There’s room for all in top-quality sedation care


 

The Society for Pediatric Sedation strives to promote safe, high-quality care, innovative research and quality professional education in the area of pediatric procedural sedation. The recent reports from Washington University School of Medicine and St. Louis Children’s Hospital describing a hospitalist-led procedural sedation program are good examples of the kinds of organized sedation programs and teams that fit the models espoused by the SPS no matter what "kind" of licensed clinician provides the sedation care.

The SPS maintains a database of pediatric procedural sedation episodes populated by data from about 35 institutions; the institutions include children’s hospitals, children’s hospitals within hospitals, and community hospitals. Reported data include patient characteristics and outcomes from moderate and deep sedation care delivered by subspecialist pediatric care providers (anesthesiologists, intensivists, emergency care physicians) and by hospitalists and general pediatricians. Of the more than 200,000 episodes of pediatric procedural sedation about 33,000 sedations (approximately 15%) are listed as performed by general pediatricians or hospitalists with a complication or intervention rate similar to the St. Louis single-center data and to the rates reported for subspecialists from the database.

It is important to realize that the complication and intervention rate reported from this large multicenter database is biased toward reporting data from well-organized teams who would be expected to provide safe, high-quality care in a hospital setting. The SPS provides quality reports to institutions submitting data about their sedation care including blinded comparative data from the institution group as a whole and would welcome new institution involvement.

Reports of single-center data also should stress the importance of organized systems of sedation care. St. Louis Children’s Hospital has many layers of safety and rescue back-up for pediatric patients. It is crucial for hospitalists practicing in smaller or in primarily non-pediatric inpatient settings to investigate the systems at their institution for rescue and clinical back-up in the event of the more serious airway-related events that occur during as many as 1 in 400 pediatric procedural sedation episodes. Dr. Mythili Srinivasan, in her report of the St. Louis hospitalist experience, did stress the important safety and quality concepts of a close and collaborative relationship with the department of anesthesiology and the significance of a rigorous training program for any clinician involved in procedural sedation for children.

Many pediatric institutions (St. Louis Children’s is one) have credentialing training programs involving didactic and often simulation-based and/or patient-care based experience for the individual clinician working in the area of pediatric procedural sedation within the home institution. The SPS sponsors and produces a simulation based pediatric procedural sedation course which provides clinicians with the tools and skills to evaluate and/or organize a procedural sedation program in addition to understanding the assessment, treatment and rescues skills necessary to provide safe and effective sedation care.

The safety and efficacy of sedation care by a team of trained providers are the domains of quality considered of paramount importance by the SPS. Billing and reimbursement issues surrounding pediatric procedural sedation care are widespread. The SPS considers the vast variation in billing and reimbursement issues across the country a situation that may be associated with inequity of access and timeliness to effective sedation care and is working to eliminate inconsistencies that do not represent high quality-care for children.

Dr. Lowrie is president of the Society for Pediatric Sedation.

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