Sedacion

PAIN MANAGEMENT AND SEDATION/POLICY STATEMENT

Procedural Sedation and Analgesia in the Emergency Department:
Recommendations for Physician Credentialing, Privileging,
and Practice
Robert E. O’Connor, MD, Andrew Sama, MD, John H. Burton, MD, Michael L. Callaham, MD, Hans R. House, MD,
William P. Jaquis, MD, Patrick M. Tibbles, MD, Marilyn Bromley, RN, Steven M. Green, MD, for the AmericanCollege of
Emergency Physicians

[Ann Emerg Med. 2011;58;365-370.]

INTRODUCTION
Procedural sedation refers to the technique of administering
sedatives or dissociative agents with or without analgesics to
induce an altered state of consciousness that allows the patient
to tolerate unpleasant procedures while preserving
cardiorespiratory function.1 Procedural sedation and analgesia is
acore competency in emergency medicine and a daily part of
emergency department (ED) practice.2-4 As noted by the United
States Centers for Medicare & Medicaid Services (CMS): “The
ED is a unique environment where patients present on an
unscheduled basis with often very complex problems that may
require several emergent or urgent interventions to proceed
simultaneously to prevent furthermorbidity or mortality.” The
CMS guidelines also state that “. . . emergency
medicine–trained physicians have very specific skill sets to
manage airways and ventilation that is necessary to provide
patient rescue. Therefore, these practitioners are uniquely
qualified to provide all levels of analgesia/sedation and
anesthesia (moderate to deep to general).”5
Emergency medicine residency andpediatric emergency
medicine fellowship core curricula include all of the requisite
procedural sedation skills, eg, advanced airway management,
resuscitation, critical care, monitoring, sedation pharmacology,
pain management.2-4 Emergency physicians have a wellestablished track record of safe sedation and are important
research and thought leaders in this multidisciplinary field.
The AmericanCollege of Emergency Physicians (ACEP) is
an authoritative body that has established guidelines for the use
of sedation, analgesia, and anesthesia by emergency physicians.1
CMS guidelines support the use of the ACEP guideline: “A
hospital could use multiple guidelines, for example, ACEP for
sedation in the ED and American Society of Anesthesiologists
(ASA) for anesthesia/sedation in surgicalservices, etc.”5 ACEP
convened this task force in 2011 to provide this update to guide
hospital policy for the administration of analgesia, sedation, and
anesthesia by emergency physicians.

HOSPITAL SEDATION LEADERSHIP
The Joint Commission and CMS each requires that hospitals
maintain central leadership over the sedation practices of their
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various specialistsand departments.6,7 Accordingly, many
institutions have a hospital-wide sedation committee that
oversees each individual department’s sedation practices.
Given that procedural sedation is a multidisciplinary field,
ACEP strongly supports the principle that institutional
oversight is best provided by a committee structure in which all
of those providing sedation services have representation.This
format best facilitates open interspecialty dialog on optimal
sedation practice, collaboration, and innovation.8 Interspecialty
collaborative institutional sedation authority is necessary to
ensure that sedation practices are in accordance with specialtyspecific national standards and that sedation privileges are
granted to all appropriate specialties, such as emergency
medicine.8,9 ACEPfurther believes that the statement in the
CMS Guidelines specifying that “the anesthesia services must be
under the direction of one individual who is a qualified doctor
of medicine (MD) or doctor of osteopathy (DO)” may be
counterproductive to their stated intent of developing
“anesthesia policies and procedures in collaboration with several
other hospital disciplines,” especially since...