Commentary: Simple Policy, Entrenched System: Lessons From Post-Sedation Accompaniment

Porter and Houston describe how post-sedation accompaniment requirements, intended to promote patient safety, can restrict access to care and exacerbate inequities. Although examined through the lens of endoscopy, their analysis points to a broader challenge in how safety policies are developed, maintained and revisited within health systems. Rigid accompaniment rules are associated with predictable downstream effects, including cancelled procedures, workarounds such as unsedated procedures and hospital admissions driven to satisfy discharge requirements rather than clinical need. These consequences raise questions about how safety trade-offs are defined and evaluated. The persistence of such policies appears to reflect policy inertia, unclear lines of accountability and limited mechanisms for systematic review or de-implementation. Drawing on the concept of "stupid stuff," front-line friction should be framed as a potential signal of governance misalignment rather than individual non-compliance. Greater attention to policy ownership, routine reassessment and the visibility of access-related harms may help ensure that safety policies remain proportionate, evidence-informed and aligned with person-centred care.