staff member will determine whether the participant will receive the standard care (i.e. entertainment via tablet) or the (i.e. BERT, Bedside EnteRtainment System; Video Projection) via random assignment. Once determined, the research staff will set up the system for the patient and will be asked to fill out questionnaires, on REDCap or by paper, about how they are feeling at that time before their surgery. Parents will also be asked to fill out questionnaires about their feelings of their child's preoperative emotions. The child will continue to view their preoperative entertainment through to induction. A video camera mounted to the BERT screen or tablet will be used for retrospective coding by blinded research assistants. When possible, a blinded research assistant will also live-code the observer-rated surveys. We aim for this to occur for around 20-30% of participants. care) The research assistants will complete the mYPAS (modified Yale Preoperative Anxiety Scale) and ICC (Induction Compliance Checklist) when coding in vivo. Vitals (i.e. blood pressure, heart rate, oxygen saturation, end tidal CO2, and temperature) will also be recorded as they undergo preoperative preparations. The parent will be asked to remain with their child from the preoperative holding area until the child has undergone induction. Once child enters induction phase in the OR, the patient will undergo surgery as scheduled.

Post-operation, the research assistant will further examine the child's behaviors as they wake from anesthesia. They will also give the the parent, child, and child's anesthesiologist a survey about their experiences with the screen-based device. 1 week after the surgery, the research assistant will follow up with the parent/guardian with questions about their and their child's preoperative and perioperative via phone. The call will also be audio recorded. After the one-week follow-up survey, the study will be concluded for the participant.

b) Explain how the above research procedures are the least risky that can be performed consistent with sound research design.

All survey questions are meant to answer questions pertaining to the study aims. Set up of the Video Projection unit will be performed by trained members of the research team and will be of minimal risk to patients.