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In 2006 alone, according to AHRQ's Healthcare Cost Utilization Project, over 3 million procedures were performed on hospitalized children. These numbers are staggering but also do not include the additional millions of children who underwent procedures in an outpatient or office setting.
So how are all these procedures being completed? Are children being physically restrained, distracted, sedated or anesthetized? We in the sedation community, I would imagine from our experiences, recognize that most children will not simply lie still for painful or non-painful diagnostic tests or procedures. The majority of children require one of these four options in order to complete a procedure or test. So what care are all these children receiving? What factors impact this decision and ultimate delivery of care? When we are consulted to sedate a child for a procedure, do we deliver care of the highest quality?
I think we all feel we are delivering quality sedation care? However, do we really know what quality sedation is? Do we know the factors that make up quality? Do we really address all of these factors in the care we deliver? Also, how do we define, measure and compare quality related to pediatric sedation?
These questions led to the SPS applying for and receiving grants from AHRQ and The Mayday Fund help answer these questions. With this grant funding, The Society for Pediatric Sedation Consensus Meeting: Defining Quality in Pediatric Sedation was held in Baltimore from November 13-15, 2012. The conference goals included:
We explored each of these 6 aims of quality with a multi-professional group of clinical experts which included representation from pediatric anesthesia, child life, pediatric critical care, dentistry, emergency medicine, oncology, oral/maxillofacial surgery, hospital medicine, pediatrics, psychology, quality and safety, radiology and sedation providers. This group of forty four was made up of nurses, mid-level practitioners, physicians, dentists, and a clinical psychologist.
We spent 48 hours exploring each of these areas in depth. The discussion was collaborative, patient centered and broad. We learned about quality, quality metrics and followed with great debate of how quality applies to sedation. Over the coming months, we will document and disseminate the findings from this consensus meeting. We will highlight some key questions raised in future newsletter as well. In the meantime, I would challenge you to consider your views related to each of these areas, and challenge your own practice. Are you delivering quality sedation? How do you define quality? Are you collaborating with your medical peers and families to improve this quality?
Mick Connors, MD
Past President - Society for Pediatric Sedation®
References from Consensus Meeting: