A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland

McCoy, S; Lyttle, Mark D; Hartshorn, Stuart; Larkin, Philip; Brenner, Maria; O’Sullivan, Ronan

doi:10.1136/emermed-2015-205418

Cited by 19 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other countries report similar gaps between adult and paediatric PSA in the ED [ 13 , 14 ]. McCoy et al addressed the challenges of practice and provision of paediatric PSA in the UK and Ireland.…”

Section: Discussionmentioning

confidence: 69%

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

et al. 2017

View full text Add to dashboard Cite

BackgroundSeveral efforts have been made to assure and to improve the quality of procedural sedation and analgesia (PSA) performed by emergency physicians (EPs) in The Netherlands. This study investigated the current PSA practice and competences of EPs in both adult and paediatric patients. In particular, if residency and current training, awareness of guidelines is sufficient for registered EPs to adequately perform PSA and if the availability of both adult and paediatric PSA in the ED is adequate.MethodsA cross-sectional nationwide survey was performed amongst Dutch EPs (n = 463) in June 2016. We collected data on background, training, practice, and competencies of both adult and paediatric PSA. We investigated guideline adherence, reasons for not performing PSA, and desired improvements.ResultsThe respondents (n = 191) represented 84.6% hospitals with EPs and 41.3% of all EPs in The Netherlands. Nearly all EPs (97.8%) performed PSA in adult patients compared to only 59.1% who performed PSA in paediatric patients (p < 0.001). The major reason for not performing paediatric PSA was caused by a lack of exposure during the training-program (74.1%). PSA-guideline knowledge (98.3%) and PSA related adverse event registration (98.3%) were excellent. Lack of 24/7-availability of both adult and paediatric emergency department PSA was mainly caused by a shortage of EPs. Self-reflection indicated that EPs feel less competent in performing paediatric PSA when compared to adult PSA.ConclusionThis nationwide survey demonstrates that there is still a significant gap between the performance of adult and paediatric PSA even though guideline adherence and registration of PSA-related adverse events appear to be adequate. Enhancement of paediatric PSA training in combination with an increase of EP-staffing can help improve the availability of adult and paediatric PSA in the emergency department.Electronic supplementary materialThe online version of this article (10.1186/s12245-017-0159-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 69%

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

et al. 2017

View full text Add to dashboard Cite

show abstract

“…In pediatrics, unlike adult patients, the aim of sedation is to control behavior and facilitate safe completion of the procedure. 7 The analysis of our results suggests that proceduralist given sedation with midazolam and ketamine combination is effective, feasible, and safe in controlled settings. We didn't specifically record sedation scores; however, the combination was titrated to ensure minimal or no patient movement or response during the procedure.…”

Section: Discussionmentioning

confidence: 72%

“…5,6 The aim of sedation is to facilitate the safe and successful performance of the procedure, as well as to minimize complications, and decrease the pain and anxiety associated with the said procedure. 7 Historically, procedural sedation and analgesia in children have been the domain of anesthesiologists; however, there is mounting evidence suggesting that procedural sedation and analgesia can also be safely provided by a nonanaesthesiologist. 8 The most commonly used agent is midazolam alone or in combination with opioid/ketamine/propofol.…”

Section: Introductionmentioning

confidence: 99%

Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy

Bhat

Charoo

Tramboo

et al. 2019

J Pediatr Intensive Care

View full text Add to dashboard Cite

The objective of this research was to study the effectiveness and safety of proceduralist given sedation in pediatric flexible bronchoscopy. Flexible bronchoscopy was performed in all 267 patients. All patients received midazolam and/or ketamine. The median (interquartile range [IQR]) age of the studied population was 16 (18) months. The indication of bronchoscopy varied. The mean ± standard deviation (SD) dose of midazolam was 0.109 (0.03) mg/kg and that of ketamine was 1.17 (0.43) mg/kg. We observed minor side effects of procedural sedation. All patients underwent procedure successfully. Flexible bronchoscopy in children can be safely performed under sedation using a combination of midazolam and ketamine.

show abstract

“…Instead of promptly returning to the comforts of home, the frightened child and his or her anxious parents must endure delays in management, prolongation of pain, unpleasant fasting and an awkward night with little sleep in a noisy hospital room. As stated in McCoy et al 5: “Participants considered the goal of procedural sedation is to provide the best service for families at the point of care by reducing length of stay, requirement for general anaesthetic, and admissions for theatre.” The experience from other countries is clear that procedural sedation can substantially improve service to patients and their families—while dramatically reducing cost. Focusing on the patient and their best interests will prove a useful compass to guide discussions regarding procedural sedation implementation.…”

Section: Focus On the Patientmentioning

confidence: 99%

Procedural sedation and its place in paediatric emergency medicine

Krauss

Green

2016

Emerg Med J

View full text Add to dashboard Cite

A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland

Abstract: A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland.

Cited by 19 publications

References 20 publications

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy

Procedural sedation and its place in paediatric emergency medicine

Contact Info

Product

Resources

About