The Who, Where, and What of Procedural Sedation: Effects on Resource Utilization and Patient Care in the Hospital

Background:

Children undergo painful procedures in hospitals and deserve appropriate procedural sedation (PS). Pediatric hospitalists (PH) are increasingly providing PS. We hypothesize that variability in PS practices impact resource utilization and patient care and that in hospitals where PH provides sedation, the sedations needs of children are better met and that sedation is provided with less resource utilization

Methods:

A survey was sent to PH leaders of hospitals that belong to the Child Health Corporation of America (CHCA) or in states that did not have CHCA hospital to hospitals that belonged to National association of Children’s Hospitals and Related Institutions. In total we sent surveys to 90 hospitals.

Results:

We received 56 responses (62%) of which 49 completed the survey. 83% of respondents were from an academic children’s hospital. PH provided sedation in 18 of the 56 hospitals who responded to the survey. The predominant providers of sedation are anesthesiologists (abscess I&D [50%], renal biopsy [56%], joint aspiration [29%]). There was variability in provider, setting of sedation and agents used for sedation. Procedures where anesthesiologists are the predominant sedation provider are mostly performed in the OR. Other sedation providers were PH, pediatric emergency physicians and intensivists and they provided sedation in non‐OR settings. OR utilization in hospitals where PH provide sedation for procedures (all: 44%, abscess I &D:28%,renal biopsy: 28%) was significantly less compared to hospitals in which PH do not provide sedation (all:74%,abscess I &D 63%,renal biopsy:43%). For procedures performed predominantly by anesthesiologists, propofol and general anesthesia were utilized in more than 50% of reporting hospitals. Ketamine is used relatively less (abscess I&D, 19%; renal biopsy, 22%; burn and postoperative dressing changes, 30% and 14% respectively) in the hospitals surveyed. Nitrous oxide was used in only four hospitals surveyed for any procedure. We found that in hospitals where PH provide sedation a significant reduction occurred in painful/traumatic procedures for which no sedation is provided (22%) compared to hospitals where PH do not provide sedation (68%)

Conclusions:

There is variability in sedation practices in hospitals across the nation. There are unmet sedation needs for children (specifically for postoperative dressing changes and VCUG) in hospitals where PH do not provide sedation. There is a significantly greater OR utilization in hospitals where PH do not provide sedation.