Retrospective comparison of emergency department length of stay for procedural sedation and analgesia by nurse practitioners and physicians.
OBJECTIVE
To determine if use of nurse practitioners (NPs) for procedural sedation and analgesia (PSA) compared with physicians (MDs) decreased overall length of stay (LOS) in the pediatric emergency department (PED).


METHODS
Retrospective chart review was conducted on all children (age <21 years) undergoing procedural sedation and analgesia (PSA) for 36 consecutive months at a tertiary academic children's hospital (n = 690). Data included times values for triage, evaluation by practitioner (NP, MD), sedation, discharge, and total LOS in the PED. Data collected also included medications given, patient diagnosis, and severe airway complications.


RESULTS
Results revealed statistically significant time-related advantages to NP-managed sedations. Both PED LOS and time to sedation were significantly lower for NPs versus MDs across diagnoses (P < 0.01). The diagnoses managed by MDs versus NPs were significantly different for 3 diagnoses: fracture, finger, and lacerations. There were no differences between NP and MD for severe airway complication rates.


CONCLUSIONS
Overall LOS and time to sedation were significantly improved when NPs independently managed patients requiring PSA without an increase in documented severe airway complication rates.
Wood
Charene
C
Women and Children's Hospital of Buffalo, Buffalo, NY 14222, USA. Charene.wood@utoronto.ca
Hurley
Colleen
C
Wettlaufer
Julie
J
Penque
Michelle
M
Shaha
Steven H
SH
Lillis
Kathleen
K
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000698:Analgesia / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009518:New York; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies