How can the practice and documentation of procedural sedation pre-assessment be improved in a high-volume tertiary care emergency department?

Abstract

Background: Procedural sedation (PS) is commonly used in the Emergency Department (ED) to lessen pain, apprehension, and agony for patients during medical procedures. PS encompasses administering of sedative medications with or without the simultaneous delivery of analgesic agents. Safe and effective PS in the ED is a skill that is fundamental to practice of Emergency Medicine. Patients undergoing PS in ED should have a documented evidence of pre-sedation assessment, including prediction of difficulty in airway management, ASA physical status and fasting status. Aim: The aim of this audit, as a part of a QIP, was to assess the current practice and documentation of PS pre-reassessment among the ED physicians. Methods and settings: This was an electronic questionnaire survey sent to all ED physicians via their work e-mails. Sixty-seven emergency physicians took part in the survey; however, only 62 completed it. This is a high-volume ED in a large tertiary care hospital where up to 1,600 patients are seen daily and PS is practiced frequently. Results: Sixty-two ED physicians completed the electronic survey. Only 33.33% (n = 21) stated that they document PS pre-assessment as a usual practice. Among the participants, 69.35% (n = 43) stated the lack of time as the commonest reason for not documenting the PS pre-assessment. And 79.03% (n = 49) admitted that availability of a PS pre-assessment form would improve practice and documentation. Conclusion and recommendation: Only one-third of the physicians documented PS pre-assessment as a usual practice. The majority of the physicians indicated lack of time as the reason for not documenting the PS pre-assessment. There is a need for a simple assessment form with a checklist and regular training for all ED physicians in PS pre-assessment to practice safely and effectively.