Improving Preoperative Experiences in Pediatric Patients: Comparing Virtual Reality to Electronic Tablets

Abstract

This quality improvement project aims to improve the preoperative experience for pediatric patients by assessing whether virtual reality (VR) is more effective than electronic tablets in reducing preoperative anxiety in pediatric patients aged 5 to 21 undergoing elective surgery at Shriners Children’s Northern California. BACKGROUND: Preoperative anxiety in children is associated with increased distress, delayed procedures, and a higher reliance on pharmacologic sedation. Although electronic tablets are commonly used to distract pediatric patients, research indicates that immersive technologies like VR may offer superior anxiety reduction. This project was guided by Rogers’ Diffusion of Innovations theory to assess VR’s efficacy and feasibility as a superior alternative to electronic tablets. METHODS: A total of 56 pediatric patients were recruited and evenly assigned to either the VR or tablet group. Pre- and post-intervention anxiety was measured using the Modified Yale Preoperative Anxiety Scale (mYPAS), Observational Scale of Behavioral Distress (OSBD), and Child Engagement Rating Scale (CERS). Data was analyzed using paired and independent t-tests to assess changes in anxiety and engagement. RESULTS: VR participants demonstrated a significantly greater reduction in anxiety scores (mYPAS: ↓29.5 points) compared to the tablet group (↓11.6 points), with a mean post-intervention difference of 17.9 points favoring VR. Behavioral distress (OSBD) and engagement (CERS) scores similarly favored VR, indicating reduced distress and higher cognitive/emotional engagement. These outcomes surpassed the project’s goal of a 20% anxiety reduction and supported VR as the more effective intervention. CONCLUSIONS: Virtual reality significantly outperforms tablets in reducing pediatric preoperative anxiety and improving engagement. Its adoption into preoperative routines may enhance clinical outcomes, reduce reliance on sedatives, and improve workflow efficiency. Findings support the integration of VR into standard preoperative pediatric care to improve patient experiences before surgery.