title: A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland.
abstract: BACKGROUND
  There is extensive literature on paediatric procedural sedation (PPS) and its clinical applications in emergency departments (EDs). While numerous guidance and policy documents exist from international bodies, there remains a lack of uniformity and consistency of PPS practices within EDs. PPS is now gaining traction in the UK and Ireland and this study aimed to describe existing PPS practices and identify any challenges to training and provision of ED-based PPS.
  
  
  METHODS
  A qualitative approach was employed to capture data through a focus group interview. Nine consultants in emergency medicine (EM) participated, varying in years of experience, clinical settings (mixed adult and paediatric ED or paediatric only) and geographical location (UK and Ireland). The focus group was audio-recorded, transcribed verbatim and analysed using Attride-Stirling's framework for thematic network analysis.
  
  
  RESULTS
  The global theme 'The Future of PPS in EM-A UK and Ireland Perspective' emerged from the following three organising themes: (1) training and education of ED staff; (2) current realities of PPS in EDs and (3) PPS and the wider hospital community. The main findings were (1) there is variability in ED PPS practice throughout the UK and Ireland; (2) lack of formal PPS training for trainees is a barrier to its implementation as a standard treatment and (3) there is a lack of recognition of PPS at a College level as a specialised EM skill.
  
  
  CONCLUSIONS
  Establishment of PPS as a standard treatment option in the emergency setting will require implementation of robust training into general and paediatric EM training. This should be supported and enhanced through national and international collaboration in EM-led PPS research and audit.
authors.affiliation: Paediatric Emergency Research Unit (PERU), National Children's Research Centre, Our Lady's Children's Hospital, Dublin , Ireland.
authors.forename: Siobhán
authors.initials: S
authors.lastname: McCoy
authors.affiliation: Department of Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lyttle
authors.affiliation: Department of Emergency Medicine, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Hartshorn
authors.affiliation: School of Nursing, Midwifery and Health Systems & Our Lady's Hospice and Care Services, Health Sciences Centre, University College Dublin, Dublin, Ireland.
authors.forename: Philip
authors.initials: P
authors.lastname: Larkin
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Maria
authors.initials: M
authors.lastname: Brenner
authors.affiliation: Paediatric Emergency Research Unit (PERU), National Children's Research Centre, Our Lady's Children's Hospital, Dublin , Ireland School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Ronan
authors.initials: R
authors.lastname: O'Sullivan
mesh_terms: D004739:England; D005260:Female; D017144:Focus Groups; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007318:Inservice Training; D007494:Ireland; D008297:Male; D059408:Pain Management / Q000379:methods*; D000070316:Pediatric Emergency Medicine; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research
chemical_list: D006993:Hypnotics and Sedatives
keywords: emergency care systems, admission avoidance; emergency department; paediatric emergency med; paediatrics, paediatric emergency medicine