From: Rachel Tuuri <[log in to unmask]>

> ...interested in knowing if your institution does sedate in the PED for PTA drainage

--> Discouraged at our place... On principle... We have an anaesthesia department who provide such services for a living and an operating theatre suite where an environment has been set up to the best standard our institution can currently achieve for the provision of safe sedation and surgical environment... To have someone who "also" does sedation provide this service instead and do so in whichever room in the ED is best at the time, but not as good as the one built for the purpose, simply appears to be a step in the wrong direction for us.

This is not a judgement on other places. At our place there is simply always more EM work that needs to be done than there are EPs who can do it, so it's not as easy to justify pulling one away to provide some other service instead of dealing with emergencies. The ED facility is also not set up to provide on-going and follow-up care should complications ensue - the care would have to be handed over.

We have less experience with litigation here, but where litigation is more prevalent, should a complication happen, how does one answer the question of "there is an anaesthesia expert, whose career is to do these things, working right next door. He/she provides sedation/anaesthesia for pretty much 90+% of his professional clinical time. Why did you, who spends 1% or so of your time providing sedation, decide to spare this patient his/her expertise?"

Before anyone asks, of course, I am fully aware that there are EPs who are really really good at sedation and there have been studies which showed that EPs can provide sedation at the same standard... I know quite a few EPs who are not that good. For a few years now, I quite confidently count myself among this latter group, but I am completely uncertain when it was that I dropped out of the "doing enough of it to keep my skills up" group...

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