Review of the Mature Sedation Service: Keys to success
Reviewed by Lia Lowrie, MD
Dr. Kopec is a pediatric intensivist who established a very successful pediatric sedation service at what is now the Helen DeVos Children’s Hospital in Grand Rapids, Michigan approximately 25 years ago. He and his sedation service providers sedated approximately 6000 cases a year and have been diligently reporting their results in the PSRC for years.
His presentation of their service started with a review of their history as starting as a small travelling sedation service that gradually developed a home in initially a PICU procedure room, then a three bed sedation unit, then a seven bed unit until 2011 when they moved to a brand new children’s hospital that included a planned 15 bed sedation unit attached to both an endoscopy suite and Radiology.
The Sedation Team includes Intensivists and a Hospitalist and an Anesthesiologist, Child Life, dedicated nursing support and the Unit functions very much like any other Service Unit in the hospital administratively. They provide sedation services to all areas and service lines in the children’s hospital except the ER, dental services and the Cardiac Cath Laboratory. They are open some weekend hours and weekday late afternoon and evening hours.
Dr. Kopec made several points to which he attributes the success and growth of the Service. I have listed below some of these points and would refer the reader to Dr. Kopec’s excellent presentation for more details.
- Early on, enlist support from the Subspecialists and cater to their patient and clinical service needs. He particularly mentioned the Hematology/Oncologists and Gastroenterologists as keys users of non-operating room based services.
- Enlist support of the hospital leaders, who were able to “use” access to the subspecialists enabled by sedation services as a marketing draw.
- Dr. Kopec was fortunate in having no limitations on drug use by intensivists in the state of Michigan and this didn’t limit ability to grow the service.
- The Sedation Unit model has allowed great nursing staff development that has added to great retention of a very skilled sedation nursing and child life team.
- The Sedation Unit model has allowed extraordinary efficiency particularly in preprocedure and recovery phase use of nursing and child life support.
- The Sedation Unit model has also allowed for planned response and growth to development in the hospital for new procedures – IR in particular. They are considering potential for moving some urologic and ENT procedures out of the traditional OR.
- This planning is enhanced by the philosophy that we should not be competing within our own institutions with what might be a siloed separate Anesthesiology service line. The shared service model with Anesthesiology support for complex patients as well as Anesthesiologists who routinely cover the Sedation Service using Sedation Service procedures and policies has engendered trust, learning and a sense of shared mission rather than feelings of competition or “poaching.”
- The Sedation Unit model has proven cost effective for the Institution, but it is not necessarily budget neutral if considered as a single cost center itself. The benefit of improved access to radiology and subspecialists is important in accounting for value.