A proactive approach to ED information technology: the case of pediatric procedural sedation

Samuel, Nir; Shavit, Itai; Steiner, Ivan P.; Kimia, Amir A.

doi:10.1016/j.ajem.2016.06.102

Cited by 4 publications

(7 citation statements)

References 9 publications

(11 reference statements)

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“…15 Each sedation is recorded in real time by the nurse responsible for the sedation into a structured computerized form, called sedation recording tool (SRT). 16 The SRT was developed by the information technology department to collect real-time procedural sedation data in pediatric emergency medicine and integrate it directly into the hospital's electronic medical record system, Prometheus. Adverse events are recorded and classified based on the Quebec guidelines for sedation provided to children in the emergency setting.…”

Section: Data Collectionmentioning

confidence: 99%

“…Intervention in response to an adverse event is recorded in the SRT in detail, including bag-mask ventilation, airway repositioning, and airway suctioning. 16 Additional information collected include demographic data, fasting time, American Society of Anesthesiologists (ASA) score, known chronic disease, past medical and surgical procedures, known allergies, and dosages of sedative agents used. 17 The following disease characteristics were extracted as well: onset of symptoms, triage acuity score, length of total hospitalization, amount of pleural fluid drained after pigtail catheter insertion, amount of pleural fluid drained until removal of pigtail catheter, and duration of antibiotic treatment.…”

Section: Data Collectionmentioning

confidence: 99%

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Emergency Physician–Administered Sedation for Thoracostomy in Children With Pleuropneumonia

et al. 2020

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Background: Thoracostomy drainage is sometimes required in children with pleuropneumonia who have large parapneumonic effusion. This procedure is usually performed under sedation. The aim was to report sedation adverse events (SAEs) in pneumonia patients sedated for thoracostomy by pediatric emergency physicians.Methods: A retrospective cohort study was conducted. The medical records of all emergency department patients who underwent thoracostomy between January 1, 2012, and December 31, 2018, were extracted. Study outcomes were SAEs that required intervention.Results: Pigtail catheters were placed by chest surgeons in 28 children with a median age of 2 years (interquartile range [IQR], 1-5 years). All the thoracostomies were successfully performed under sedation performed by 11 pediatric emergency physicians. The median amount of fluid drained after catheter insertion was 200 mL (IQR, 100-500 mL). The median pleural fluid PH was 7.0 (IQR, 6.9-7.3), and the median white blood cell count was 34,600 per mm 3 (IQR, 11,800-109,000 per mm 3 ). Thirteen patients (46.4%) were sedated with a total median dose of 3 mg/kg of ketamine (IQR, 2-4 mg/kg) and 0.2 mg/kg of midazolam (IQR, 0.2-0.3 mg/kg); 11 patients (39.3%) were treated with 1 mg/kg of ketamine (IQR, 0.5-2 mg/kg) and 3 mg/kg of propofol (IQR, 2-4 mg/kg). Four patients (14.3%) were treated exclusively with 4 mg/kg of ketamine (IQR, 3-5 mg/kg). Nine oxygen desaturations required intervention; 1 was associated with laryngospasm and 1 with apnea. All the SAEs were successfully managed. No cases of hypotension, bradycardia, airway obstruction, or pulmonary aspiration were recorded. Conclusions:The first series of pneumonia patients sedated for thoracostomy by pediatric emergency physicians is reported. Sedation was safely performed in this cohort.

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Section: Data Collectionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Emergency Physician–Administered Sedation for Thoracostomy in Children With Pleuropneumonia

et al. 2020

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“…The sedation section in the Prometheus includes procedure begin time, procedure end time, vital signs, medication administration, medication dose, and any SAE related to the sedation. 14 Recording of SAE is based on standardized definitions from the Quebec guidelines, a consensus-based document developed by North American experts in ED pediatric procedural sedation, to report sedation data and adverse events requiring intervention. 15 Based on Prometheus, the Information Technology department of the hospital developed a business intelligence information system (BIINS) that provides reporting and analytical functions across multiple datasets.…”

