title: Development of a pediatric hospitalist sedation service: training and implementation.
abstract: OBJECTIVE
  There is growing demand for safe and effective procedural sedation in pediatric facilities nationally. Currently, these needs are being met by a variety of providers and sedation techniques, including anesthesiologists, pediatric intensivists, emergency medicine physicians, and pediatric hospitalists. There is currently no consensus regarding the training required by non-anesthesiologists to provide safe sedation. We will outline the training method developed at St. Louis Children's Hospital.
  
  
  METHODS
  In 2003, the Division of Pediatric Anesthesia at St. Louis Children's Hospital approached the Division of Pediatric Hospitalist Medicine as a resource to provide pediatric sedation outside of the operating room. Over the last seven years, Pediatric Hospitalist Sedation services have evolved into a three-tiered system of sedation providers. The first tier provides sedation services in the emergency unit (EU) and the Center for After Hours Referral for Emergency Services (CARES). The second tier provides sedation throughout the hospital including the EU, CARES, inpatient units, Ambulatory Procedure Center (APC), and Pediatric Acute Wound Service (PAWS); it also provides night/weekend sedation call for urgent needs. The third tier provides sedation in all of the second-tier locations, as well as utilizing propofol in the APC.
  
  
  RESULTS
  This training program has resulted in a successful pediatric hospitalist sedation service. Based on fiscal year 2009 billing data, the division performed 2,471 sedations. We currently have 43 hospitalists providing Tier-One sedation, 18 Tier-Two providers, and six Tier-Three providers.
  
  
  CONCLUSIONS
  A pediatric hospitalist sedation service with proper training and oversight can successfully augment sedation provided by anesthesiologists.
authors: Department of Pediatrics/Division of Hospitalist Medicine, Washington University/St Louis Children's Hospital, St Louis, Missouri 63110, USA. turmelle_m@kids.wustl.edu
authors: Michael
authors: M
authors: Turmelle
authors: Lisa M
authors: LM
authors: Moscoso
authors: Kim P
authors: KP
authors: Hamlin
authors: Yasmeen N
authors: YN
authors: Daud
authors: Douglas W
authors: DW
authors: Carlson
mesh_terms: D000776:Anesthesiology / Q000193:education* / Q000379:methods / Q000639:trends; D004636:Emergency Service, Hospital / Q000639:trends; D020445:Hospitalists / Q000193:education* / Q000379:methods / Q000639:trends; D006776:Hospitals, Pediatric / Q000639:trends; D006801:Humans; D010372:Pediatrics / Q000193:education* / Q000379:methods / Q000639:trends; D016730:Program Development / Q000379:methods