Anne Stormorken, MD, Education Chair and President-Elect, interviews Vanessa Olbrecht, MD, MBA, Associate Professor, Associate Director of Research for the Department of Anesthesia, and Director of Quality Improvement and Accreditation at Cincinnati Children’s Hospital Medical Center.
AS: Will you please describe your program?
Our sedation program at Cincinnati Children’s Hospital is a bit unique. We do not have a dedicated sedation service that provides sedation across the organization. Rather, our non-anesthesia sedations are done by providers of multiple specialties in their own units for their own patients. We have approximately 155 providers who are privileged to give procedural sedation and that core privilege is maintained as part of their delineation of privileges through the medical staff office. Non-anesthesia sedations are primarily done in the Pediatric ICU, Cardiac ICU, Dental Clinic, and Emergency Department. We also have a neurologist who provides sedation for patients undergoing MEG scans. All our providers who are privileged for procedural sedation are attending physicians or dentists.
AS: What is your institutional leadership role in providing oversight for sedation provided by non-anesthesiologists?
I am the Director of Quality Improvement and Accreditation for Procedural Sedation at Cincinnati Children’s Hospital. I have been in this role since 2015. I work directly with the Anesthesiologist-in-Chief to oversee procedural sedation at the hospital as well as with each of the directors of sedation in the areas in which procedural sedation is done.
AS: Are there deficits or problems within your program you plan to address?
I am very fortunate to work in an institution that is very forward-thinking and believes in process improvement. When I first took this role in 2015, providers requesting privileging for procedural sedation had to show documentation of 10 sedation cases and had to complete a brief, written quiz about the policies governing procedural sedation at the hospital. Furthermore, they had to document a pre-sedation note as well as a post-sedation note and use a specific order set for each patient’s procedural sedation. As I learned more about the process, I realized that we could make significant improvements to both the clinical practice as well as the privileging process. From a clinical practice perspective, we embarked on a journey with EPIC about two years ago to completely overhaul the documentation process for procedural sedation.
I am excited to say that beginning March 1, we will be using an EPIC Sedation Narrator for documentation of procedural sedation, allowing all providers involved in the process to have ease of documentation and allowing a record of the sedation to be generated to facilitate patient care. From a privileging perspective, beginning July 1, all physicians requesting procedural sedation privileging will undergo a simulation-based skills assessment. All physicians will also complete an online learning module (the SPS Sedation Provider CourseTM) and document successful completion of the course as well as any testing metrics. Upon time of re-privileging over the next two years, all our providers will complete this training.
AS: How will the new SPS Sedation Provider CourseTM Online Learning and Simulation be used in your institution?
The new SPS Sedation Provider CourseTM Online Learning will be the foundation of the online learning that our providers will use. This is an incredibly valuable online learning tool that uses multiple case-based learning scenarios that highlight key aspects of sedation and areas of difficulty that providers may encounter. We are also using the SPS Sedation Provider Simulation scenarios as the foundation for our skills’ assessments. We will be evaluating providers’ skills in recognizing sedation-related adverse events such as apnea or airway obstruction and their response utilizing important skills such as bag-mask ventilation, LMA insertion, or intubation. This will also be a key component of privileging and re-privileging for our providers.
AS: What are your hopes for progress/positive outcomes in a year?
We have had an incredibly busy year! We are hopeful to have a successful roll-out of the EPIC Sedation Narrator on March 1 as well as successful implementation of the new privileging (and re-privileging) process on July 1. As we move forward, we will be able to collect meaningful data that will allow us to refine the process. We also hope to be able to better understand what impact this may have on improving the standards of patient care and safety. Fortunately, complications during procedural sedation are very rare – however, I am sure that we can do even better than how we are doing now!
AS: What metrics will you be using to determine the success of this training?
This is still to-be-determined! Beginning this summer, we would like to begin to collect end-user feedback. From there, we will start to design metrics assessing success of the training. Ideally, I would love to be able to identify a correlation between this new system and improved patient care. As I mentioned, fortunately, complications during sedation are rare. However, we will certainly be looking for ways to assess improvements in patient care. We certainly want to assess provider satisfaction as well as comfort in recognizing and managing problems. We will certainly be open to evolution of this process and hope that we can collaborate with other institutions as others begin to create similar processes.