Using Quality Improvement Methodology to Inform Safe Implementation of Propofol Procedural Sedation in a Pediatric...

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Pharmacology

Background:

• Procedural sedation in pediatric emergency departments (EDs) is common.
• Optimizing sedation practices is crucial for patient flow and safety.
• Propofol offers potential benefits but requires careful implementation.

Purpose of the Study:

• To implement propofol for pediatric procedural sedation across a multisite ED system using quality improvement (QI) methods.
• To evaluate the impact of propofol on sedation duration, length of stay (LOS), and serious adverse events (SAEs).

Main Methods:

• A QI initiative employed the Define-Measure-Analyze-Improve-Control (DMAIC) framework across 4 pediatric EDs.
• A standardized propofol sedation protocol was developed and implemented for short procedures in low-risk patients.
• Interventions included protocol development, multidisciplinary education, simulation, and EMR order set modifications.

Main Results:

• Propofol sedation was significantly shorter than ketamine sedation (18-24 min vs. 33-52 min; P < 0.001).
• ED LOS was shorter for propofol sedations at primary and secondary sites.
• Serious adverse event (SAE) rates remained low and stable (2.6% for propofol-associated SAEs).

Conclusions:

• QI methodology facilitated the safe and feasible implementation of propofol in a multisite pediatric ED system.
• Propofol use, within a defined scope, shortened sedation length and LOS for selected pediatric patients.
• This study provides a reproducible framework for implementing propofol sedation in similar settings.