An interprofessional pediatric procedural sedation service: development, pilot testing, and implementation

To ensure safe, effective, and timely pediatric care, a standardized procedural sedation service was developed and implemented at a tertiary pediatric hospital.

Model development was guided by working group input, literature and policy review, site benchmarking, and an environmental scan. Sedation outcomes were evaluated using the Dartmouth Operative Conditions Scale (DOCS) and the Ramsay Sedation Score (RSS) in two groups of children aged > 1 year: dental outpatients and inpatients undergoing chest tube removal after cardiac surgery. The primary outcome was the proportion achieving optimal sedation (DOCS score - 2 to 2). Pre- and post-implementation outcomes were compared using Fisher's exact and Mann-Whitney U tests.

The new interprofessional sedation model significantly improved sedation outcomes. In dental patients, the proportion with optimal DOCS scores increased from 32% (95% confidence interval, 16-52%) to 94% (79-99%) during local anesthetic injection [difference = 62% (43-81%), OR = 32 (6-163), P < 0.001] and from 18% (6-37%) to 94% (79-99%) at tooth extraction [difference = 76% (59-92%), OR = 69 (12-388), P < 0.001]. For chest tube removal, the proportion with optimal DOCS scores increased from 22% (5-38%) to 100% (92-100%) [difference = 78% (61-95%), OR = 144 (7.5-2793), P < 0.001], with a significant improvement in Ramsay sedation scores [median (10th-90th percentiles)] from 1 (1-2) to 4 (3-4) (P < 0.001).

Implementing a standardized, interprofessional sedation service that aligns with best-practice guidelines improved sedation quality and patient outcomes across pediatric outpatient and inpatient settings.