Development of a Pediatric Hospitalist Sedation Program

1Washington University, St. Louis, MO
2Washington University, St. Louis, MO
3Washington University, St. Louts, MO
4Washington University, St. Louis, MO
5Washington University, St. Louis, MO

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 198

Background:

There is growing demand for safe procedural sedation in pediatric hospitals around the country.

Purpose:

Through training with pediatric anesthesiologists, we have developed a successful model for a pediatric hospitalist‐administered sedation program.

Description:

In 2003, Pediatric Anesthesia approached pediatric hospitalists as a potential resource to provide pediatric sedation outside Ihe operating room. Pediatric hospitalists were already experienced in providing procedural sedation in the emergency unit (EU) and were prepared to take on This service. Over the last 5 years, the service has developed into a 3‐tiered system of sedation providers The first tier provides sedation services in the EU, primarily utilizing ketamine or nitrous oxide. Training for this tier consists of a 2‐hour didactic orientation with continuing on‐the‐job training. The second tier provides sedation throughout the hospital: EU, Ambulatory Procedure Center (APC), Pediatric Acute Wound Service (PAWS) and night/weekend call for urgent needs. Sedations performed by This tier are similar To Tier 1 but also utilize pentobarbital or dexmedetomidine for non‐painful radiologic procedures for both inpatients and outpatients. Training for this tier consists of completion of 1 year of first‐tier experience plus 5 days of operating room (OR) training with an anesthesiologist. The third tier provides all the prior services, as well as deep sedation using propofol. Training for This group consists of a 3‐hour didactic session followed by 10 days of OR training with anesthesia and 25 supervised propofol sedations. To maintain certification for tier 3, hospitalists must perform at least 150 propofol sedations per year.

Conclusions:

This design and training method has resulted in a successful pediatric hospitalist sedation program. Based on fiscal year 2009 billing data, the hospitalist division performed 2471 sedations. One thousand and seventeen of these were performed on inpatients in the APC or PAWS. One thousand and fifty‐two were performed on outpatients in the APC or PAWS. Four hundred and two were performed on patients in the EU. We currently have 20 hospitalists providing tier 1 sedation, 12 providing tier 2 sedation, and 5 providing tier 3 sedation. Average hospitalist experience for tier 1 is 1 year, for tier 2 is 5 years, and for tier 3 is 8 years. A pediatric hospitalist sedation team with proper training and oversight can successfully augment sedation services provided by anesthesiologists.

Author Disclosure:

M. Turmelle, none; L. Moscoso, none; K. Hamlin, none; D, Carlson, none.

To cite this abstract:

Turmelle M, Moscoso L, Hamlin K, Daud Y, Carlson D. Development of a Pediatric Hospitalist Sedation Program. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 198. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/development-of-a-pediatric-hospitalist-sedation-program/. Accessed August 24, 2019.

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