In recent years, clinicians have been dedicating more time and effort to developing quality programs that will assure safe and effective practice. The Society for Pediatric Sedation adopted the six principles of the Institute of Medicine conceptual framework for categorizing health care quality and disparities measurement: Effectiveness, Safety, Timeliness, Patient/Family Centeredness, Equitability, and Efficiency. For a pediatric sedation program to improve on all those areas, it is important to have accurate data regarding the operations of the sedation service.
Databases are one of the most important tools for identifying opportunities for quality improvement projects, monitoring the effect of change, and disseminating the results of effective strategies to others in the field through scientific publications or national conference presentations. The creation of such databases can be time consuming, and maintaining accurate data entry should be structured in a way that guarantees sustainability and minimizes variations between data recorders.
Elements of the database
Any database should be structured to the specific need of the institution, although some general themes can be implemented in most pediatric sedation databases:
- Patient information: patient information can include demographics (e.g. age, weight, race, BMI), allergies, past medical history, contact information, and other relevant information. This will help in understanding the demographics of the population served and in identifying any health disparities in the practice.
- Sedation scheduling information: information regarding the date of sedation request received, when the procedure was scheduled, and any reason for cancelation or change of schedule. This will have a significant impact on the efficiency of the service by identifying scheduling issues and other important measures (e.g. no-show rate, cancelation rate, third available appointment date). This also can be customized to each area of operations or to specific procedures.
- Pre-sedation information: ASA classification, goal of sedation, arrival time, information related to the procedure (e.g. what is the procedure?, did the sedation occur?, and did the procedure occur?), information related to cancelation prior to sedation (e.g. reason for cancelation, alternative provided to the patient, and reschedule information), and the location where the procedure is performed.
- Sedation Information: who performed the sedation, medication used, doses of medication and route of administration, sedation start and sedation end time.
- Post-sedation information: any complications, was the procedure completed?, discharge time, and other relevant information.
How to Collect the Data
Collecting the data will depend on two main factors:
- Availability of resources: the created database tool may have different forms. Some databases are based on paper forms that are later collected and entered into a main database; some databases are created by using automatic reports generated by the electronic medical record (EMR); and others are developed using real time data collection by providers using electronic forms or mobile phone applications. The availability of resources will dictate the nature of the tool, and this should be considered in the design phase.
- Time of collection: real time collection of data is ideal. The longer it takes to record the information, the less reliable the data would be. Utilizing mobile phone applications for real time data entry may be an effective way to achieve this goal. Although detailed and comprehensive databases are usually our goal, it is also important to consider the time commitment needed for the data entry and the sustainability of it without significantly adding to the workload of the sedation team.
How to Use the Data
The data can be used in many ways depending on the program’s needs, and that should be determined during the design of the tool. The usage of the data can be categorized in the following ways:
- Operation improvement: a proper utilization of our ever-diminishing resources can be achieved by carefully studying some data elements. For example, the data can be used to evaluate cancelation rate, no show rates, delayed starts, and appointment availability trends.
- Procedure focused projects: using the data to identify opportunities for improving particular procedures or services. In some cases, a higher rate of complications can be identified with specific procedures, providers, or areas of operations. Targeted projects can be implemented, and the results can be evaluated through the continuous collection and evaluation of data.
- Business case studies: this is a vital resource for managers and directors of sedation services when arguing the need for additional resources. The healthcare system in the United States is becoming more conscious of value to the system and the patient. Developing business case studies that cite high quality data would help in presenting the needs of the sedation program.
For those reasons, development of high-quality databases should be considered for all pediatric sedation programs. In addition to the program’s own database, participating in national databases is considered a worthy investment as it allows for comparing the quality of care to other sedation programs and developing national benchmarking for pediatric sedation.