Documentation of Procedural Sedation by Emergency Physicians

Abstract

Introduction

Patients presenting to the emergency department (ED) frequently require procedural sedation and analgesia (PSA) to facilitate procedures, such as joint reduction. Proper documentation of screening demonstrates awareness of the necessity of presedation assessment. It is unknown if introducing emergency physicians (EPs) at the ED improves presedation assessment and documentation. In this study the differences in documentation of ED sedation and success rates for reduction of hip dislocations in the presence versus absence of EPs are described.

Methods

In this retrospective descriptive study, we analyzed data of patients presenting with a dislocated hip post total hip arthroplasty (THA) shortly after the introduction of EPs. The primary outcome measure was the presence of documentation of presedation assessment. Secondary outcomes were documentation of medication, vital signs, and success rate of hip reductions.

Results

In the two-year study period, 133 sedations for hip reductions were performed. Sixty-eight sedations were completed by an EP. The documentation of fasting status, airway screening, analgesia use, and vital signs was documented significantly more often when an EP was present (respectively 64.9%, 80.3%, 37.4%, and 72.7%, all P < 0.001). There was no difference in success rate of hip reductions between the groups.

Conclusion

PSA in the ED is associated with superior documentation of presedation assessment, medication, and vital signs when EPs are involved.

Keywords:

• conscious sedation
• emergency department
• sedation
• analgesia

Ethics

This study was reviewed, approved and granted exempt status by the regional Ethical Review Board (METC, Southwest Holland, nr. 17-026). The requirement for participation consent was waived, by the Review Board, as all information was collected as part of routine clinical care and anonymized for the purpose of this observational study. This study conformed to the principles of the Declaration of Helsinki as it only consists of observational data research, without the involvement of any interventions to the patients.

Acknowledgments

The authors thank Crispijn L. van den Brand, Mariske Toonen, and Thomas Vissers for their critical appraisal of early versions of this study, and also Susy and Tod Hubert van Beusekom for their linguistic advice.

Disclosure

The authors report no conflict of interest in this work.