Abstract
Objective
Sedation is commonly required for painful procedures in the emergency department (ED).
Some facilities mandate two physicians be present for deep sedation cases. Evidence
is lacking, however, that a two-physician approach improves safety outcomes. We report
our experience on the feasibility of replacing a two-physician ED procedural sedation
policy with a single-physician policy in a small, single-coverage community ED.
Methods
This is a retrospective, before/after, single-center observational study of prospectively
collected data from January 2013 through December 2016. In September 2014, our medical
center implemented a single-physician policy requiring only one emergency physician,
accompanied by a sedation-trained ED registered nurse. The primary outcome was a sedation-related
escalation of care that resulted in one of the following adverse events or interventions:
dysrhythmia (symptomatic bradycardia or ventricular arrhythmias), cardiac arrest,
endotracheal intubation, or unanticipated hospitalization. Secondary outcomes included
hypoxemia (peripheral oxygen saturation less than 90% for greater than 1 min), the use of bag-valve mask ventilation (BVM), use of a reversal agent, laryngospasm
or pulmonary aspiration.
Results
We performed 381 sedations during the study period: 135 patients in the two-physician
group (before) and 246 patients in the single-physician group (after). The two groups
were comparable in age and gender. There was no occurrence of the primary outcome.
Secondary outcomes were uncommon, and were similar in the two groups.
Conclusions
In this small, single-coverage community ED, replacement of a two-physician policy
with a single-physician policy for deep sedation in the ED was feasible and was not
associated with an increase in adverse events.
Keywords
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Article Info
Publication History
Published online: November 03, 2017
Accepted:
November 2,
2017
Received:
October 24,
2017
Footnotes
☆Prior presentations: An abstract of this study was presented at the American College of Emergency Physicians Research Forum, Washington, DC, October, 2017.
☆☆Funding sources/disclosures: None.
★CPJ reports no conflict of interest.
★★DRV reports no conflict of interest.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
