Wow- four hours- that's 'kookie-talk'.
We had this problem for years and eventually I took the Joint Commission
standards to the Medical Executive Committee
- you have to be able to provide the same level of care across the hospital
continuum. By definition, an ED is not an OR so
it is not difficult to prove that deep sedation for anything but brief
periods of time cannot be provided the same level of care
in both places. Not to mention that if there was an untoward event it would
be a 'write the check' situation (eg - simple- corneal
abrasion during procedure; complex- kid has a URI you didn't know about
prior to sedation and develops atelectasis/hypoxia during the procedure
- I have seen both of these happen).
We got the plastics group to agree that anything more than 30 minutes needs
an OR. We still go back and forth about occasional cases
but never have a case that is more than an hour now.
Jay D. Fisher MD
Pediatric Emergency Services
Children's Hospital of Nevada
From: "Thomas Krzmarzick" <[log in to unmask]>
Sent: Thursday, April 01, 2010 5:53 AM
To: <[log in to unmask]>
Subject: Length of plastic surgery procedures in the ED
> Recently, one of our plastic surgeons is repairing complex wounds in small
> children in the ED rather than take them to the operating room. Several
> these cases have lasted 4 hours (one case was 6 hours). He has been
> resistant to having these patients sedated for their procedure. I don't
> patients to the OR so I don't know everything that goes into the decision
> making process. My gut tells me that a case that takes longer than 90
> minutes or so needs to be done elsewhere (OR). Besides the care issues,
> tying up my PCA/nurse for hours (or ED MD if he would let us sedate these
> patients) is detrimental to our patient flow.
> I am trying to get a feel for what is done in other peds EDs.
> Do you have a limit on the length of the case that can be done in the ED?
> How do you handle these type of cases in your institution?
> Thomas Krzmarzick M.D.
> Medical Director
> Dayton Childrens
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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