SPS Plenary Session | May 20, 2019, 12:45 pm | Moderator—Amber Rogers, MD
In the “A Tale of Three Cities: Variation in Sedation Service Lines” plenary session, multidisciplinary representatives from three different children’s hospitals compared and contrasted their sedation service structures, typical processes, and approach to a variety of sedated procedures.
Dayton Children’s Hospital intensivists currently sedate mostly for radiological procedures, with anesthesiologists responsible for other sedated procedures. At The Children’s Hospital of Philadelphia, pediatric hospitalists also work mainly in radiology, while at Comer Children’s Hospital, a pediatric sedation physician and intensivists perform a wide variety of radiological and procedural sedation. Training and credentialing processes were fairly similar between the groups for physicians and nurses, with combinations of didactic exams and working with experienced providers to acquire practical skills. All providers greatly appreciated collaborating with child life specialists and praised their helpful expertise within the sedation areas.
Descriptions of the scheduling and patient triage systems demonstrated some individual hospital customization, but the overarching themes were the importance of experienced clinical providers, nurses and physicians, working with schedulers (or scheduling patients themselves) to ensure appropriate patient screening and selection.
All groups used a variety of medication regimens, including propofol, but nitrous oxide and dexmedetomidine were currently restricted from hospitalist use at The Children’s Hospital of Philadelphia. All groups encouraged collaborating with anesthesia and other departments to facilitate the development of the sedation services. When presented with common patient cases, the presenters stated that high dose dexmedetomidine infusions or propofol would be the typical medications used for healthy MRI patient sedations. Somewhat higher risk patients (obese, history of significant snoring) may be deferred to anesthesia colleagues at some institutions but not others depending upon the organization of the sedation services.
In summary, although there are variations in the structures of the services, specialty of the sedation providers, and medications used, all services exhibited robust multidisciplinary collaboration between physicians, nursing, and child life specialists and dedication to caring effectively and safely for all of their patients.