Utility of Procedural Sedation as a Marker for Quality Assurance in Emergency Medicine
| Autor: | Shamai A. Grossman, Richard E. Wolfe, Jonathan L. Burstein, Jonathan A. Edlow, Elizabeth M. Foley |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Midazolam Sedation 030106 microbiology Conscious Sedation Near Miss Healthcare Endoscopy Gastrointestinal Cohort Studies 03 medical and health sciences 0302 clinical medicine Etomidate Health care medicine Humans Hypnotics and Sedatives Prospective Studies Adverse effect Propofol Quality Indicators Health Care Medical Errors business.industry 030208 emergency & critical care medicine Emergency department medicine.disease Fentanyl Emergency medicine Emergency Medicine Ketamine Medical emergency medicine.symptom Emergency Service Hospital business Health care quality medicine.drug |
| Zdroj: | The Journal of Emergency Medicine. 50:711-714 |
| ISSN: | 0736-4679 |
| DOI: | 10.1016/j.jemermed.2016.02.007 |
| Popis: | Background The Joint Commission requires health care organizations to monitor and evaluate procedural sedation. However, the utility of mandatory review of procedural sedation in evaluating health care quality is unknown. Objective To determine whether procedural sedation is a useful marker for evaluating error in the emergency department (ED). Methods We prospectively collected data for patients presenting to an urban, tertiary care, academic medical center ED between October 2013 and June 2015. We used an automated, electronic tracking system to identify patients who underwent procedural sedation. We randomly assigned cases to physician reviewers. Reviewers used a structured tool to determine the presence of error and adverse events. If a reviewer felt that the case had an error or adverse event, it was referred to a quality assurance (QA) committee, which made a final determination as to whether or not an error or adverse event occurred. Results There were 166 cases of procedural sedation reviewed. Two errors were identified, for an error rate of 1.2% (95% confidence interval [CI] 0.003–0.043). Both errors occurred during the use of propofol to facilitate upper gastrointestinal endoscopy. Neither error resulted in an adverse event. One adverse event was identified that was unrelated to physician error (0.6%; 95% CI 0.001–0.033). Conclusion Routine review of procedural sedation performed in the ED offers little advantage over existing QA markers. Directed review of high-risk cases, such as those involving endoscopy or other longer-duration procedures, may be more useful. Future studies focusing quality review on projected high-risk sedation cases may establish more valuable markers for QA review. |
| Databáze: | OpenAIRE |
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