Section: Data Collection and Selection Of Participantsmentioning

confidence: 99%

<p>Serious Adverse Events in Pediatric Procedural Sedation Before and After the Implementation of a Pre-Sedation Checklist</p>

Librov¹,

Shavit²

2020

JPR

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Objective: Procedural sedation is considered by the Joint Commission on Accreditation of Healthcare Organizations as a high-risk procedure when performed in the emergency department (ED). A pre-sedation checklist is a set of items checked before any sedation. We evaluated the impact of a pre-sedation checklist on the rate of serious adverse events (SAE) in a pediatric ED. Methods: We conducted a retrospective study comparing the rate of SAE in children treated with the combination of ketamine and propofol before and after the implementation of a presedation checklist. The before-and-after periods lasted from 1.1.2013 to 30.6.2016 and from 1.7.2016 to 30.6.2019, respectively. Patient data were extracted from the electronic medical records using an integrated business intelligence information system. Results: The before-and-after cohorts included 1349 and 1846 patients, respectively. The two groups were similar with regard to age, sex, length and type of procedure, medications dosage, and level of physicians' training. A total of 183/1349 (13.5%) and 420/1846 (22.7%) SAE were recorded during the before-checklist and after-checklist periods, respectively (p<0.0001). The rates of laryngospasm, apnea, and oxygen saturation ≤90% at the beforeand-after checklist periods were 9/1349 (0.6%) and 30/1846 (1.6%); p<0.05, 48/1349 (3.5%) and 77/1846 (4.2%); p=0.37, and 123/1349 (9.1%) and 312/1846 (16.9%); p< 0.0001, respectively. All the SAE were successfully managed by the emergency physicians and no patient required hospitalization due to a SAE. Conclusion: In this large cohort of ED children who underwent deep sedation, the administration of a pre-sedation checklist was not associated with a reduction in SAE rate.

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“…7 Each sedation procedure is recorded in real time by the nurse responsible for the sedation into a structured computerized form, called the sedation recording tool (SRT). 11 The SRT was developed by the Information Technology Department to collect real-time procedural sedation data and to integrate it directly into the hospital's electronic medical record system, Prometheus. Adverse events are recorded and classified based on the Quebec guidelines for sedation provided to children in the emergency setting.…”

mentioning

confidence: 99%

“…Intervention in response to an adverse event is recorded in the SRT in detail, including bag-mask ventilation, airway repositioning and airway suctioning. 11 Only intraoral injuries were included in the study.…”

mentioning

confidence: 99%

Adverse events during sedation for oro‐dental trauma in an Israeli paediatric emergency department

Bilder

Librov

Gutmacher

et al. 2021

Dental Traumatology

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practice, 1,2 but there is a paucity of data regarding the safety of sedation for the emergency treatment of oro-dental trauma in paediatric ED. [3][4][5] A previous study reported the safety of intramuscular ketamine administered by trained ED physicians. 3 The combination of intravenous ketamine and propofol (KP) has gained popularity in recent years because the drugs are thought to complement one another. 6,7 The antiemetic and hypnotic properties of propofol can mitigate the vomiting and emergent reactions induced by ketamine, while the sympathomimetic effect of ketamine can mitigate the hypotension induced by propofol. 6 In the paediatric ED of Rambam Health Care Campus (RHCC) in Haifa, Israel, one of two ketaminebased regimens is used to treat young injured children: sedation with intramuscular ketamine alone or sedation with intravenous KP. The choice of the type of sedation is at the physician's discretion. The aim of this study was to assess the safety of KP sedation in children undergoing oro-dental injuries in a paediatric ED.

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A proactive approach to ED information technology: the case of pediatric procedural sedation

Cited by 4 publications

References 9 publications

Emergency Physician–Administered Sedation for Thoracostomy in Children With Pleuropneumonia

Emergency Physician–Administered Sedation for Thoracostomy in Children With Pleuropneumonia

<p>Serious Adverse Events in Pediatric Procedural Sedation Before and After the Implementation of a Pre-Sedation Checklist</p>

Adverse events during sedation for oro‐dental trauma in an Israeli paediatric emergency department

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