A Model for Pediatric Sedation Centers Using Pharmacologic Sedation for Successful Completion of Radiologic and Procedural Studies

St. Louis Children's Hospital is a 368-bed tertiary care center for Washington University St. Louis School of Medicine. Due to increased needs for procedural sedation, in 2004 an Ambulatory Procedure Center (APC), formerly run by the department of radiology, was recreated to combine the expertise of sedation services under the guidance of pediatric anesthesia, and centralizing sedation within our treating facility to optimize patient care and improve sedation safety. The center uses sedation specialists in nursing, pediatric hospitalists, and pediatric anesthesia to care for patients. Patient population is comprised of both inpatient and outpatient referrals. The center provides sedation services to 18 different types of subspecialty physicians performing numerous diagnostic, therapeutic, and radiologic studies. In 2006, the APC successfully completed 4,276 sedations, showing consistent increases in number of patients and decreases in rates of unexpected cancellation. The collaborative efforts creating the APC have been successful in establishing a more efficient and regulated sedation center, and have further improved safety and quality assurance management regarding pediatric sedation in our hospital. On-going studies and data collection will continue to provide information regarding areas for improvement, as the center continues to grow and expand in its referral base. This article will describe the APC, the personnel involved, the training and expertise needed to create the sedation unit, the patient base, scope of services provided, and sedation provider selection based on patient characteristics. Modalities and options for providing sedation are based on procedure type, level of sedation care warranted, and previous sedation history of the patient. The article will explain the operational flow of a typical APC day, and describe the APC patient experience. We believe the APC to be a unique endeavor, which could be modeled as one solution to the growing need for directed, competent, and consistent pediatric sedation services in the health care system.