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Objectives Patient centeredness is an essential component of high‐quality care, yet little is known regarding the patient experience during procedures performed in the cardiac catheterization lab. Background Available literature focuses on the safe delivery of sedation, but does not address patient‐reported satisfaction or comfort. Further delineation of how procedural factors impact the patient experience is needed. Methods We conducted a retrospective, exploratory analysis of adult cardiac catheterization outpatients (n = 375) receiving physician ordered, nurse administered procedural sedation (benzodiazepine and/or opioids) between April and June, 2017. Data were abstracted from the procedural database, Electronic Health Record, and Press Ganey© surveys. Results The mean age was 63 (SD 12.2), a majority were male (n = 226; 60%), white (n = 271; 73%), and overweight (mean body mass index = 29, SD 6.8). Patient‐reported satisfaction with pain control and perceived staff concern for comfort were >75th percentile (Press Ganey© survey), with no difference in preprocedure and postprocedure pain scores (p = .596). Intraprocedural medication dose range and mean frequency were highly variable: midazolam (0.25–5.5 mg; 1.48); fentanyl (12.5–200 mcg; 1.63); and hydromorphone (0.5–2.5 mg; 1.33). Median time interval between administration of initial sedation and local anesthetic was 6 min. Patients with longer intervals had less frequent dosing (p < .001) and less total procedural sedation (p < .001). Sensitivity analysis revealed that trainee/fellow involvement (p = .001), younger age (p = .002), and shorter time intervals (p < .001) were associated with increased frequency and larger total dose. Conclusions Waiting to gain vascular access following administration of procedural was associated with less frequent subsequent dosing, lower overall administration, and similar patient satisfaction. Optimizing processes for administering periprocedural sedation may allow for less medication without impacting patient experience.

Background Invasive cardiac catheterization (CC) temporarily increases pain, discomfort, and anxiety. Procedural sedation is deployed to mitigate these symptoms, though practice varies. Research evaluating peri‐procedural patient‐reported outcomes is lacking. Methods and Results We randomized 175 patients undergoing CC to short interval ([SI] group, <6 min) or long interval ([LI] group, ≥6 min) time intervals between initial intravenous sedation and local anesthetic administration. Outcomes included: (1) total pain medication use, (2) patient‐reported and behaviorally assessed pain and (3) patient satisfaction during outpatient CC. Generalized linear mixed effect models were used to evaluate the impact of treatment time interval on total medication utilization, pain, and satisfaction. Among enrollees the mean age was 62 (standard deviation [SD] = 13.4), a majority were male (66%), white (74%), and overweight (mean body mass index = 28.5 [SD = 5.6]). Total pain medication use did not vary between treatment groups (p = 0.257), with no difference in total fentanyl (p = 0.288) or midazolam (p = 0.292). Post‐treatment pain levels and nurse‐observed pain were not statistically significant between groups (p = 0.324 & p = 0.656, respectively. No significant differences with satisfaction with sedation were found between the groups (p = 0.95) Patient‐reported pain, satisfaction and nurse‐observed measures of pain did not differ, after adjustment for demographic and procedural factors. Analyses of treatment effect modification revealed that postprocedure self‐reported pain levels varied systematically between individuals undergoing percutaneous coronary intervention (PCI) (SI = 2.2 [0.8, 3.6] vs. LI = 0.7 [−0.6, 2.0]) compared with participants not undergoing PCI (SI = 0.4 [−0.8, 1.7] vs. LI = 0.7 [−0.3, 1.6]) (p = 0.043 for interaction). Conclusion No consistent treatment differences were found for total medication dose, pain, or satisfaction regardless of timing between sedation and local anesthetic. Treatment moderations were seen for patients undergoing PCI. Further investigation of how procedural and individual factors impact the patient experience during CC is needed.

Background: Patient centeredness is an essential component of high-quality care, yet little is published regarding the patient experience during procedures performed in the cardiac catheterization lab. Available literature focuses on the safe delivery of sedation, but does not address patient-reported satisfaction, comfort, or procedural experience. Further delineation of how procedural factors impact the patient experience is needed. Methods and Results: We conducted a retrospective, exploratory analysis of adult cardiac catheterization outpatients receiving nurse-administered, physician-prescribed procedural sedation (benzodiazepine and/or opioids) between April-June, 2017. Data were abstracted from the procedural database, EHR and Press Ganey© surveys. Patients (n=375) had a mean age of 63, were male 60% (226/375), White 73% (271/375), and overweight / obese (mean BMI = 29). Procedural sedation was given in 93% (348/375) of cases. Press Ganey© results showed good satisfaction with pain control (>75 th percentile) and staff concern for comfort in all patients. There was no significant difference in pre- and post-procedural patient reported pain scores. The median patient received 1.63 doses of midazolam with either 1.48 doses of fentanyl or 1.33 doses of hydromorphone. Median time interval between administration of initial sedative dose and local anesthetic was 6.2 minutes. Patients with longer intervals had less frequent dosing (p<0.001) and less total procedural sedation (p<0.001). Adjusting for demographic and procedural characteristics, trainee involvement (p=0.001), older age (p=0.002) and longer time intervals (p=<0.001) between dosing and local anesthetic were associated with decreased frequency and total dose. Conclusions: Extended duration of sedation intervals was associated with lower overall sedation administration with similar patient satisfaction. Optimizing processes for administering peri-procedural sedation may allow for less total medication without impacting patient experience.