Michael & David,
We have been using it for almost a decade so I can speak about our process. We had initially sought approval for a resarch trial prior to obtaining full clinical privileges. It should be easier now since several pediatric institutions utilize propofol for procedural sedation in the ED. 

I will assume that all PEM's (& intensivists) by virtue of our training, have deep sedation privileges at your respective institutions. Is that correct?

With this premise, here are some talking points and suggestions to getting your protocol approved:
	1. Meet privately with the key players and then follow up with a formal presentation to your hospital sedation &/or P&T committee

	2. Emphasize the advantages of adding this medication to your deep sedation armamentarium i.e. smoother induction & recovery, shorter recovery time, shorter LOS and ? cost effective from an institutional perspective.

	3. As PEM's we already have the skill set to monitor and perform rescue airway procedures.
	4. Cite all the literature in support of pediatric ED use of propofol in conjunction with your protocol. List all the institutions using propofol in their ED's. Emphasize the outstanding safety record with its use by PEM physicians

	5. Emphasize that your existing options for procedural sedation have limitations. You may highlight the controversial issue of ketamine related neuroapoptosis described in infant animal models and the ongoing FDA investigation. You could also highlight recent data about higher post hospital behavioral questionnaire (PHBQ) scores & emesis with F/M or ketamine.  

	6. If propofol is being used by non anesthesiologists or anesthesiologists outside of the operating room setting, perhaps as part of a sedation service, highlight the fact that our ED patients deserve the same level of care. The alternative would be to consult the sedation service for all ED procedural sedations!

	7. Be proactive about establishing a QA program after implementation

	8. Propofol sedations would be billed using MAC codes with potentially higher revenue capture than usual moderate sedation encounters. 

Hope this helps
Jay Pershad, 
Le Bonheur Children's Medical Ctr.

From: Michael Kim <[log in to unmask]>
Dear Members,

We are faced with a challenge in developing a pediatric propofol credentialing guideline in the ED setting here at University of Wisconsin.

As most institutions who have gone through the process know, it is a highly sensitive and debated issue which we find ourselves in.

I was hoping to obtain some thoughts and examples of credentialing requirements your institution for PEM physicians AND General EM physicians in pediatric use of propofol in the ED.

Any thoughts would be helpful.

Thanks in advance.


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