Presented by Trish Scherrer, MD
In what appeared to be a channeling of Dr. Anne Stormorken, who was unfortunately unable to attend the SPS conference, Dr. Trish Scherrer seamlessly presented a discussion of the benefits of aligning sedation and anesthesia services. Viewing the sedation/anesthesia processes from the perspective of the IOM Six Domains of Healthcare Quality, Trish discussed the key components of a quality integrated sedation/anesthesia system and some suggested metrics for tracking & quality improvement. Some highlights include:
- Safety: The importance of prescreening for adverse event prevention, optimally using a validated tool (in development).
- Efficacy: Procedural sedation efficacy is judged by much more than just completion of the procedure; using a sedation state scale can help to guide care processes to minimize adverse psychological impacts and optimize the procedural environment.
- Patient & Family-Centered: Patients and families are truly part of the care team, and the sedation/anesthesia system should assist in care coordination between the different services to provide appropriate patient preparation and family participation. The Iowa Satisfaction with Anesthesia or PAPS assessments can assist with evaluating these systems.
- Timeliness: Unifying care between the sedation and anesthesia services can dramatically improve the timeliness of procedural sedation via appropriate patient triage systems and optimization of staffing between the services to avoid care delays.
- Efficiency: Linking sedation and anesthesia services improves the system responsiveness to patient needs and helps to balance the demand and team availability at the right times. Efficiency can be measured by the equation: Team Efficiency = # sedation hours / FTE sedation team.
- Equitable: All types of patients in all areas of the hospital system should have access to the same high-quality care, although evaluating for care disparities is often not straightforward. Contributing to patient outcome databases like the PSRC and PHIS can assist programs in this process.
The “Great Expectations—Defining Quality in Pediatric Sedation: Outcomes of a Multidisciplinary Consensus Conference” paper by several SPS leaders suggests sedation outcome measures for reference (J Healthc Qual. 2015 Mar-Apr;37(2):139-54). Aligned sedation and anesthesia services can work towards optimizing quality care, as shown by these tracked outcome measures, via shared schedulers, administrative support, and care tracking systems. This care coordination can facilitate appropriate scheduling and successful, quality completion of even complicated procedural sedation care needs.