Presented by Lowell Clark, MD
Every organization needs a Lowell Clark. His vast experience and wisdom, not to mention his wonderfully dry sense of humor, provide a unique frame through which his audience can view the big picture of acute care pediatrics. Dr. Clark was charged with providing a 30-min talk on the topic of “Mobile Service vs. Procedural Sedation Unit”. He did touch on that topic, but in addition, we were provided with the history of pediatric procedural sedation through the eyes of one who lived it. Dr. Clark reminded us all of our “raison d’etre”, that being safe yet practical patient care. He began by describing the evolution of his facility in Macon, Georgia, from the dreaded “procedure room” to his “Just for Kids” team, to the current full-service CHOPS unit (Children’s Hospital Outpatient Services). He made the point that the sedation service can offer not just sedation, but a place where all kinds of problems are fixed in a family-friendly manner. He finished a list of about two dozen services that his unit provides with a final item: “(We) Fix stuff: tangible or situational”. I have found that statement to be very true in sedation services with which I have worked—our sedation teams provide much more than sedatives. From the toddler with a newly diagnosed malignancy to the autistic teen for whom basic labs would be impossible to obtain without us, with dozens of procedures in between, we improve care for children.
Dr. Clark then went on to provide a timeline of pediatric sedation, illustrated by his diagram below. He discussed how pediatric sedation came to be, from a foundation of anesthesia safety initiatives in the 1960s, through the growth of pediatric emergency medicine and pediatric critical care in the 1980s, through to the present establishment of the SPS. I’m a firm believer in the tenet that one must understand the past to improve the future, and I thoroughly enjoyed this aspect of the presentation.
Dr. Clark concluded with a brief discussion of the economic factors that come to play in the sedation field, in particular that not every procedure warrants a trip to the OR, and that the flexibility afforded by a sedation unit can drive family satisfaction, which in turn drives business. He didn’t provide a definitive answer as to whether a mobile service is a practical alternative to a sedation unit. However, he did include an interesting thought towards the end of his presentation, that is “a unit must be mobile, but mobility does not create a unit”. Thank you, Lowell, for sharing your wisdom.