Development of a pediatric hospitalist sedation service: Training and implementation

Abstract

OBJECTIVE:There is growing demand for safe and effective procedural sedation in pediatric facilities nationally. Currently, these needs are being met by a variety of providers and sedation techniques, including anesthesiologists, pediatric intensivists, emergency medicine physicians, and pediatric hospitalists. There is currently no consensus regarding the training required by non‐anesthesiologists to provide safe sedation. We will outline the training method developed at St. Louis Children's Hospital.METHODS:In 2003, the Division of Pediatric Anesthesia at St. Louis Children's Hospital approached the Division of Pediatric Hospitalist Medicine as a resource to provide pediatric sedation outside of the operating room. Over the last seven years, Pediatric Hospitalist Sedation services have evolved into a three‐tiered system of sedation providers. The first tier provides sedation services in the emergency unit (EU) and the Center for After Hours Referral for Emergency Services (CARES). The second tier provides sedation throughout the hospital including the EU, CARES, inpatient units, Ambulatory Procedure Center (APC), and Pediatric Acute Wound Service (PAWS); it also provides night/weekend sedation call for urgent needs. The third tier provides sedation in all of the second‐tier locations, as well as utilizing propofol in the APC.RESULTS:This training program has resulted in a successful pediatric hospitalist sedation service. Based on fiscal year 2009 billing data, the division performed 2,471 sedations. We currently have 43 hospitalists providing Tier‐One sedation, 18 Tier‐Two providers, and six Tier‐Three providers.CONCLUSIONS:A pediatric hospitalist sedation service with proper training and oversight can successfully augment sedation provided by anesthesiologists. Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine

Procedural Sedation by Pediatric Hospitalists: Analysis of the Nature and Incidence of Complications During Ketamine and Nitrous Oxide Sedation

“…A tiered system of sedation providers exists, ranging from PH who provide sedation only in the ED (tier 1) to providers who are trained to use propofol in the APC (tier 3). 8 The sedation service follows safety standards established by the American Academy of Pediatrics and the Ameri can Society of Anesthesiologists, as well as institutional standards. [9][10][11] Adverse events during sedation are tracked by using a quality improvement (QI) sedation database in which all sedation-related adverse events are manually entered.…”

Current Roles and Perceived Needs of Pediatric Hospital Medicine Fellowship Graduates

“…Fellowship programs should expand training in these clinical and administrative areas, particularly as the field of PHM matures. [13][14][15] In research, the need for training in more advanced research topics did not differ by duration of training. Considering graduates of $2-year programs may have received more comprehensive research training, this may highlight the study limitation that these are only perceived training needs.…”

Complex pediatric wound care with a dedicated pediatric wound care service: a review of our 12-year experience

“…1 Our procedural sedation program utilizes pediatric hospitalists instead of pediatric anesthesiologist to administer inhaled or intravenous sedation within our unit. 18 A pediatric hospitalist is a growing pediatric model that has been defined "as a physician whose primary focus is the general medical care of hospitalized patients". The American Academy of Pediatrics developed guidance for hospitals with regard to having a pediatric hospitalist service.…”