Initiating a Hospital-Wide Pediatric Sedation Service Provided by Emergency Physicians

This observational study from the University of Hawaii describes the use of a hospital sedation team managed by emergency physicians to provide deep sedation to 133 pediatric patients and the effects on patient care and hospital financial performance. Over a 10-month period, a sedation team was made available for all procedures requiring sedation outside the Emergency Department. The majority of patients were sedated with propofol alone, some received ketamine, and 2 patients received both drugs. The procedures and studies requiring sedation included magnetic resonance imaging scans, hematology-oncology procedures, computed tomography scans, nuclear medicine studies, electroencephalograms, and surgical procedures. The sedation process was facilitated by having the physician set up pre-sedation clearance 7 days in advance, and having a nurse telephone service call the family to advise of what to expect and to make sure the child had nothing by mouth before the procedure. Also, a sedation nurse was made available for all procedures. During this 10-month period, there were eight documented adverse events, including three cases of hypoxia, three cases of apnea, three cases of noisy breathing, and two cases of coughing. No endotracheal intubations were required. After establishment of the sedation team, the backlog of hematology-oncology procedures and radiologic studies was eliminated. The authors concluded that having an emergency-physician-based sedation service improved patient care and was financially beneficial to their hospital.