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A qualitative study of the barriers to procedural sedation practices in paediatric emergency medicine in the UK and Ireland
  1. Siobhán McCoy1,
  2. Mark D Lyttle2,3,
  3. Stuart Hartshorn4,
  4. Philip Larkin5,
  5. Maria Brenner6,
  6. Ronan O'Sullivan1,7
  7. on behalf of PERUKI
  1. 1Paediatric Emergency Research Unit (PERU), National Children's Research Centre, Our Lady's Children's Hospital, Dublin , Ireland
  2. 2Department of Emergency Medicine, Bristol Royal Hospital for Children, Bristol, UK
  3. 3Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
  4. 4Department of Emergency Medicine, Birmingham Children's Hospital, Birmingham, UK
  5. 5School of Nursing, Midwifery and Health Systems & Our Lady's Hospice and Care Services, Health Sciences Centre, University College Dublin, Dublin, Ireland
  6. 6School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
  7. 7School of Medicine, University College Cork, Cork, Ireland
  1. Correspondence to Professor Ronan O'Sullivan, School of Medicine, University College Cork, Cork, T12 DX01 Ireland; ronanandber{at}me.com

Abstract

Introduction 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.

  • emergency care systems, admission avoidance
  • emergency department
  • paediatric emergency med
  • paediatrics, paediatric emergency medicine

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